Article
Indication and technical implementation of intraoperative neurophysiological monitoring during spine surgeries – a transnational survey in the DACH countries
Die Anwendung des intraoperativen neurophysiologischen Monitorings während spinaler Operationen – eine länderübergreifende Erhebung in den DACH-Ländern
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Authors
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Sebastian Siller
- Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, Neurochirurgische Klinik, München, Deutschland
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Constance Raith
- Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, Neurochirurgische Klinik, München, Deutschland
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Stefan Zausinger
- Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, Neurochirurgische Klinik, München, Deutschland
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Joerg-Christian Tonn
- Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, Neurochirurgische Klinik, München, Deutschland
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Andrea Szelenyi
- Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, Neurochirurgische Klinik, München, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: There is a debate whether intraoperative neurophysiological monitoring (IONM) can improve the safety of spine surgery. However, guidelines for IONM in spine procedures (sIONM) are still lacking and its use is mainly driven by individual surgeons’ preferences. In this study, we report the results of a transnational survey in the DACH countries regarding indication and technical implementation of sIONM.
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 questionnaire was performed between 12/2017 and 04/2018 with invitations being sent to all spine centers listed as a member of the German Society of Neurosurgery (DGNC) and the German Spine Society (DWG), therefore including all neurosurgical and orthopedic spine centers of rural or urban, academic or non-academic and public or private practice settings from primary to tertiary medical care level.
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). 75.9% of the participating neurosurgical spine centers, but only 14.7% of the orthopedic spine centers utilized spinal IONM. Utilization rates of sIONM were highest in tertiary care (63.3%) and lowest in primary care medical centers (17.1%). sIONM was mostly performed with motor and sensory evoked potentials (93.7% resp. 94.3%), followed by D-wave (66.5%) and direct nerve stimulation (65.8%). Whereas sIONM utilization was low in spine surgeries for degenerative, traumatic and extradural tumor diseases, it was high in scoliosis and intradural spinal tumor surgeries. 82.3% of the spine centers deemed sIONM indispensable for intramedullary spinal cord tumor surgeries. Overall, the general satisfaction within the institutional setting regarding technical skills, staff, performance and reliability of sIONM was rated as “high” by 87.9% of the centers. However, shortage of skilled staff and insufficient reimbursement were claimed to be a negative factor by 37.3% and 58.2% of the centers.
Conclusion: Especially in neurosurgical spine centers, sIONM is frequently used with a high general satisfaction primarily in spinal cord tumor and scoliosis surgeries. However, shortage of skilled staff and restricted reimbursement were rated as limitations for more frequent sIONM use.
