Abstract
BACKGROUND: The use of intraoperative neuromonitoring (IONM) has recently increased in popularity among spinal surgery to reduce rates of postoperative neurological complications. However, its utility has been mixed, especially in elective surgeries, due to increased healthcare spending and limited guidelines. In this study, we investigated the associations between IONM and clinical outcomes, as well as both financial and demographic factors, for patients with primary non-malignant spine tumors (PNMT) undergoing surgery. METHODS: A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of PNMT patients who underwent surgery from 2011 to 2021. Rates of IONM usage were compared based on patient age, sex, family income, and region. Complications and 30-day readmissions were also assessed. RESULTS: 5,692 patients undergoing surgery with PNMTs were identified, with 1,914 (33.6%) of these utilizing IONM. Younger age (p < 0.001) and male sex (p < 0.05) were both significantly associated with IONM usage and there was significant regional variability in utilization observed (Midwest: 33.8%; Northeast: 24.6%; South: 29.0%; West: 12.6%; p < 0.001). Among clinical outcomes, nerve injury (p < 0.001), surgical complications (p < 0.001), and 30-day readmission rates (p < 0.001) were all significantly associated with IONM usage. Both mean family income (p < 0.005) and reimbursement amounts were not clinically significant in association with IONM usage. CONCLUSIONS: Among patients with PNMTs, this study demonstrates significant differences in IONM usage across geographic regions, sex, and age as well as a positive association with 30-day readmission rates with use. While associations between IONM and family income have been observed previously, neither income nor reimbursement measures were clinically significant in our cohort. Given the growing usage of IONM in spinal surgeries, these results provide important insights into the utility of IONM among patients with non-malignant spinal tumors.