Indication and Technical Implementation of the Intraoperative Neurophysiological Monitoring During Spine Surgeries-a Transnational Survey in the German-speaking Countries

Overview

Journal Acta Neurochir (Wien)

Specialty Neurosurgery

Date 2019 Jun 23

PMID 31227966

Citations 5

Authors

Sebastian Siller

Constance Raith

Stefan Zausinger

Joerg-Christian Tonn

Andrea Szelenyi

Affiliations

Soon will be listed here.

Abstract

Background: Intraoperative neurophysiological monitoring is widely used in spine surgery (sIONM). But guidelines are lacking and its use is mainly driven by individual surgeons' preferences and medicolegal advisements. To gain an overview over the current status of sIONM implementation, we conducted a transnational survey in the German-speaking countries.

Methods: We developed a Web interface-based survey assessing prevalence, indication, technical implementation, and general satisfaction regarding sIONM in German, Austrian, and Swiss spine centers. The electronic survey was performed between November 2017 and April 2018, including both neurosurgical and orthopedic spine centers.

Results: A total of 463 German, 60 Austrian, and 52 Swiss spine centers were contacted with participation rates of 64.1% (Germany), 68.3% (Austria), and 55.8% (Switzerland). Some 75.9% participating neurosurgical spine centers and only 14.7% of the orthopedic spine centers applied sIONM. Motor- and somatosensory-evoked potentials (93.7% and 94.3%, respectively) were the most widely available modalities, followed by direct wave (D wave; 66.5%). Whereas sIONM utilization was low in spine surgeries for degenerative, traumatic, and extradural tumor diseases, it was high for scoliosis and intradural tumor surgeries. Overall, the general satisfaction within the institutional setting regarding technical skills, staff, performance, and reliability of sIONM was rated as "high" by more than three-quarters of the centers. However, shortage of skilled staff was claimed to be a negative factor by 41.1% of the centers and reimbursement was considered to be insufficient by 83.5%.

Conclusions: sIONM availability was high in neurosurgical but low in orthopedic spine centers. Main modalities were motor/somatosensory-evoked potentials and main indications were scoliosis and intradural spinal tumor surgeries. A more frequent sIONM use, however, was mainly limited by the shortage of skilled staff and restricted reimbursement.

Citing Articles

Current trends in intraoperative neurophysiological monitoring among Asia-Pacific countries: an Asia-Pacific Spine Society survey.

Shigematsu H, Yasuda A, Tangente R, Wei Chan C, Shetty A, Cheung J Asian Spine J. 2025; 18(6):813-821.

PMID: 39763357 PMC: 11711165. DOI: 10.31616/asj.2024.0273.

Augmented or Mixed Reality Enhanced Head-Mounted Display Navigation for In Vivo Spine Surgery: A Systematic Review of Clinical Outcomes.

Moga K, Holgyesi A, Zrubka Z, Pentek M, Haidegger T J Clin Med. 2023; 12(11).

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Current Trends in Intraoperative Spinal Cord Monitoring: A Survey Analysis among Japanese Expert Spine Surgeons.

Shigematsu H, Yoshida G, Morito S, Funaba M, Tadokoro N, Machino M Spine Surg Relat Res. 2023; 7(1):26-35.

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Barriers of neurophysiology monitoring in spine surgery: Latin America experience.

Guiroy A, Valacco M, Gagliardi M, Cabrera J, Emmerich J, Willhuber G Surg Neurol Int. 2020; 11:130.

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Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues - surgeons' views.

Biscevic M, Sehic A, Krupic F EFORT Open Rev. 2020; 5(1):9-16.

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