Routine Use of Intraoperative Neuromonitoring During ACDFs for the Treatment of Spondylotic Myelopathy and Radiculopathy Is Questionable: A Review of 15,395 Cases.

Abstract

A retrospective database study. The goal of this study was to (1) evaluate the trends in the use of intraoperative neuromonitoring (ION) for anterior cervical discectomy and fusion (ACDF) surgery in the United States and (2) assess the incidence of neurological injuries after ACDFs with and without ION. Somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs) are the commonly used ION modalities for ACDFs. Controversy exists on the routine use of ION for ACDFs and there is limited literature on national practice patterns of its use. A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of spondylotic myelopathy and radiculopathy that underwent ACDF from 2007 to 2014. The type of ION modality used and the rates of neurological injury after surgery were assessed. During the study period, 15,395 patients underwent an ACDF. Overall, ION was used in 2627 (17.1%) of these cases. There was a decrease in the use of ION for ACDFs from 22.8% in 2007 to 4.3% use in 2014 (P < 0.0001). The ION modalities used for these ACDFs were quite variable: SSEPs only (48.7%), MMEPs only (5.3%), and combined SSEPs and MMEPs (46.1%). Neurological injuries occurred in 0.23% and 0.27% of patients with and without ION, respectively (P = 0.84). Younger age was associated with a higher utility of ION (<45: 20.3%, 45-54: 19.3%, 55-64: 16.6%, 65-74: 14.3%, and >75: 13.6%, P < 0.0001). Significant regional variability was observed in the utility of ION for ACDFs across the country (West; 21.9%, Midwest; 12.9% (P < 0.0001). There has been a significant decrease in the use of ION for ACDFs. Furthermore, there was significant age and regional variability in the use of ION for ACDFs. Use of ION does not further prevent the rate of postoperative neurological complications for ACDFs as compared with the cases without ION. The utility of routine ION for ACDFs is questionable. 3.