Lawrence G Lenke1,2, Adam N Fano3, Rajiv R Iyer3, Hiroko Matsumoto4,5, Daniel J Sucato6, Amer F Samdani7, Justin S Smith8, Munish C Gupta9, Michael P Kelly9, Han Jo Kim10, Daniel M Sciubba11, Samuel K Cho12, David W Polly13, Oheneba Boachie-Adjei14, Stephen J Lewis15, Peter D Angevine2,16, Michael G Vitale3,17. 1. Division of Spinal Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA. 2. The Daniel and Jane Och Spine Hospital at New York-Presbyterian/Allen, 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. 4. 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. 5. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. hm2174@cumc.columbia.edu. 6. Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA. 7. Shriners Hospitals for Children, Philadelphia, PA, USA. 8. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA. 9. Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA. 10. Hospital for Special Surgery, New York, NY, USA. 11. Department of Neurosurgery, Long Island Jewish Medical Center and North Shore University Hospital of Northwell Health, New York, NY, USA. 12. Department of Orthopedic Surgery, Mount Sinai Medical Center, New York, NY, USA. 13. Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA. 14. FOCOS Orthopedic Hospital, Patang, Accra, Ghana. 15. Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada. 16. Division of Spinal Surgery, Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA. 17. Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
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.
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.
Authors: Kent T Yamaguchi; David L Skaggs; Shaun Mansour; Karen S Myung; Muharram Yazici; Charles Johnston; George Thompson; Paul Sponseller; Behrooz A Akbarnia; Michael G Vitale Journal: Spine Deform Date: 2014-10-27
Authors: Michael G Vitale; David L Skaggs; Gregory I Pace; Margaret L Wright; Hiroko Matsumoto; Richard C E Anderson; Douglas L Brockmeyer; John P Dormans; John B Emans; Mark A Erickson; John M Flynn; Michael P Glotzbecker; Kamal N Ibrahim; Stephen J Lewis; Scott J Luhmann; Anil Mendiratta; B Stephens Richards; James O Sanders; Suken A Shah; John T Smith; Kit M Song; Paul D Sponseller; Daniel J Sucato; David P Roye; Lawrence G Lenke Journal: Spine Deform Date: 2014-08-27
Authors: J Alex Sielatycki; Meghan Cerpa; Griffin Baum; Martin Pham; Earl Thuet; Ronald A Lehman; Lawrence G Lenke Journal: Spine Deform Date: 2020-03-23