Authors' objectives:

This report evaluates the evidence in favor of implementing combined monitoring, using somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) for spinal surgery at the MUHC.

Authors' results and conclusions: A total of 11 studies were identified meeting the inclusion criteria. No studies involved randomized comparisons, and all were simple case series. Despite this limitation, this literature gives ample evidence that INM allows potential intraoperative damage to the spinal cord to be identified rapidly and avoided through corrective action. Health Benefits: Because the reported series vary greatly no precise estimate of the health benefits that might result from intraoperative neurophysiological monitoring (INM) is possible. As a first approximation for the purpose of policy decisions, on the basis of the literature and reported present outcomes at the MUHC, it will be assumed that INM might prevent postoperative nerve deficit in approximately 3% of procedures, and might prevent severe and lasting deficits (eg. paraplegia) in 1% of procedures. Even nerve deficits that are not prevented are likely to be less severe as a consequence of the surgical adjustment resulting from monitoring. Furthermore, though this can also not be quantified, the assurance that monitoring gives to the surgeon is likely to result in more effective surgical procedures.

Authors' recommendations: There is good evidence to support the conclusion that intraoperative spinal monitoring during surgical procedures that involve risk of spinal cord injury is an effective procedure that is capable of substantially diminishing this risk. In the absence of any precise estimates it is reasonable, for the purpose of this decision, to assume that an expenditure of approximately $46,000 per year (or $460 per patient) might prevent one patient suffering serious permanent spinal cord injury and less serious complications or sequelae in approximately 2 other patients. Even if the cost of maintaining such patients is excluded, this is a highly acceptable cost to benefit ratio. A potential problem relating to the extension of combined somatosensory evoked potentials (SSEP)/motor evoked potentials (MEP) monitoring to two MUHC sites is the relatively low rate of remuneration of the Neurophysiologists who play an essential role in this activity, and the resulting difficulty of recruitment. Recommendations: It is recommended that the MUHC make available combined SSEP/MEP monitoring for all cases of spinal surgery for which there is a risk of spinal cord injury. Although professional remuneration is outside the hospitals responsibility, it is suggested that the MUHC, together with other institutions that undertake this form of monitoring, should consider drawing this problem to the attention of the FMSQ.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://upload.mcgill.ca/tau/SPINAL_MONITORING_Final.pdf

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, 536-5100 Boul. Maisonneuve O, Montreal, H4A 3T2

Contact Name: eva.suarthana@mcgill.ca

Contact Email: nisha.almeida@muhc.mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)