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Though patients rarely experience neurologic complications during spine deformity surgery, when they occur they can be catastrophic. Providers can use neuromonitoring during surgery to better detect changes in a patient’s spinal cord to intervene and reverse neurological deficits if they arise.
Risk factors for changes in intraoperative neuromonitoring include:
Twenty-one spine surgeons created a consensus-based checklist and best practice guide for neuromonitoring during spine deformity surgery. The team, which included Mark Erickson, MD, the medical director of the Spine Program at Children’s Hospital Colorado, aims to improve outcomes for patients who undergo spine deformity surgery.
The providers created a consensus-based surgical checklist to guide surgeon responses to intraoperative neuromonitoring changes in spinal deformity surgery patients with a stable spine. The group also developed a consensus-based guide for intraoperative neuromonitoring best practice in the U.S.
The group chose to pursue the creation of the surgical checklist and best practice guide for several reasons:
After an extensive literature review of risk factors and recommendations for responding to intraoperative neuromonitoring changes, the research authors administered four surveys to 21 orthopedic spine surgeons and one neurologist experienced in intraoperative neuromonitoring.
The team used the Delphi method to develop and modify the final surgical checklist, which was completed in 12 months. After the group established a balance of opinion, they used a nominal group process to determine which items should be included in the surgical checklist.
Then, the authors reevaluated and modified the checklist during three in-person meetings. Consensus was defined as 80% agreement. After the third meeting and a formal vote on adoption of the checklist by all consensus group participants, the group unanimously agreed to surgeon adoption of the stable spine surgical checklist.
Surgical checklist for the response to intraoperative neuromonitoring changes in patients with a stable spine
Consensus-based guide for intraoperative neuromonitoring best practices in the U.S.
With the increased focus on quality and patient safety in healthcare, providers need to implement highly reliable systems and processes to manage the irregularity of human behavior and decision making.
Spine deformity surgery continues to increase in complexity and sophistication. Just as techniques have evolved to better address greater degrees of deformity, so have the methods for detecting imminent neurologic change through intraoperative neuromonitoring.
Limitations of research:
The final checklist and best practice guide represent the consensus of a group of expert spine surgeons. The checklist includes the most important items to consider when responding to intraoperative neuromonitoring changes in patients with a stable spine.
The intraoperative neuromonitoring guide represents the group consensus on items that should be considered best practices among intraoperative neuromonitoring teams with the appropriate resources. Widespread and successful implementation of the products could improve surgical outcomes and patient safety.