TY - JOUR
T1 - A Clinical Practice Guideline for Prevention, Diagnosis and Management of Intraoperative Spinal Cord Injury
T2 - Recommendations for Use of Intraoperative Neuromonitoring and for the Use of Preoperative and Intraoperative Protocols for Patients Undergoing Spine Surgery
AU - Fehlings, Michael G.
AU - Alvi, Mohammed Ali
AU - Evaniew, Nathan
AU - Tetreault, Lindsay A.
AU - Martin, Allan R.
AU - McKenna, Stephen L.
AU - Rahimi-Movaghar, Vafa
AU - Ha, Yoon
AU - Kirshblum, Steven
AU - Hejrati, Nader
AU - Srikandarajah, Nisaharan
AU - Quddusi, Ayesha
AU - Moghaddamjou, Ali
AU - Malvea, Anahita
AU - Pinto, Ricardo Rodrigues
AU - Marco, Rex A.W.
AU - Newcombe, Virginia F.J.
AU - Basu, Saumayajit
AU - Strantzas, Samuel
AU - Zipser, Carl M.
AU - Douglas, Sam
AU - Laufer, Ilya
AU - Chou, Dean
AU - Saigal, Rajiv
AU - Arnold, Paul M.
AU - Hawryluk, Gregory W.J.
AU - Skelly, Andrea C.
AU - Kwon, Brian K.
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2024/3
Y1 - 2024/3
N2 - Study Design: Development of a clinical practice guideline following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process. Objective: The objectives of this study were to develop guidelines that outline the utility of intraoperative neuromonitoring (IONM) to detect intraoperative spinal cord injury (ISCI) among patients undergoing spine surgery, to define a subset of patients undergoing spine surgery at higher risk for ISCI and to develop protocols to prevent, diagnose, and manage ISCI. Methods: All systematic reviews were performed according to PRISMA standards and registered on PROSPERO. A multidisciplinary, international Guidelines Development Group (GDG) reviewed and discussed the evidence using GRADE protocols. Consensus was defined by 80% agreement among GDG members. A systematic review and diagnostic test accuracy (DTA) meta-analysis was performed to synthesize pooled evidence on the diagnostic accuracy of IONM to detect ISCI among patients undergoing spinal surgery. The IONM modalities evaluated included somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), electromyography (EMG), and multimodal neuromonitoring. Utilizing this knowledge and their clinical experience, the multidisciplinary GDG created recommendations for the use of IONM to identify ISCI in patients undergoing spine surgery. The evidence related to existing care pathways to manage ISCI was summarized and based on this a novel AO Spine-PRAXIS care pathway was created. Results: Our recommendations are as follows: (1) We recommend that intraoperative neurophysiological monitoring be employed for high risk patients undergoing spine surgery, and (2) We suggest that patients at “high risk” for ISCI during spine surgery be proactively identified, that after identification of such patients, multi-disciplinary team discussions be undertaken to manage patients, and that an intraoperative protocol including the use of IONM be implemented. A care pathway for the prevention, diagnosis, and management of ISCI has been developed by the GDG. Conclusion: We anticipate that these guidelines will promote the use of IONM to detect and manage ISCI, and promote the use of preoperative and intraoperative checklists by surgeons and other team members for high risk patients undergoing spine surgery. We welcome teams to implement and evaluate the care pathway created by our GDG.
AB - Study Design: Development of a clinical practice guideline following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process. Objective: The objectives of this study were to develop guidelines that outline the utility of intraoperative neuromonitoring (IONM) to detect intraoperative spinal cord injury (ISCI) among patients undergoing spine surgery, to define a subset of patients undergoing spine surgery at higher risk for ISCI and to develop protocols to prevent, diagnose, and manage ISCI. Methods: All systematic reviews were performed according to PRISMA standards and registered on PROSPERO. A multidisciplinary, international Guidelines Development Group (GDG) reviewed and discussed the evidence using GRADE protocols. Consensus was defined by 80% agreement among GDG members. A systematic review and diagnostic test accuracy (DTA) meta-analysis was performed to synthesize pooled evidence on the diagnostic accuracy of IONM to detect ISCI among patients undergoing spinal surgery. The IONM modalities evaluated included somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), electromyography (EMG), and multimodal neuromonitoring. Utilizing this knowledge and their clinical experience, the multidisciplinary GDG created recommendations for the use of IONM to identify ISCI in patients undergoing spine surgery. The evidence related to existing care pathways to manage ISCI was summarized and based on this a novel AO Spine-PRAXIS care pathway was created. Results: Our recommendations are as follows: (1) We recommend that intraoperative neurophysiological monitoring be employed for high risk patients undergoing spine surgery, and (2) We suggest that patients at “high risk” for ISCI during spine surgery be proactively identified, that after identification of such patients, multi-disciplinary team discussions be undertaken to manage patients, and that an intraoperative protocol including the use of IONM be implemented. A care pathway for the prevention, diagnosis, and management of ISCI has been developed by the GDG. Conclusion: We anticipate that these guidelines will promote the use of IONM to detect and manage ISCI, and promote the use of preoperative and intraoperative checklists by surgeons and other team members for high risk patients undergoing spine surgery. We welcome teams to implement and evaluate the care pathway created by our GDG.
KW - D-Wave
KW - electromyography
KW - intraoperative neuromonitoring
KW - intraoperative spinal cord injury
KW - motor evoked potential
KW - multimodal
KW - somatosensory evoked potential
UR - http://www.scopus.com/inward/record.url?scp=85188652040&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85188652040&partnerID=8YFLogxK
U2 - 10.1177/21925682231202343
DO - 10.1177/21925682231202343
M3 - Article
C2 - 38526921
AN - SCOPUS:85188652040
SN - 2192-5682
VL - 14
SP - 212S-222S
JO - Global Spine Journal
JF - Global Spine Journal
IS - 3_suppl
ER -