Comparative effectiveness analyses of intraoperative neurophysiological monitoring in spinal surgery

Intraoperative neurophysiological monitoring for surgeries of the spine has been performed in clinical practice for several decades, but recent alterations in reimbursement schemes by third party payers have raised issues of the value of these procedures. Decision modeling using comparative effectiveness techniques holds the promise of evidence-based assessment of both cost and meaningful outcomes. In this article, we review the elements of comparative effectiveness analyses followed by a critical appraisal of the small but growing body of cost-effectiveness literature for intraoperative neurophysiological monitoring in spine.