Rowe Dana G, Barrett Connor, Owolo Edwin, Rivera Nicole, Johnson Eli, Abdelgadir Jihad, Crowell Kerri-Anne, Goodwin C Rory, Erickson Melissa M
Duke University School of Medicine.
Department of Neurosurgery, Duke University Medical Center.
Clin Spine Surg. 2025 Jun 1;38(5):E283-E288. doi: 10.1097/BSD.0000000000001723. Epub 2024 Oct 30.
Retrospective cohort study.
The purpose of this study was to (1) evaluate recent trends in the use of intraoperative neuromonitoring (IONM) for anterior cervical discectomy and fusion (ACDF) in the United States, (2) assess regional variations in the use of IONM, and (3) assess the association between IONM and clinical outcomes.
IONM is frequently used during anterior cervical procedures to mitigate the risk of neurological injury. Prior studies have demonstrated decreasing utilization of IONM in ACDFs. However, no recent studies have re-assessed these trends.
Cases of cervical myelopathy and radiculopathy that underwent ACDF from 2011 to 2021 were identified through the PearlDiver Patient Record Database. Rates of IONM were compared based on patient age, gender, income, and region. Complications, 30-day readmissions, and reimbursement rates were also assessed.
We identified 285,939 patients undergoing isolated ACDF, with 45,943 (16.1%) of these cases using IONM. There was a significant increase in the use of IONM for ACDFs over the study period ( R2 =0.87, P <0.001). Significant regional variability was observed in the utility of IONM (Northeast; 21.2%, Midwest; 16.3%, South; 14.7%, West; 14.2%; P <0.001). Younger age and higher patient income were associated with increased utility of IONM ( P <0.001). IONM was associated with significantly higher costs but no reduction in rates of postoperative neurological complications ( P <0.001 and 0.29, respectively).
This study demonstrates a significant increase in IONM utilization during ACDFs over the past decade. Considerable differences exist in IONM use concerning patient demographics, income, and geographic region, with the highest utilization in the Northeast. Notably, despite the association of IONM with over a 20% increase in reimbursement rates, its implementation was not associated with a reduction in rates of neurological complications.
回顾性队列研究。
本研究的目的是（1）评估美国颈椎前路椎间盘切除融合术（ACDF）中术中神经监测（IONM）使用的近期趋势，（2）评估IONM使用的区域差异，以及（3）评估IONM与临床结果之间的关联。
IONM常用于颈椎前路手术以降低神经损伤风险。先前的研究表明ACDF中IONM的使用有所减少。然而，最近没有研究重新评估这些趋势。
通过PearlDiver患者记录数据库识别2011年至2021年接受ACDF的脊髓型颈椎病和神经根病病例。根据患者年龄、性别、收入和地区比较IONM的使用率。还评估了并发症、30天再入院率和报销率。
我们确定了285,939例接受单纯ACDF的患者，其中45,943例（16.1%）使用了IONM。在研究期间，ACDF中IONM的使用显著增加（R2 = 0.87，P < 0.001）。IONM的使用存在显著的区域差异（东北部；21.2%，中西部；16.3%，南部；14.7%，西部；14.2%；P < 0.001）。年龄较小和患者收入较高与IONM的使用增加相关（P < 0.001）。IONM与显著更高的成本相关，但术后神经并发症的发生率没有降低（分别为P < 0.001和0.29）。
本研究表明在过去十年中ACDF期间IONM的使用显著增加。IONM在患者人口统计学、收入和地理区域方面的使用存在相当大的差异，东北部的使用率最高。值得注意的是，尽管IONM与报销率增加超过20%相关，但其实施与神经并发症发生率的降低无关。
