Questionnaire study of neuromonitoring availability and usage for spine surgery

Questionnaire study presented to practicing spine surgeons.

To evaluate surgeon preference and availability of selected electrophysiologic neuromonitoring for different spine surgeries.

Maximizing the safety of spinal procedures and limiting potential iatrogenic neurologic injury has made intraoperative neuromonitoring an attractive option.

We distributed a questionnaire to 180 orthopedic spine surgeons and neurosurgeons at a clinically oriented spine meeting asking surgeon preference and availability of various types of intraoperative neuromonitoring modalities for different types of surgical procedures. Demographic data were also gathered.

Somatosensory evoked potentials (SSEPs) were the most available neuromonitoring modality, followed by electromyographies and motor-evoked potentials. In both anterior and posterior cervical surgery, SSEPs were the most preferred modality. MEPs were frequently preferred in myelopathic cervical cases. Almost 70% preferred some neuromonitoring for anterior thoracic/thoracolumbar cases and 55% for posterior thoracic/thoracolumbar cases. Surgeon satisfaction was related to the number of available neuromonitoring modalities. No significant differences were found between orthopedist and neurosurgeon preferences. Fellowship-trained surgeons were more likely to use neuromonitoring for specific indications.

SSEPs remains the most widely available and preferred type of neuromonitoring for spine surgeons. The type of case and neurologic status of patient (eg, presence of myelopathy) affects these choices. Surgeons were more satisfied with greater neuromonitoring availability, and were more likely to use neuromonitoring if they had a fellowship background.