Intraoperative spinal cord and nerve root monitoring: a survey of Canadian spine surgeons.

BACKGROUND: Intraoperative spinal cord and nerve root monitoring is used to identify an insult to the neural elements with the goal of preventing injury. There are 2 major categories of monitoring: evoked potentials (somatosensory evoked potentials and motor evoked potentials) and electromyography. The availability of intraoperative neuromonitoring and the indications for use vary widely. In this study, we aimed to document the current practices and opinions of Canadian spine surgeons with regards to intraoperative spinal monitoring. METHODS: We surveyed members of the Canadian Spine Society about the availability and use of various types of intraoperative neuromonitoring modalities for surgical procedures. RESULTS: We distributed 105 surveys and received 95 responses (90%). Somatosensory evoked potentials were the most commonly available form of intraoperative neuromonitoring, although it was available to only 65.3% of respondents. Surgeons in either full-time or part-time academic practice used monitoring more frequently than those in private practice (p < 0.001), but this association was not based on surgeon preference after controlling for availability. Years of practice and training background (orthopedic or neurosurgical) did not influence the use of monitoring. Canadian spine surgeons overwhelmingly reported that they use intraoperative neuromonitoring to reduce the risk of adverse operative events, rather than because of liability concerns. Most respondents believed that monitoring should be used in the correction of major deformity and scoliosis. CONCLUSION: The availability of spinal monitoring in Canada is variable. Most surgeons believe that it is an important adjunct to improve patient safety.