Trends and Differences in Intraoperative Neuromonitoring Utilization Across Various Spinal Tumors

Introduction: Surgical resection of spinal tumors poses unique potential for neural injury and post-operative complications, making intraoperative neuromonitoring (IONM) a valuable tool. While IONM has generally grown in usage, little is known about its utilization and efficacy across different spine cancer types. In this study, we compared the associations between IONM and sociodemographic factors, as well as clinical outcomes, compared across patients undergoing surgery for either non-malignant spine tumors (NMTs) or primary malignant tumors (PMTs).

Methods: A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of NMTs and PMTs that underwent surgery from 2011 to 2021. Rates of IONM usage across groups were compared based on patient age, sex, family income, and region. Complications and 30-day readmissions were also compared.

Results: Overall, 10,243 total patients were identified (PMT: n = 4,551; NMT: n = 5,692 NMT) with a higher proportion of PMT patients utilizing IONM (36.1% vs. 33.6%). Across both groups, younger age was associated with IONM usage (both p < 0.001) and significant regional variability was observed in IONM utilization (p < 0.001), with the Midwest having the most utilization across both groups (PMT: 32.6%; NMT: 33.8%) and the West having the least (PMT: 12.5%; NMT: 12.6%). Mean family income was associated with IONM usage in the PMT group (p < 0.01) but not the NMT group. Clinically, 30-day readmission rates and complications were associated with IONM utilization for both groups (all p < 0.001).

Conclusion : This study demonstrates significant associations between sociodemographic factors—including age and gender—and IONM utilization. Among PMT patients, family income was associated with higher IONM usage but this was not seen in the NMT group. Given the growing usage of IONM in spinal surgeries, these results provide important insights on the utility of IONM among patients with spinal tumors.