Introduction: To analyze societal costs of routine neuromonitoring in deformity surgery versus the potential societal costs of spinal cord injury from an adverse surgical event in terms of malpractice settlements and lifetime patient care needs.
Methods: A national database of personal injury verdicts/awards (Westlaw) was searched to determine the average settlement after an adverse outcome following spinal surgery in the past 10 yrs, regardless of fault. Lifetime patient care needs were also determined, based on age at injury/life expectancy. 4,000 spinal deformity cases/yr in the US at a neural injury rate of .03% were assumed for analysis. The cost of neuromonitoring was determined to be $190/hr based on review of 2 separate hospital contract rates (mean $950/case). Search terms included spine surgery, scoliosis, paraplegia and neurologic injury yielded 110 potential cases, of which there were 43 defense verdicts, 22 cases determined to be n/a, and 27 injuries determined not to be related to surgery.
Results: The database yielded 18 cases of neural injury in spine surgery, of which 6 were deformity operations (ave. age 16.6 yrs) having an average verdict of $11.9 million (range $2.9–25.0 mil). The other 12 cases (ave $754,000 payout) did not involve spinal deformity. This also did not include an evaluation of settlements prior to trial, where payout of a typical structured settlement may be 1.5–5 times the final settlement. The estimated cost of neuromonitoring was $950/case X 4000, or $3.8 million/yr. Assuming a false negative rate of MEPs at ˜0.25% and an inability to monitor 10% of cases, potentially 3 cases/yr of paraplegia would be avoided with complete neuromonitoring (SSEP, MEP, EMG).
Conclusion: Assuming 12 cases of neurologic injury/yr (.03% of 4000 cases) not including other non‐paraplegic neurologic injuries and pre‐trial settlements, and with monitoring at $950/case ($3.8 mil/yr), a conservative estimate of societal savings would be over $30–40 mil/yr of direct costs ‐ hence insurance reimbursement of neuromonitoring services should be mandatory.