John P.Ney, Instructor, Neurology, University of Washington, Comparative Effectiveness and Cost Outcomes Research Centerneyj@uw.edu
David N. van der Goes
Submitted March 06, 2012
Nuwer et al. consolidated the best evidence available on the use of evoked potentials during spinal operations. [1] However, focusing on the value of intraoperative neurophysiological monitoring (IOM) alerts in predicting post-operative motor deficits does not offer new answers to the question: "Why use IOM?." The guideline authors agree with the results of a review [2] that supported IOM as a predictive diagnostic tool with a high level of evidence. Prediction alone is insufficient to warrant use of IOM especially when actual outcomes will be revealed almost immediately following the surgery. Also, short-term prediction is insufficient to justify the costs of the specialized equipment, technicians, and professional oversight necessary for proper IOM performance. The evidence for IOM to alter outcomes is weak with only one non-randomized study [3] showing a 52% rate of preventing neurological deficits from acting on IOM alerts. In the absence of randomized controlled trials, outcomes research from large observational datasets may clarify the utility of IOM as cost-effectiveness becomes a greater factor in medical decision making. [4]
1. Nuwer MR, Emerson RG, Galloway G, et al. Evidence-based guideline update: Intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials. Neurology 2012;78:585- 589.
2. Fehlings MG, Brodke DS, Norvell DC, Dettori JR. The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? In: Spine (Phila Pa 1976). United States, 2010: S37-46.
3. Wiedemayer H, Fauser B, Sandalcioglu IE, Schafer H, Stolke D. The impact of neurophysiological intraoperative monitoring on surgical decisions: a critical analysis of 423 cases. J Neurosurg 2002;96:255-262.
4. Ney JP, van der Goes DN, Watanabe JH. Cost-Effectiveness of Intraoperative Neurophysiological Monitoring for Spinal Surgeries: Beginning Steps. Clinical Neurophysiology In Press.
For disclosures contact the editorial office at journal@neurology.org.
Nuwer et al. consolidated the best evidence available on the use of evoked potentials during spinal operations. [1] However, focusing on the value of intraoperative neurophysiological monitoring (IOM) alerts in predicting post-operative motor deficits does not offer new answers to the question: "Why use IOM?." The guideline authors agree with the results of a review [2] that supported IOM as a predictive diagnostic tool with a high level of evidence. Prediction alone is insufficient to warrant use of IOM especially when actual outcomes will be revealed almost immediately following the surgery. Also, short-term prediction is insufficient to justify the costs of the specialized equipment, technicians, and professional oversight necessary for proper IOM performance. The evidence for IOM to alter outcomes is weak with only one non-randomized study [3] showing a 52% rate of preventing neurological deficits from acting on IOM alerts. In the absence of randomized controlled trials, outcomes research from large observational datasets may clarify the utility of IOM as cost-effectiveness becomes a greater factor in medical decision making. [4]
1. Nuwer MR, Emerson RG, Galloway G, et al. Evidence-based guideline update: Intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials. Neurology 2012;78:585- 589.
2. Fehlings MG, Brodke DS, Norvell DC, Dettori JR. The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? In: Spine (Phila Pa 1976). United States, 2010: S37-46.
3. Wiedemayer H, Fauser B, Sandalcioglu IE, Schafer H, Stolke D. The impact of neurophysiological intraoperative monitoring on surgical decisions: a critical analysis of 423 cases. J Neurosurg 2002;96:255-262.
4. Ney JP, van der Goes DN, Watanabe JH. Cost-Effectiveness of Intraoperative Neurophysiological Monitoring for Spinal Surgeries: Beginning Steps. Clinical Neurophysiology In Press.
For disclosures contact the editorial office at journal@neurology.org.