{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T21:58:23Z","timestamp":1783807103180,"version":"3.55.0"},"reference-count":25,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,6,21]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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 &lt;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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Increased SCI risk among patients with IONM likely reflects higher baseline risk, and further research is needed for risk mitigation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104325","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T21:40:10Z","timestamp":1688593210000},"page":"192-199","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Intraoperative neurophysiological monitoring and spinal cord stimulator implantation"],"prefix":"10.1136","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9311-1399","authenticated-orcid":false,"given":"Vasudha","family":"Goel","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander M","family":"Kaizer","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Infomatics, University of Colorado School of Public Health, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sejal","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9335-0584","authenticated-orcid":false,"given":"David","family":"Darrow","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1567-3887","authenticated-orcid":false,"given":"Hariharan","family":"Shankar","sequence":"additional","affiliation":[{"name":"Anesthesiology, Clement Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,5]]},"reference":[{"key":"2025101110513022000_49.3.192.1","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12692"},{"key":"2025101110513022000_49.3.192.2","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12208"},{"key":"2025101110513022000_49.3.192.3","first-page":"325","article-title":"Complications of spinal cord stimulation and peripheral nerve stimulation techniques: A review of the literature","volume":"17","author":"Eldabe","year":"2016","journal-title":"Pain Med"},{"key":"2025101110513022000_49.3.192.4","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2021-103307"},{"key":"2025101110513022000_49.3.192.5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/ner.12370","article-title":"The incidence of spinal cord injury in implantation of percutaneous and paddle electrodes for spinal cord stimulation","volume":"19","author":"Petraglia III","year":"2016","journal-title":"Neuromodulation: Technology at the Neural Interface"},{"key":"2025101110513022000_49.3.192.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1403.2011.00395.x"},{"key":"2025101110513022000_49.3.192.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1403.2010.00319.x"},{"key":"2025101110513022000_49.3.192.8","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.neurom.2021.11.014","article-title":"A prospective multicenter case series utilizing intraoperative Neuromonitoring with evoked compound action potentials to confirm spinal cord stimulation lead placement","volume":"25","author":"Falowski","year":"2022","journal-title":"Neuromodulation"},{"key":"2025101110513022000_49.3.192.9","unstructured":"Ghatol D , Widrich J . Intraoperative neurophysiological monitoring. Treasure Island (FL): StatPearls, 2022."},{"key":"2025101110513022000_49.3.192.10","unstructured":"Quality management and departmental administration Ahod. Definition of general anesthesia and levels of sedation\/analgesia."},{"key":"2025101110513022000_49.3.192.11","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31819432e5"},{"key":"2025101110513022000_49.3.192.12","doi-asserted-by":"publisher","DOI":"10.1007\/s11229-021-03276-4"},{"key":"2025101110513022000_49.3.192.13","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"2025101110513022000_49.3.192.14","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/anae.14139","article-title":"Spinal cord injury arising in anaesthesia practice","volume":"73 Suppl 1","author":"Hewson","year":"2018","journal-title":"Anaesthesia"},{"key":"2025101110513022000_49.3.192.15","first-page":"363","article-title":"Osteoporosis and the management of spinal degenerative disease (II)","volume":"5","author":"Tom\u00e9-Bermejo","year":"2017","journal-title":"Arch Bone Jt Surg"},{"key":"2025101110513022000_49.3.192.16","doi-asserted-by":"crossref","first-page":"357","DOI":"10.36076\/ppj.2010\/13\/357","article-title":"A report of paraparesis following spinal cord Stimulator trial, implantation and revision","volume":"13","author":"Smith","year":"2010","journal-title":"Pain Physician"},{"key":"2025101110513022000_49.3.192.17","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/77.3.347"},{"key":"2025101110513022000_49.3.192.18","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/78.2.149"},{"key":"2025101110513022000_49.3.192.19","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000700"},{"key":"2025101110513022000_49.3.192.20","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/ner.12564","article-title":"The Neurostimulation appropriateness consensus Committee (NACC) safety guidelines for the reduction of severe neurological injury","volume":"20","author":"Deer","year":"2017","journal-title":"Neuromodulation"},{"key":"2025101110513022000_49.3.192.21","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/j.1525-1403.2012.00460.x","article-title":"Intraoperative Neurophysiologic methods for spinal cord Stimulator placement under general anesthesia","volume":"15","author":"Shils","year":"2012","journal-title":"Neuromodulation"},{"key":"2025101110513022000_49.3.192.22","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.jocn.2015.01.008","article-title":"Intraoperative Neurophysiologic monitoring with Hoffmann reflex during Thoracic spine surgery","volume":"22","author":"Feyissa","year":"2015","journal-title":"J Clin Neurosci"},{"key":"2025101110513022000_49.3.192.23","doi-asserted-by":"crossref","first-page":"444","DOI":"10.3988\/jcn.2018.14.4.444","article-title":"Neuromonitoring for spinal cord stimulation lead placement under general anesthesia","volume":"14","author":"Shils","year":"2018","journal-title":"J Clin Neurol"},{"key":"2025101110513022000_49.3.192.24","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s10877-018-0201-9","article-title":"Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring","volume":"33","author":"Gertsch","year":"2019","journal-title":"J Clin Monit Comput"},{"key":"2025101110513022000_49.3.192.25","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s10877-019-00266-3","article-title":"Is the new ASNM intraoperative Neuromonitoring supervision \"guideline\" a trustworthy guideline? 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