Medical Student Department of Neurosurgery, Duke University School of Medicine, Durham, NC Durham, NC, US
Disclosure(s):
Tara Elizabeth Dalton, MD: No financial relationships to disclose
Introduction: Decompressive and fusion surgeries are the primary treatment modality for incomplete cervical spinal cord injury (cSCI) to limit further progression and to achieve potential improvement of symptoms. While neuromonitoring with intraoperative somatosensory evoked potentials is commonly integrated, there has been little understanding or guidance regarding the utilization of intraoperative neuromonitoring (IONM). The objective of this study was to describe utilization patterns of IONM for incomplete cSCI.
Methods: The PearlDiver National Insurance Claims Database was retrospectively queried to include patients from 2010-2023 with a history of incomplete cSCI that was treated with either a cervical decompressive or fusion procedure. Patients were stratified by IONM status. IONM utilization was evaluated based on patient gender, age, region, insurance payor status, service location, procedure type, cases per year, and length of stay.
Results: A total of 459,505 patients with incomplete cSCI were identified. 86,268 (18.8%) of patients received IONM. There were 43,438 (50.4%) female and 42,831 (49.6%) male patients with a mean age of 57.96 years. A majority of procedures were performed in the Southern region of the United States (40.5%) for patients with commercial insurance plans (76.4%) and in the inpatient setting (70.2%). The most common procedure that utilized IONM was a single level anterior cervical discectomy and fusion (ACDF) below C2 (48.1%). The proportion of cases utilizing IONM has slowly increased from 2010 (13.1% of cases) to 2023 (20.0% of cases). Mean length of stay was 6.05 days.
Conclusion : This study is the first to report on utilization trends of IONM for incomplete cSCI procedures. Investigating IONM utilization trends using a national insurance claims database is limited by the lack of information regarding variances in resource access. Future research is needed to develop a more comprehensive understanding on the utility of IONM in regard to preventing surgical and medical complications.
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