Utilization of Neuromonitoring in Surgical Cervical Spondylosis Patients With the Presence or Absence of Myelopathy: Is It Standard?

IF 1.7 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-07-01 Epub Date: 2024-11-25 DOI:10.1097/BSD.0000000000001739

Glenn A Gonzalez, Katherine Corso, Guilherme Porto, Jill Ruppenkamp, Jingya Miao, Daniel Franco, Kevin Hines, Matthew O'Leary, Sara Thalheimer, James Harrop

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引用次数: 0

Abstract

Study design: Cross-sectional, observational study.

Objective: Investigate the frequency of intraoperative neuromonitoring (IONM) utilization among Medicare patients diagnosed with cervical spondylosis (CS), both with and without myelopathy.

Background: IONM is widely used as a tool in spine surgery. However, the overall prevalence of neuromonitoring utilization among CS undergoing surgical intervention is not well characterized.

Methods: This study observed neuromonitoring usage in CS patients who had cervical spinal procedures from 2012 to 2020, using a 5% random sample of Medicare data. Logistic regression compared patient characteristics between those who received neuromonitoring and those who did not. The model included age, sex, region, Elixhauser Comorbidity Index score, year of surgery, elective status, and procedure type. Odds ratios with a 95% CI were generated for each covariate.

Results: Of the 6224 patients who underwent cervical procedures for CS, 4053 were included in the study, with 2845 having myelopathy and 1208 without. Myelopathy patients had a higher number of hospitalizations (2884) compared with non-myelopathy patients (1229). Among myelopathy patients, the prevalence of neuromonitoring increased from 49.2% in 2012 to 56.5% in 2020. The range of utilization for each type of monitoring was: 96.4%-100% for somatosensory evoked potential, 73.2%-86.1% for electromyography, 70.0%-86.1% for motor evoked potential, and 17.6%-33.6% for other modalities. For non-myelopathy patients, neuromonitoring prevalence increased from 33.1% in 2012 to 43.3% in 2020. The range of utilization for each type of monitoring was: 93.0%-100% for somatosensory evoked potential, 68.9%-89.7% for electromyography, 55.8%-77.4% for motor evoked potential, and 17.8%-36.4% for other modalities.

Conclusions: This study investigates the utilization of IONM during cervical spinal surgeries in Medicare patients with cervical spondylotic myelopathy or CS between 2012 and 2020. Although IONM is employed in cervical spine procedures, its adoption and standardization appear to vary across the country and different health care settings.

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在存在或不存在脊髓病的颈椎病手术患者中使用神经监测仪。是否符合标准？

研究设计横断面观察研究：调查被诊断为颈椎病（CS）的医保患者使用术中神经监测仪（IONM）的频率，包括有脊髓病和无脊髓病的患者：背景：IONM 是脊柱手术中广泛使用的一种工具。背景：IONM 是脊柱手术中广泛使用的一种工具，但在接受手术治疗的 CS 患者中，神经监测仪的总体使用率并不高：本研究使用5%的医疗保险随机抽样数据，观察了2012年至2020年接受颈椎手术的CS患者中神经监测仪的使用情况。逻辑回归比较了接受和未接受神经监测的患者特征。该模型包括年龄、性别、地区、Elixhauser 生病指数评分、手术年份、选择性状态和手术类型。针对每个协变量生成了带有 95% CI 的比值比：在6224名接受颈椎手术治疗的CS患者中，有4053人被纳入研究，其中2845人患有脊髓病，1208人没有脊髓病。与非脊髓病变患者（1229例）相比，脊髓病变患者的住院次数（2884例）更多。在骨髓病患者中，神经监测仪的使用率从2012年的49.2%增至2020年的56.5%。每种监测方式的使用率范围为：体感诱发电位 96.4%-100% ，肌电图 73.2%-86.1% ，运动诱发电位 70.0%-86.1% ，其他方式 17.6%-33.6% 。对于非脊髓病患者，神经监测的普及率从 2012 年的 33.1% 增加到 2020 年的 43.3%。每种监测方式的使用率范围为：体感诱发电位 93.0%-100%，肌电图 68.9%-89.7%，运动诱发电位 55.8%-77.4%，其他方式 17.8%-36.4%：本研究调查了2012年至2020年期间医保颈椎病或CS患者在颈椎手术中使用IONM的情况。虽然颈椎手术中使用了 IONM，但在全国各地和不同的医疗机构中，其采用情况和标准化程度似乎各不相同。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.