Study design:

Retrospective database analysis.

Objective:

To elucidate trends in the utilization of IONM during elective lumbar surgery procedures and to investigate the association between the use of IONM and surgical outcomes.

Summary of background data:

The routine use of Intraoperative Neurophysiological Monitoring (IONM) in elective lumbar spine procedures has recently been called into question due to longer operative time, higher cost and other substitute advanced technologies.

Methods:

The Statewide Planning and Research Cooperative System (SPARCS) database was accessed to perform this retrospective study. The trends of IONM use for lumbar decompression and fusion procedures were investigated from 2007 to 2018. The association between IONM use and surgical outcomes was investigated from 2017 to 2018. Multivariable logistic regression analyses as well as propensity score matching (PS-matching) were conducted to assess IONM association in neurological deficits reduction.

Results:

The utilization of IONM showed an increase in a linear fashion from 79 cases in 2007 to 6,201 cases in 2018. A total of 34,592 (12,419 monitored and 22,173 unmonitored) patients were extracted, and 210 patients (0.6%) were reported for postoperative neurological deficits. Unadjusted comparisons demonstrated that the IONM group was associated with significantly fewer neurological complications. However, multivariable analysis indicated that IONM was not a significant predictor of neurological injuries. After PS-matching of 23,642 patients, the incidence of neurological deficits was not significantly different between IONM and non-IONM patients.

Conclusion:

The utilization of IONM for elective lumbar surgeries continues to gain popularity. Our results indicated that IONM use was not associated with a reduction in neurological deficits and will not support routine use of IONM for all elective lumbar surgery.