Intraoperative Spinal Neuromonitoring – A Socioeconomic Review

Keywords: medicolegal, neurophysiological monitoring, complications, survey, spine surgery

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     Intraoperative neurophysiological monitoring in spinal surgery focuses on the risk to neural structures. The use of monitoring has undergone scrutiny in the literature as to its utilization and efficacy.
     This survey was an attempt to discern practice patterns associated with intraoperative neurophysiological monitoring.
     683 neurosurgeons were surveyed.
     The authors reviewed the literature on intraoperative neurophysiological monitoring to determine the current evidence base for monitoring as well as the medicolegal ramifications associated with intraoperative neurophysiological monitoring. A survey of 683 neurosurgeons was conducted to assess current practice patterns with regards to monitoring frequency, monitoring modality, and medicolegal impact upon practice patterns.
     Our survey demonstrated differing monitoring frequency for the various procedures, and consistent with previous literature, most frequent monitoring use was noted for spinal deformity correction surgery and tumor or vascular malformation resection. Four procedures demonstrated higher monitoring use among spine fellowship trained neurosurgeons: anterior cervical, posterior cervical, posterior thoracic, and deformity correction surgery. Our survey demonstrated that 54.4% of respondents felt fear of litigation contributed to their use of intraoperative monitoring, though only 6.3% of respondents had been involved in a claim regarding neuromonitoring and, of those, only 47.5% had judgments in favor of the plaintiff.
     This is survey-based data.
     Intraoperative neurophysiological neuromonitoring has become widely utilized in spine surgery. Though no formal guidelines exist for their use, certain practice patterns can be noted among surgeons performing spine surgery.
     Fear of litigation plays a significant role in the utilization of intraoperative neuromonitoring, though literature does not support the use of intraoperative neuromonitoring solely for medicolegal defense purposes.


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