Benefit of Intraoperative IONM and Expenses?...

The risks are minimal but they are real, and when you are not using the advanced technology and knowledge available to assess and safeguard the patients from risks of nerve damage or paralysis, your care is flawed and pretty dangerous, if you can spent 25 thousands for surgery and do not use Neuromonitoring that might cost another thousand or two, and you think that is cost effective, then something wrong with such ideas. Bringing safety inside OR must be the top priority of an operating surgeon (performing surgeon). There are several vascular or neurological complications happen during spine surgical procedures that may not be identified timely if you do not use neuromonitoring techniques, and when you find out after the surgery, it is too late.  

I agree with Professor Fessler, right views when it comes to the benefits and cost effectiveness of IONM. However, totally regard this is yet another Rat and Mice study that is irrelevant to the better care and safe outcome of surgeries, if you do not use IONM then you take the responsibility of a life that might be put into serious risks.................so, it is the surgeon who can make that fine decision at the right time.

Medscape Medical News 

Benefit of Intraop Neuromonitoring May Not Outweigh Costs by Caroline Helwick, Apr 30, 2013 

But Richard Fessler, MD, professor of Neurological Surgery at Northwestern University Feinberg School of Medicine, Chicago, Illinois, disagreed. In a comment to Medscape Medical News, he called the study "very interesting," with predictable but perhaps irrelevant results.

"If you have one patient where the IOM tells you that you have a problem, and causes you to stop what you are doing and correct that problem and perhaps prevent having a patient who is paralyzed, I would argue that that is cost-effective," he said.
He added that he will not change practice on the basis of the study's findings.