title: A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes.
abstract: OBJECTIVE
  In the United States in recent years, a dramatic increase in the use of intraoperative neurophysiological monitoring (IONM) during spine surgeries has been suspected. Myriad reasons have been proposed, but no clear evidence confirming this trend has been available. In this study, the authors investigated the use of IONM during spine surgery, identified patterns of geographic variation, and analyzed the value of IONM for spine surgery cases.
  
  
  METHODS
  In this retrospective analysis, the Nationwide Inpatient Sample was queried for all spine surgeries performed during 2007-2011. Use of IONM (International Classification of Diseases, Ninth Revision, code 00.94) was compared over time and between geographic regions, and its effect on patient independence at discharge and iatrogenic nerve injury was assessed.
  
  
  RESULTS
  A total of 443,194 spine procedures were identified, of which 85% were elective and 15% were not elective. Use of IONM was recorded for 31,680 cases and increased each calendar year from 1% of all cases in 2007 to 12% of all cases in 2011. Regional use of IONM ranged widely, from 8% of cases in the Northeast to 21% of cases in the West in 2011. Iatrogenic nerve and spinal cord injury were rare; they occurred in less than 1% of patients and did not significantly decrease when IONM was used.
  
  
  CONCLUSIONS
  As costs of spine surgeries continue to rise, it becomes necessary to examine and justify use of different medical technologies, including IONM, during spine surgery.
authors.affiliation: Division of Neurosurgery, University of Arizona, Tucson, Arizona; and.
authors.forename: Whitney Sheen
authors.initials: WS
authors.lastname: James
authors.forename: Anand I
authors.initials: AI
authors.lastname: Rughani
authors.forename: Travis M
authors.initials: TM
authors.lastname: Dumont
mesh_terms: D016208:Databases, Factual; D017586:Diskectomy / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000191:economics* / Q000706:statistics & numerical data*; D007796:Laminectomy / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013122:Spinal Diseases / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D014481:United States
keywords: ICD-9 = International Classification of Diseases, Ninth Revision; IONM = intraoperative neurophysiological monitoring; NIS = Nationwide Inpatient Sample; neurophysiological monitoring; socioeconomics; spine surgery