Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery

Lawrence G. Lenke, Adam N. Fano, Rajiv R. Iyer, Hiroko Matsumoto, Daniel J. Sucato, Amer F. Samdani, Justin S. Smith, Munish C. Gupta, Michael P. Kelly, Han Jo Kim, Daniel M. Sciubba, Samuel K. Cho, David W. Polly, Oheneba Boachie-Adjei, Stephen J. Lewis, Peter D. Angevine, Michael G. Vitale

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To expand on previously described intraoperative aids by developing consensus-based best practice guidelines to optimize the approach to intraoperative neuromonitoring (IONM) events associated with “high-risk” spinal deformity surgery. Methods: Consensus was established among a group of experienced spinal deformity surgeons by way of the Delphi method. Through a series of iterative surveys and a final virtual consensus meeting, participants expressed their agreement (strongly agree, agree, disagree, and strongly disagree) with various items. Consensus was defined as ≥ 80% agreement (“strongly agree” or “agree”). Near-consensus was defined as ≥ 60% but < 80%. Equipoise was ≥ 20% but < 60%, and consensus to exclude was < 20%. Results: 15 out of 15 (100%) invited surgeons agreed to participate. Final consensus supported inclusion of 105 items (53 in Response Algorithm, 13 in Ongoing Consideration of Etiology, 31 in Real-Time Data Scenarios, 8 in Patterns of IONM Loss), which were organized into a final set of best practice guidelines. Conclusion: Detailed consensus-based best practice guidelines and aids were successfully created with the intention to help organize and direct the surgical team in exploring and responding to neurological complications during high-risk spinal deformity surgery. Level of evidence: Level V.

Original languageEnglish
Pages (from-to)745-761
Number of pages17
JournalSpine deformity
Volume10
Issue number4
DOIs
StatePublished - Jul 2022

Keywords

  • Best practice guideline
  • Expert consensus
  • High-risk
  • Intraoperative neuromonitoring
  • Neurological deficit
  • Spinal deformity

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