The Management of Intraoperative Spinal Cord Injury – A Scoping Review

Nader Hejrati, Nisaharan Srikandarajah, Mohammed Ali Alvi, Ayesha Quddusi, Lindsay A. Tetreault, James D. Guest, Rex A.W. Marco, Steven Kirshblum, Allan R. Martin, Samuel Strantzas, Paul M. Arnold, Saumyajit Basu, Nathan Evaniew, Brian K. Kwon, Andrea C. Skelly, Michael G. Fehlings

Research output: Contribution to journalArticlepeer-review


Study Design: Scoping Review. Objective: To review the literature and summarize information on checklists and algorithms for responding to intraoperative neuromonitoring (IONM) alerts and management of intraoperative spinal cord injuries (ISCIs). Methods: MEDLINE® was searched from inception through January 26, 2022 as were sources of grey literature. We attempted to obtain guidelines and/or consensus statements from the following sources: American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), American Academy of Neurology (AAN), American Clinical Neurophysiology Society, NASS (North American Spine Society), and other spine surgery organizations. Results: Of 16 studies reporting on management strategies for ISCIs, two were publications of consensus meetings which were conducted according to the Delphi method and eight were retrospective cohort studies. The remaining six studies were narrative reviews that proposed intraoperative checklists and management strategies for IONM alerts. Of note, 56% of included studies focused only on patients undergoing spinal deformity surgery. Intraoperative considerations and measures taken in the event of an ISCI are divided and reported in three categories of i) Anesthesiologic, ii) Neurophysiological/Technical, and iii) Surgical management strategies. Conclusion: There is a paucity of literature on comparative effectiveness and harms of management strategies in response to an IONM alert and possible ISCI. There is a pressing need to develop a standardized checklist and care pathway to avoid and minimize the risk of postoperative neurologic sequelae.

Original languageEnglish (US)
Pages (from-to)150S-165S
JournalGlobal Spine Journal
Issue number3_suppl
StatePublished - Mar 2024


  • care pathways
  • checklists
  • guidelines
  • intraoperative spinal cord injury

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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