Is intraoperative neuromonitoring cost-effective? 5 key points

Laura Dyrda -   Print  |

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.


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