Analysis of the Effects of Intraoperative Neurophysiological Monitoring on Anterior Cervical Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study. (16th November 2020)

• Record Type: Journal Article
• Authors: Chang, Victor W; Bazydlo, Michael; Yeh, Hsueh-Han; Schultz, Lonni; Nerenz, David; Easton, Richard; Khalil, Jad; Schwalb, Jason M; Abdulhak, Muwaffak; Aleem, Ilyas; Park, Paul; Macki, Mohamed; Hamilton, Travis M
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_729
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: The utility of intraoperative neurophysiological monitoring (IOM) for anterior cervical surgery remains controversial. Despite insufficient evidence demonstrating a clear benefit, IOM continues to be utilized and in some areas is considered standard of care. METHODS: Anterior cervical surgeries from February 2014 to November 2019 were included for analysis. IOM (EMG, MMG, SSEPs, or MEP) was the primary variable examined. Primary outcome measures were: new weakness after surgery, new radicular symptoms, return to OR, operative time and length of stay (LOS). Logistic Generalized Estimation Equations (GEE) were used for multivariate analysis adjusting for demographic, premorbid, and disease specific variables. RESULTS: There were 10, 853 cases with 4, 218 (38.9%) where IOM was used. On univariate analysis, we did not find differences in incidence of post-operative weakness, new radicular symptoms, return to OR, or length of stay. Operative time was longer in the IOM group, 1.8 hours (CI 1.3-2.4) vs 1.4 hours (CI 1.1-2) P < .001. On multivariate GEE, IOM was not found to decrease the risk of post-operative weakness, radicular symptoms or return to OR. For weakness as an outcome, baseline weakness (OR 1.63, CI 1.29-2.06, P < .001), myelopathy (OR 1.51, CI 1.21-1.9, P < .001), CAD (OR 1.33, CI 1.07-1.65, P < .05) and ASA>2 (OR 1.23, CI 1.01-1.5, P < .05) were all associated with increased risk. For radicular symptoms as an outcome, baseline weakness (OR 1.25, CI 1.04-1.49, P < .05), ASA>2 (OR 1.24, CI 1.06-1.44, P < .05) and previous spine surgery (OR 1.22, CI 1.06-1.4, P < .05) were associated with increased risk. For return to OR, previous spine surgery (OR 1.51, CI 1.18-1.93, P < .001), myelopathy (OR 1.52, CI 1.07-1.9, P < .05), male gender (OR 1.32, CI 1.04-1.68, P < .05) were associated with increased risk. CONCLUSION: Our study found no correlation between the use of IOM and reduction of post-operative weakness and new radicular symptoms. Conversely, we did find significant associations with increased operative time. Baseline weakness had the highest correlation with both negative outcomes.