Intraoperative neuromonitoring practice patterns in spinal deformity surgery: a global survey of the Scoliosis Research
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Intraoperative neuromonitoring practice patterns in spinal deformity surgery: a global survey of the Scoliosis Research Society Pinar Yalinay Dikmen1 · Matthew F. Halsey2 · Altug Yucekul3 · Marinus de Kleuver4 · Lloyd Hey5 · Peter O. Newton6 · Irem Havlucu7 · Tais Zulemyan7 · Caglar Yilgor3 · Ahmet Alanay3 Received: 27 May 2020 / Accepted: 30 October 2020 © Scoliosis Research Society 2020
Abstract Purpose Although multimodal IONM has reached a widespread use, several unresolved issues have remained in clinical practice. The aim was to determine differences in approaches to form a basis for taking actions to improve patient safety globally. Methods A survey comprising 19 questions in four sections (demographics, setup, routine practices and reaction to alerts) was distributed to the membership of the SRS. Results Of the estimated 1300 members, 205 (~ 15%) completed the survey. Respondent demographics reflected SRS member distribution. Most of the respondents had > 10 years of experience. TcMEP and SSEP were available to > 95%. Less than 5% reported that a MD/PhD with neurophysiology background routinely examines patients preoperatively, while 19% would consult if requested. After an uneventful case, 36% reported that they would decrease sedation and check motor function if the patient was to be transferred to ICU intubated. Reactions to dropped signals that recovered or did not fully recover varied between attempting the same correction to aborting the surgery with no rods and returning another day, with or without implant removal. After a decrease of signals, 85.7% use steroids of varied doses. Of the respondents, 53.7% reported using the consensus-created checklist by Vitale et al. Approximately, 14% reported never using the wake-up test while others use it for various conditions. Conclusion The responses of 205 experienced SRS members from different regions of the world showed that surgeons had different approaches in their routine IONM practices and in the handling of alerts. This survey indicates the need for additional studies to identify best practices. Keywords IONM · Neuromonitoring · Spine · Scoliosis · Surgery · Safety
* Ahmet Alanay [email protected] 1
Department of Neurology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
2
Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
3
Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
4
Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands
5
Hey Clinic, 3320 Wake Forest Rd #450, Raleigh, NC 27609, USA
6
Rady Children’s Hospital, San Diego, CA 92123, USA
7
Comprehensive Spine Center, Acibadem University Maslak Hospital, Buyukdere Cad No: 40, Maslak, Sariyer, 34457 Istanbul, Turkey
Introduction Multimodal intraoperative neuromonitoring (IONM) has been used in spinal surgery for the last few decades. Various techniques include transcrani
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