Establishing a standard of care for neuromonitoring during spinal deformity surgery.

STUDY
DESIGN: Literature review.
OBJECTIVE: This article presents a critical examination of standard of care (SOC) related to intraoperative neurophysiologic monitoring during spine surgery. Definition of SOC and its applications in the surgical setting is accompanied by discussions on SOC for neuromonitoring, credentialing of neuromonitoring personnel, off-site remote monitoring, and unattended surgeon-controlled neuromonitoring devices.
METHODS: A literature review of neuromonitoring and SOC over the past 10 years was performed. This information, in conjunction with the author's experience and evidence-based medicine, was used to formulate a framework for critique and discussion.
CONCLUSION: An appropriate SOC as it relates to neuromonitoring is difficult to devise because of national variance with regard to qualifications of neurophysiologic technical and professional personnel, different levels of training and certification, and anesthesia protocols. A unified group of surgeons working in collaboration with a multidisciplinary group of experienced doctoral level nonphysician and physician professional surgical neurophysiologists is needed to define a protocol for providing and interpreting such data. In addition to ensuring that only the most qualified and experienced personnel are delivering and/or interpreting neuromonitoring services, surgeons, hospital administrators, and insurance company medical directors need to understand the different service delivery models and their respective strengths and limitations with particular attention to the qualifications and competencies of all respective parties. Only then can a well-defined SOC be established, thus improving the treatment of surgical patients for whom neuromonitoring is required.