Is intraoperative neuromonitoring the standard of care for pedicle screw placement surgery? A survey of neurosurgeons' practices.

Abstract

Spine surgery is highly litigious; misplaced screws and intraoperative neuromonitoring frequently feature in lawsuits. Intraoperative neuromonitoring aims to prevent injury but its standards are debated, and literature suggests its benefits are mixed. We surveyed its use among neurosurgeons from the Congress of Neurological Surgeons with Pearson's chi-square test applied to analyse data within R. Among 188 respondents, 39.9% worked in private practice or academic institutions. Usage rates were 50.5% always, 27.7% never and 21.8% sometimes. Opinions on intraoperative neuromonitoring necessity varied, with 55% disagreeing and 32% agreeing. No differences were noted by practice type or location. Among intraoperative neuromonitoring users, 47% found it sensitive and specific, while 45% used it for medico-legal reasons. Of non-users, 26% preferred other technologies. Overall, the usage of intraoperative neuromonitoring is nuanced and opinions leaned more heavily toward its implementation not being a current standard of care in pedicle screw placement surgery.