Rajiv R Iyer1, Michael G Vitale1,2, Adam N Fano1, Hiroko Matsumoto3,4, Daniel J Sucato5, Amer F Samdani6, Justin S Smith7, Munish C Gupta8, Michael P Kelly8, Han Jo Kim9, Daniel M Sciubba10, Samuel K Cho11, David W Polly12, Oheneba Boachie-Adjei13, Peter D Angevine14,15, Stephen J Lewis16, Lawrence G Lenke14,17. 1. Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. 2. Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA. 3. Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. hm2174@cumc.columbia.edu. 4. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. hm2174@cumc.columbia.edu. 5. Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA. 6. Shriners Hospitals for Children, Philadelphia, PA, USA. 7. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA. 8. Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA. 9. Hospital for Special Surgery, New York, NY, USA. 10. Department of Neurosurgery, Long Island Jewish Medical Center, North Shore University Hospital of Northwell Health, New York, NY, USA. 11. Department of Orthopedic Surgery, Mount Sinai Medical Center, New York, NY, USA. 12. Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA. 13. FOCOS Orthopedic Hospital, Patang, Accra, Ghana. 14. The Daniel and Jane Och Spine Hospital at New York-Presbyterian/Allen, New York, NY, USA. 15. Division of Spinal Surgery, Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA. 16. Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada. 17. Division of Spinal Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Abstract
PURPOSE: To establish expert consensus on various parameters that constitute elevated risk during spinal deformity surgery and potential preventative strategies that may minimize the risk of intraoperative neuromonitoring (IONM) events and postoperative neurological deficits. METHODS: Through a series of surveys and a final virtual consensus meeting, the Delphi method was utilized to establish consensus among a group of expert spinal deformity surgeons. During iterative rounds of voting, participants were asked to express their agreement (strongly agree, agree, disagree, strongly disagree) to include items in a final set of guidelines. Consensus was defined as ≥ 80% agreement among participants. Near-consensus was ≥ 60% but < 80% agreement, equipoise was ≥ 20% but < 60%, and consensus to exclude was < 20%. RESULTS: Fifteen of the 15 (100%) invited expert spinal deformity surgeons agreed to participate. There was consensus to include 22 determinants of high-risk (8 patient factors, 8 curve and spinal cord factors, and 6 surgical factors) and 21 preventative strategies (4 preoperative, 14 intraoperative, and 3 postoperative) in the final set of best practice guidelines. CONCLUSION: A resource highlighting several salient clinical factors found in high-risk spinal deformity patients as well as strategies to prevent neurological events was successfully created through expert consensus. This is intended to serve as a reference for surgeons and other clinicians involved in the care of spinal deformity patients. LEVEL OF EVIDENCE: Level V.
PURPOSE: To establish expert consensus on various parameters that constitute elevated risk during spinal deformity surgery and potential preventative strategies that may minimize the risk of intraoperative neuromonitoring (IONM) events and postoperative neurological deficits. METHODS: Through a series of surveys and a final virtual consensus meeting, the Delphi method was utilized to establish consensus among a group of expert spinal deformity surgeons. During iterative rounds of voting, participants were asked to express their agreement (strongly agree, agree, disagree, strongly disagree) to include items in a final set of guidelines. Consensus was defined as ≥ 80% agreement among participants. Near-consensus was ≥ 60% but < 80% agreement, equipoise was ≥ 20% but < 60%, and consensus to exclude was < 20%. RESULTS: Fifteen of the 15 (100%) invited expert spinal deformity surgeons agreed to participate. There was consensus to include 22 determinants of high-risk (8 patient factors, 8 curve and spinal cord factors, and 6 surgical factors) and 21 preventative strategies (4 preoperative, 14 intraoperative, and 3 postoperative) in the final set of best practice guidelines. CONCLUSION: A resource highlighting several salient clinical factors found in high-risk spinal deformity patients as well as strategies to prevent neurological events was successfully created through expert consensus. This is intended to serve as a reference for surgeons and other clinicians involved in the care of spinal deformity patients. LEVEL OF EVIDENCE: Level V.
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Authors: Michael G Fehlings; So Kato; Lawrence G Lenke; Hiroaki Nakashima; Narihito Nagoshi; Christopher I Shaffrey; Kenneth M C Cheung; Leah Carreon; Mark B Dekutoski; Frank J Schwab; Oheneba Boachie-Adjei; Khaled M Kebaish; Christopher P Ames; Yong Qiu; Yukihiro Matsuyama; Benny T Dahl; Hossein Mehdian; Ferran Pellisé-Urquiza; Stephen J Lewis; Sigurd H Berven Journal: Spine J Date: 2018-02-13 Impact factor: 4.166
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