Intraoperative neuromonitoring (IONM) is designed to reduce the risk of injury and complications during complex surgeries that involve the spinal cord and nervous system. A few of the most common techniques include somatosensory sensory evoked potentials (SSEPs), motor-evoked potentials (MEPs), and spontaneous and triggered electromyography (EMG). Each technique varies in its sensitivity and specificity level when it comes to detecting the possibility of injury, but having more data in real time allows the surgical team to make adjustments that can prevent adverse outcomes.
IONM has the unique distinction of being able to quantify, within a certain range, the potential for medical risk, making it more measurable for surgeons performing surgeries where liability is high and the patient may experience long-term effects after surgery. When risk is measured, it can be assessed and more frequently prevented. Not all errors or outcomes are preventable — but in high-risk surgical situations, being able to capture some of the risk and reduce it can be invaluable to all parties involved.
Quantifying Risk in Dollar Amounts
Risk can be tough to quantify, but one way to assess the effectiveness of risk avoidance measures is to add up the costs of injury.
The Global Spine Journal published an analysis on the cost-effectiveness related to the use of IONM. The authors of the study accounted for a 0.1% incidence of spinal cord injury (1 out of 201 patients) without the use of SSEP monitoring. Their analysis came out in favor of SSEP: “In their estimation, the total annual cost savings for a single injured patient would range from $64, 074 to $102,192 for their institution, while the yearly expenditure on SSEP amounted to only $31, 546.” They also concluded that IONM was associated with 49% reduction in relative risk for neurological complications in relation to spinal procedures.
In a review of the outcomes of 8,413 patients of single-level cervical spine surgery between 2008-2013, The Global Spine Journal also found the following results among patients whose surgeries had employed IONM:
- Approximately 0.4% absolute reduction in the rate of neurological complications
- A shorter length of stay
- Fewer readmissions
- A 1.7% reduction rate in opiate consumption in the year following surgery
Not only that, but decreased spending was seen in the IONM group, resulting in a net reduction of $387 in expenses per patient.
Preventing Injuries for Positive Outcomes
Other studies also make a strong case for the use of IONM techniques in reducing risk and preventing injuries.
Frontiers in Neurology recommends IONM and Intraoperative angiography with the dye indocyanine green (ICG-A) for surgeries to correct cerebral vascular malformations, especially because the risk of ischemic complications is 6.7% and a residual aneurysm can occur in 5.2% of these cases. The authors of the study reported, “With the use of IONM and ICG-A, we identified abnormalities and adjusted our interventions and treatments. IONM and ICG-A can lead to a better outcome after surgical treatment of cerebral vascular abnormalities.”
Additionally, The Journal of Clinical Medicine advocates for the use of transcranial MEPs for thoracic spine surgery. In a study on 1,156 cases, it was found that MEPs had a sensitivity of roughly 91% and a specificity of approximately 88% in predicting outcomes. With that kind of data, surgeons can act decisively to prevent injury and foster positive results for patients.
Get High Quality IONM Support
Having highly trained IONM professionals to work with during surgery is critical to the efficacy of IONM and the reduction of risk. These professionals must be well-versed in the potential for signal errors and be able to collaborate with the surgical team strategically so the best decisions can be made in real time. Our IONM professionals are highly trained and capable of integrating with your team to help you decrease the risk of injury and complications during complex surgeries. Contact us today to learn more about how we can support you!
