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Is intraoperative neuromonitoring cost-effective? 5 key points Featured

Written by  Laura Dyrda | Tuesday, 11 November 2014 00:00
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A retrospective study published in Spine examines intraoperative neuromonitoring for single-level spine surgery for quality and cost analysis.

The study included 85,640 patients who underwent single-level spinal procedures. They underwent anterior cervical discectomy and fusion, lumbar fusion, lumbar laminectomy or lumbar discectomy. Around 12.66 percent of the patients received intraoperative neuromonitoring. The researchers found:

 

1. Patients who underwent lumbar laminectomies with neuromonitoring had reduced 30-day neurological complication rates — 0 percent versus 1.18 percent.

 

2. In patients who underwent ACDF, lumbar fusion or lumbar discectomy, neuromonitoring didn't correlate with complications. The breakdown in numbers was:

 

• ACDF: 0.09 percent with neuromonitoring vs. 0.13 percent without
• Lumbar fusion: 0.32 percent with neuromonitoring vs. 0.58 percent without
• Lumbar discectomy: 1.24 percent with neuromonitoring vs. 0.91 percent without

 

3. The payments increased when neuromonitoring was added:

 

• ACDF: payments were up 16.2 percent to $3,842
• Lumbar fusion: payments were up 7.8 percent to $3,540
• Lumbar laminectomies: payments were up 24.3 percent to $3,704
• Lumbar discectomies: payments were up 22.5 percent to $2,859

 

4. There was significant geographic variation in the data, with rates for each procedure hitting as high as:

 

• ACDF: 61 percent
• Lumbar fusion: 58 percent
• Laminectomies: 22 percent
• Discectomies: 21 percent

 

5. The higher costs associated with neuromonitoring may have implications for cost-effectiveness. "We saw that total payments increased by much more than the assumed reimbursement in the study [with neuromonitoring]," concluded the study authors.

 

More articles on spine surgery:
Prospective spine care registries: The next frontier?
SI joint fusion could explode by 2020—5 things to know
What makes spine surgeons apprehensive about the future?

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