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Acta Neurochirurgica
Published in: Acta Neurochirurgica 9/2019

01-09-2019 | Intramedullary Space-Occupying Lesion | Original Article - Spine - Other

Indication and technical implementation of the intraoperative neurophysiological monitoring during spine surgeries—a transnational survey in the German-speaking countries

Authors: Sebastian Siller, Constance Raith, Stefan Zausinger, Joerg-Christian Tonn, Andrea Szelenyi

Published in: Acta Neurochirurgica | Issue 9/2019

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Abstract

Background

Intraoperative neurophysiological monitoring is widely used in spine surgery (sIONM). But guidelines are lacking and its use is mainly driven by individual surgeons’ preferences and medicolegal advisements. To gain an overview over the current status of sIONM implementation, we conducted a transnational survey in the German-speaking countries.

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 electronic survey was performed between November 2017 and April 2018, including both neurosurgical and orthopedic spine centers.

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). Some 75.9% participating neurosurgical spine centers and only 14.7% of the orthopedic spine centers applied sIONM. Motor- and somatosensory-evoked potentials (93.7% and 94.3%, respectively) were the most widely available modalities, followed by direct wave (D wave; 66.5%). Whereas sIONM utilization was low in spine surgeries for degenerative, traumatic, and extradural tumor diseases, it was high for scoliosis and intradural tumor surgeries. Overall, the general satisfaction within the institutional setting regarding technical skills, staff, performance, and reliability of sIONM was rated as “high” by more than three-quarters of the centers. However, shortage of skilled staff was claimed to be a negative factor by 41.1% of the centers and reimbursement was considered to be insufficient by 83.5%.

Conclusions

sIONM availability was high in neurosurgical but low in orthopedic spine centers. Main modalities were motor/somatosensory-evoked potentials and main indications were scoliosis and intradural spinal tumor surgeries. A more frequent sIONM use, however, was mainly limited by the shortage of skilled staff and restricted reimbursement.
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Metadata
Title
Indication and technical implementation of the intraoperative neurophysiological monitoring during spine surgeries—a transnational survey in the German-speaking countries
Authors
Sebastian Siller
Constance Raith
Stefan Zausinger
Joerg-Christian Tonn
Andrea Szelenyi
Publication date
01-09-2019
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 9/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-019-03974-6

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