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Commentary

The value of intraoperative neurophysiological monitoring: evidence, equipoise and outcomes

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Abstract

The use of intraoperative neurophysiological monitoring (IONM) has grown despite an absence of randomized controlled trials that might unequivocally demonstrate improved outcomes. At issue is how to demonstrate value when other evidence indicates patient harms (opportunity cost) if IONM is withheld for the sake of randomization. In this article we review other non-randomized methods to assess the effects of IONM on post-operative outcomes. We also examine how clinical equipoise may resolve whether (or not) an anticipated controlled study is ethical. We conclude that the value of IONM in a particular surgical setting should be determined by a benefits/harms analysis based on all the available evidence.

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359740, Seattle, WA, 98104-2499, USA

    R. N. Holdefer

  2. Intraoperative Monitoring, Department of Neurophysiology, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA

    S. A. Skinner

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  1. R. N. Holdefer
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  2. S. A. Skinner
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Correspondence to S. A. Skinner.

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Conflict of interest

Dr. Holdefer reports no conflicts of interest. Dr. Skinner receives a patent royalty from Medtronic, Inc. Neither author received funding for the authorship of this review.

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Holdefer, R.N., Skinner, S.A. Commentary. J Clin Monit Comput 31, 657–664 (2017). https://doi.org/10.1007/s10877-016-9910-0

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