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

  • Original Article - Spine - Other
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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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Abbreviations

DACH:

Germany, Austria, and Switzerland

DCM:

Dorsal column mapping

D wave:

Direct wave

DWG:

“Deutsche Wirbelsäulengesellschaft” (German Spine Society)

G-DRG:

German Diagnosis Related Group system

IMSCT:

Intramedullary spinal cord tumor

mMEPs:

Muscular motor evoked potentials

ÖGW:

“Österreichische Gesellschaft für Wirbelsäulenchirurgie” (Austrian Spine Society)

SGNC:

“Schweizerischen Gesellschaft für Neurochirurgie” (Swiss Society of Neurosurgery)

SGS:

“Schweizerische Gesellschaft für spinale Chirurgie” (Swiss Society of Spinal Surgery)

sIONM:

Spinal intraoperative neurophysiological monitoring

sMEPs:

Spinal motor-evoked potentials

SSEPs:

Somatosensory-evoked potentials

s/tEMG:

Spontaneous/triggered electromyography

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Acknowledgments

We are grateful to all colleagues participating in the survey. We want to give special thanks to Dr. Kurt Kruber and his team of the Institute of Medical Engineering & IT, Clinic of LMU, for providing technical support for the conduct of the electronic survey.

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Authors and Affiliations

  1. Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany

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

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Correspondence to Sebastian Siller.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participating spine centers included in the study.

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Siller, S., Raith, C., Zausinger, S. et al. Indication and technical implementation of the intraoperative neurophysiological monitoring during spine surgeries—a transnational survey in the German-speaking countries. Acta Neurochir 161, 1865–1875 (2019). https://doi.org/10.1007/s00701-019-03974-6

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