Michael G Vitale1, David L Skaggs2, Gregory I Pace1, Margaret L Wright1, Hiroko Matsumoto3, Richard C E Anderson4, Douglas L Brockmeyer5, John P Dormans6, John B Emans7, Mark A Erickson8, John M Flynn6, Michael P Glotzbecker7, Kamal N Ibrahim9, Stephen J Lewis10, Scott J Luhmann11, Anil Mendiratta12, B Stephens Richards13, James O Sanders14, Suken A Shah15, John T Smith16, Kit M Song17, Paul D Sponseller18, Daniel J Sucato13, David P Roye1, Lawrence G Lenke11. 1. Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY 10032, USA. 2. Department of Orthopedic Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. 3. Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY 10032, USA. Electronic address: hm2174@columbia.edu. 4. Department of Neurological Surgery, Columbia University Medical Center, New York, NY 10032, USA. 5. Department of Neurosurgery, University of Utah, Salt Lake City, UT 84112, USA. 6. Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA. 7. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02115, USA. 8. Department of Orthopedic Surgery, University of Colorado, Denver, CO 80202, USA. 9. Department of Orthopedic Surgery, Loyola University, Chicago, IL 60660, USA. 10. Department of Orthopedic Surgery, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada. 11. Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO 63130, USA. 12. Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA. 13. Department of Orthopedic Surgery, Texas Scottish Rite Hospital, Dallas, TX 75219, USA. 14. Department of Orthopedic Surgery, University of Rochester, Rochester, NY 14627, USA. 15. Department of Orthopedic Surgery, Nemours/AI duPont, Wilmington, DE 19803, USA. 16. Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT 84112, USA. 17. Department of Orthopedic Surgery, Shriners Hospitals for Children, Los Angeles, CA 90020, USA. 18. Department of Orthopedic Surgery, Johns Hopkins Medical Center, Baltimore, MD 21287, USA.
Abstract
STUDY DESIGN: Consensus-based creation of a checklist and guideline. OBJECTIVE: To develop a consensus-based checklist to guide surgeon responses to intraoperative neuromonitoring (IONM) changes in patients with a stable spine and to develop a consensus-based best practice guideline for IONM practice in the United States. SUMMARY OF BACKGROUND DATA: Studies show that checklists enhance surgical team responses to crisis situations and improve patient outcomes. Currently, no widely accepted guidelines exist for the response to IONM changes in spine deformity surgery. METHODS: After a literature review of risk factors and recommendations for responding to IONM changes, 4 surveys were administered to 21 experienced spine surgeons and 1 neurologist experienced in IONM. Areas of equipoise were identified and the nominal group process was used to determine items to be included in the checklist. The authors reevaluated and modified the checklist at 3 face-to-face meetings over 12 months, including a period of clinical validation using a modified Delphi process. The group was also surveyed on current IONM practices at their institutions. This information and existing IONM position statements were used to create the IONM best practice guideline. RESULTS: Consensus was reached for the creation of 5 checklist headings containing 26 items to consider in the response to IONM changes. Consensus was reached on 5 statements for inclusion in the best practice guideline; the final guideline promotes a team approach and makes recommendations aimed at decreasing variability in neuromonitoring practices. CONCLUSIONS: The final products represent the consensus of a group of expert spine surgeons. The checklist includes the most important and high-yield items to consider when responding to IONM changes in patients with a stable spine, whereas the IONM guideline represents the group consensus on items that should be considered best practice among IONM teams with the appropriate resources.
STUDY DESIGN: Consensus-based creation of a checklist and guideline. OBJECTIVE: To develop a consensus-based checklist to guide surgeon responses to intraoperative neuromonitoring (IONM) changes in patients with a stable spine and to develop a consensus-based best practice guideline for IONM practice in the United States. SUMMARY OF BACKGROUND DATA: Studies show that checklists enhance surgical team responses to crisis situations and improve patient outcomes. Currently, no widely accepted guidelines exist for the response to IONM changes in spine deformity surgery. METHODS: After a literature review of risk factors and recommendations for responding to IONM changes, 4 surveys were administered to 21 experienced spine surgeons and 1 neurologist experienced in IONM. Areas of equipoise were identified and the nominal group process was used to determine items to be included in the checklist. The authors reevaluated and modified the checklist at 3 face-to-face meetings over 12 months, including a period of clinical validation using a modified Delphi process. The group was also surveyed on current IONM practices at their institutions. This information and existing IONM position statements were used to create the IONM best practice guideline. RESULTS: Consensus was reached for the creation of 5 checklist headings containing 26 items to consider in the response to IONM changes. Consensus was reached on 5 statements for inclusion in the best practice guideline; the final guideline promotes a team approach and makes recommendations aimed at decreasing variability in neuromonitoring practices. CONCLUSIONS: The final products represent the consensus of a group of expert spine surgeons. The checklist includes the most important and high-yield items to consider when responding to IONM changes in patients with a stable spine, whereas the IONM guideline represents the group consensus on items that should be considered best practice among IONM teams with the appropriate resources.
Authors: Athanasios I Tsirikos; Andrew D Duckworth; Lindsay E Henderson; Ciara Michaelson Journal: Med Princ Pract Date: 2019-06-04 Impact factor: 1.927
Authors: Pinar Yalinay Dikmen; Matthew F Halsey; Altug Yucekul; Marinus de Kleuver; Lloyd Hey; Peter O Newton; Irem Havlucu; Tais Zulemyan; Caglar Yilgor; Ahmet Alanay Journal: Spine Deform Date: 2020-11-23