title: Commentary : The value of intraoperative neurophysiological monitoring: evidence, equipoise and outcomes.
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.
authors.affiliation: Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359740, Seattle, WA, 98104-2499, USA.
authors.forename: R N
authors.initials: RN
authors.lastname: Holdefer
authors.affiliation: Intraoperative Monitoring, Department of Neurophysiology, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA. drskinnermd@yahoo.com.
authors.forename: S A
authors.initials: SA
authors.lastname: Skinner
mesh_terms: D015415:Biomarkers; D004576:Electromyography; D004992:Ethics, Medical; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Equipoise; Evidence-based medicine; Intraoperative neurophysiological monitoring; Motor evoked potential; Opportunity cost; Somatosensory evoked potential; Surrogate endpoint