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Original research
Intraoperative neurophysiological monitoring and spinal cord stimulator implantation
  1. Vasudha Goel1,
  2. Alexander M Kaizer2,
  3. Sejal Jain3,
  4. David Darrow4 and
  5. Hariharan Shankar5
  1. 1 Department of Anesthesia and Pain Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
  2. 2 Department of Biostatistics and Infomatics, University of Colorado School of Public Health, Aurora, Colorado, USA
  3. 3 Department of Anesthesia and Pain medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas, USA
  4. 4 Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
  5. 5 Anesthesiology, Clement Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  1. Correspondence to Dr Vasudha Goel, Department of Anesthesia and Pain Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA; doc.vasudha{at}gmail.com

Abstract

Introduction Spinal cord injury (SCI) is one of the most dreaded complications after spinal cord stimulation (SCS) implantation surgery. As a result, intraoperative neurophysiological monitoring (IONM) has been proposed to avoid accidental damage to nervous structures under anesthesia and confirm positioning for optimal stimulation. Our study uses a large administrative claims database to determine the 30-day risk of SCI after SCS implantation.

Methods This retrospective cohort study used the IBM MarketScan Commercial and Medicare Supplemental Databases from 2016 to 2019. Adult patients undergoing SCS surgical procedures with at least 90 days of follow-up, IONM use, the type of sedation used during the procedure, and subsequent SCI were identified using administrative codes. In addition, logistic regression was used to examine the relationship between various risk factors and subsequent SCI.

Results A total of 9676 patients underwent SCS surgery (64.7% percutaneous implants) during the study period. Nine hundred and forty-four (9.75%) patients underwent SCS implantation with IONM. Conscious sedation, Monitored Anesthesia Care anesthesia, and general anesthesia were used in patients with 0.9%, 60.2%, and 28.6%, respectively. Eighty-one (0.8%) patients developed SCI within 30 days after SCS implant surgery. The SCI rate was higher in the group that underwent IONM (2% vs 0.7%, p value <0.001) during the implantation procedure, reflecting the underlying risk. After adjustment for other factors, the OR of SCI is 2.39 (95% CI: 1.33 to 4.14, p value=0.002) times higher for those with IONM than those without IONM.

Conclusions Increased SCI risk among patients with IONM likely reflects higher baseline risk, and further research is needed for risk mitigation.

  • Outcome Assessment
  • Pain Management
  • Spinal Cord Stimulation
  • Treatment Outcome
  • Health Care

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/rapm-2023-104325

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @paindocgoel, @daviddarrow, @hariharan_shank

    • Contributors All authors have read the final version and approved it for submission. The submission is the original work of the authors listed on the manuscript, and the manuscript is not under consideration elsewhere. AMK helped with planning, design, statistical analysis, and critical review. SJ helped with planning, design, and critical review. DD helped with planning, design, and critical review. HS helped with planning, conduct, reporting, conception, design, acquisition of data, interpretation of data, manuscript preparation, and submission. VG helped with planning, conduct, reporting, conception, design, data acquisition, interpretation of data, manuscript preparation, and submission, and is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.