当前位置： SCI文献检索 > SPINE期刊下所有文献 > Intraoperative neuromonitoring in single-level spinal procedures: a retrospective propensity score-matched analysis in a national longitudinal database.

Intraoperative neuromonitoring in single-level spinal procedures: a retrospective propensity score-matched analysis in a national longitudinal database.

Abstract：

STUDY DESIGN:Retrospective propensity score-matched analysis on a national database (MarketScan) between 2006 and 2010. OBJECTIVE:To compare rates of neurological deficits after elective single-level spinal procedures with and without intraoperative neuromonitoring, as well as associated payment differences and geographic variance. SUMMARY OF BACKGROUND DATA:Intraoperative neurophysiologic monitoring is a technique that may contribute to avoiding permanent neurological injury during some spine surgery procedures. However, it is unclear whether all patients undergoing spine surgery benefit from neuromonitoring. METHODS:An identified 85,640 patients underwent single-level spinal procedures including anterior cervical discectomy and fusion (ACDF), lumbar fusion, lumbar laminectomy, or lumbar discectomy. Neuromonitoring was identified with appropriate Current Procedural Terminology (CPT) codes. Cohorts were balanced on baseline comorbidities and procedure characteristics using propensity score matching. Trauma and spinal tumors cases were excluded. RESULTS:Patients (12.66%) received neuromonitoring intraoperatively. Lumbar laminectomies had reduced 30-day neurological complication rate with neuromonitoring (0.0% vs. 1.18%, P=0.002). Neuromonitoring did not correlate with reduced intraoperative neurological complications in ACDFs (0.09% vs. 0.13%), lumbar fusions (0.32% vs. 0.58%), or lumbar discectomy (1.24% vs. 0.91%). With the addition of neuromonitoring, payments for ACDFs increased 16.24% ($3842), lumbar fusions 7.84% ($3540), lumbar laminectomies 24.33% ($3704), and lumbar discectomies 22.54% ($2859). Significant geographic variation was evident. Some states had no recorded single-level spinal cases with concurrent neuromonitoring. Rates for ACDFs and lumbar fusions, laminectomies, and discectomies ranged as high as 61%, 58%, 22%, and 21%, respectively. CONCLUSION:With intraoperative neurological monitoring in single-level procedures, neurological complications were decreased only among lumbar laminectomies. No difference was observed in ACDFs, lumbar fusions, or lumbar discectomies. There was a significant increase in total payments associated with the index procedure and hospitalization. We demonstrate significant geographic variation in neuromonitoring. LEVEL OF EVIDENCE:3.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Cole T,Veeravagu A,Zhang M,Li A,Ratliff JK

doi

10.1097/BRS.0000000000000593

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

1950-9

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

杂志文章

在线工具

Intraoperative neuromonitoring in single-level spinal procedures: a retrospective propensity score-matched analysis in a national longitudinal database.