No Advantage to Intraoperative Neuromonitoring During ACDF

A nice large-database study on a hot topic with serious medicolegal implications

What’s the Claim?

A large-database analysis of over 70,000 anterior cervical discectomy and fusion (ACDF) procedures, performed either with or without intraoperative neuromonitoring (IONM), found no benefit to IONM in terms of the risk of neurological complications after surgery. Even after propensity-score matching, the risk of neurological injury was higher in patients who had surgery under IONM than those who did not. This seems likely to be related to selection bias; factors not well captured in the database used here — like more-severe compressive pathology on imaging — may both be associated with an increased risk of nerve injury and an increased likelihood of a surgeon opting to use IONM. And, of course, use of IONM may both be associated with and stimulate greater postoperative vigilance. The authors also found disparities in use of IONM, with more usage in urban settings than rural ones, and more in White patients than those of other races.

How’s It Stack Up?