136 Intraoperative Neuromonitoring in Spinal Surgery: A Systematic Review and Meta-Analyses

Intraoperative neuromonitoring (IONM) is widely used in spinal surgery as it has been shown to be highly sensitive and specific for detecting neurological injuries, although recent evidence has been conflicting in its cost-utility. The authors aim to determine whether the use of IONM during spinal surgeries significantly improves patient outcomes in terms of neurological events, and whether IONM is cost-effective. Method Literature search of studies looking at use of IONM for spinal surgeries from 2009 to 2020 was performed across several databases, following PRISMA guidelines. Quality of articles was assessed using MINORS criteria. Results The random effects model was used to evaluate the 5 studies comparing neurological events with and without IONM use. There was a higher incidence of neurological events without IONM, at 44 compared to 11 with IONM. However, pooled odds ratio was 0.56 (p = 0.11), indicating no significant difference. IONM was also found to be associated with longer operative times and costs, which is not cost-effective based on NICE recommendations. Conclusions - This study corroborate previous studies; there is no significant difference in patient outcome of neurological events with the use of IONM. There is, however, a higher incidence of neurological events without IONM.