Intraoperative Spinal Cord Monitoring Does Improve Outcomes
Marc RNuwer, professor, UCLA Dept Neurologymrn@ucla.edu
Marc R Nuwer, Los Angeles, CA
Submitted March 23, 2012
In their most recent WriteClick post, Drs. Ney and van der Goes [1] suggest that there is a lack of well-designed scientific studies demonstrating that IOM improves outcomes. They are incorrect. Human and animal data show that IOM improves outcomes. Our multicenter study [2] compared neurologic adverse outcomes in a large group of surgeons before and after adopting evoked potential spinal cord IOM. Major neurologic deficits such as paraparesis and paraplegia decreased by 60% after adopting IOM. In another study, 50 patients without IOM were compared to 50 patients with IOM. [3] In that study, the formally graded motor scores in follow-up were significantly better in those who had IOM. Drs. Ney and van der Goes would like an unrealistically idealistic, impractical, and unethical controlled outcome study. That will never occur. They will need to accept what studies can be done in a practical manner. They will also need to accept well-designed animal research, as cited in the original assessment, which has unequivocally shown that outcomes are improved by IOM. When Drs. Ney and van der Goes state that IOM literature lacks a demonstration of effectiveness, they show a lack of familiarity with and understanding of the full literature.
1. Ney J, van der Goes D. Re:Intraoperative Neurophysiologic Monitoring: Reply to Ney and van der Goes. Neurology On-Line, submitted on 14 Mar 2012.
2 Nuwer MR, Dawson EG, Carlson LG, Kanim LEA, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 1995;96:6-11.
3. Sala F, Palandri G, Basso E, et al. Motor evoked potential monitoring improves outcome after surgery for intramedulary spinal cord tumors: a historical control study. Neurosurgery, 2006;58:1129-1143.
For disclosures, contact the editorial office at journal@neurology.org.
In their most recent WriteClick post, Drs. Ney and van der Goes [1] suggest that there is a lack of well-designed scientific studies demonstrating that IOM improves outcomes. They are incorrect. Human and animal data show that IOM improves outcomes. Our multicenter study [2] compared neurologic adverse outcomes in a large group of surgeons before and after adopting evoked potential spinal cord IOM. Major neurologic deficits such as paraparesis and paraplegia decreased by 60% after adopting IOM. In another study, 50 patients without IOM were compared to 50 patients with IOM. [3] In that study, the formally graded motor scores in follow-up were significantly better in those who had IOM. Drs. Ney and van der Goes would like an unrealistically idealistic, impractical, and unethical controlled outcome study. That will never occur. They will need to accept what studies can be done in a practical manner. They will also need to accept well-designed animal research, as cited in the original assessment, which has unequivocally shown that outcomes are improved by IOM. When Drs. Ney and van der Goes state that IOM literature lacks a demonstration of effectiveness, they show a lack of familiarity with and understanding of the full literature.
1. Ney J, van der Goes D. Re:Intraoperative Neurophysiologic Monitoring: Reply to Ney and van der Goes. Neurology On-Line, submitted on 14 Mar 2012.
2 Nuwer MR, Dawson EG, Carlson LG, Kanim LEA, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 1995;96:6-11.
3. Sala F, Palandri G, Basso E, et al. Motor evoked potential monitoring improves outcome after surgery for intramedulary spinal cord tumors: a historical control study. Neurosurgery, 2006;58:1129-1143.
For disclosures, contact the editorial office at journal@neurology.org.