Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery

Lawrence G. Lenke; Adam N. Fano; Rajiv R. Iyer; Hiroko Matsumoto; Daniel J. Sucato; Amer F. Samdani; Justin S. Smith; Munish C. Gupta; Michael P. Kelly; Han Jo Kim; Daniel M. Sciubba; Samuel K. Cho; David W. Polly; Oheneba Boachie-Adjei; Stephen J. Lewis; Peter D. Angevine; Michael G. Vitale

doi:10.1007/s43390-022-00485-w

Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery

Lawrence G. Lenke, Adam N. Fano, Rajiv R. Iyer, Hiroko Matsumoto, Daniel J. Sucato, Amer F. Samdani, Justin S. Smith, Munish C. Gupta, Michael P. Kelly, Han Jo Kim, Daniel M. Sciubba, Samuel K. Cho, David W. Polly, Oheneba Boachie-Adjei, Stephen J. Lewis, Peter D. Angevine, Michael G. Vitale

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

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.

Original language	English (US)
Pages (from-to)	745-761
Number of pages	17
Journal	Spine Deformity
Volume	10
Issue number	4
DOIs	https://doi.org/10.1007/s43390-022-00485-w
State	Published - Jul 2022

Bibliographical note

Funding Information:
Dr. Lenke reports personal fees from Medtronic, non-financial support from Broadwater, grants and non-financial support from Scoliosis Research Society, grants from EOS, grants from Setting Scoliosis Straight Foundation, other from Evans Family Donation, other from Fox Family Foundation, grants and non-financial support from AOSpine, personal fees from Abryx, personal fees from EOS Technologies, personal fees from Acuity Surgical. Dr. Matsumoto reports personal fees from Pediatric Spine Study Group, grants from POSNA, grants from SRS, outside the submitted work. Dr. Samdani reports personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet, outside the submitted work. Dr. Smith reports personal fees from Stryker, personal fees from Cerapedics, personal fees from Carlsmed, personal fees from Zimmer Biomet, grants and personal fees from NuVasive, personal fees from Thieme, grants from DePuy Synthes/ISSGF, personal fees from DePuy Synthes, grants from AOSpine, outside the submitted work. Dr. Smith reports stock ownership in Alphatec and NuVasive. Dr. Gupta reports personal fees, non-financial support and other from DePuy, personal fees from Innomed, personal fees and non-financial support from Medtronic, personal fees and non-financial support from Globus, non-financial support from Scoliosis Research Society, personal fees and non-financial support from AO Spine, non-financial support from National Health Spine Foundation, other from J&J, other from P&G, personal fees from Malaysia Spine Society, personal fees from Louisiana State Univ, personal fees and non-financial support from Alphatec, non-financial support from Mizuho, non-financial support from Medicrea, outside the submitted work. Dr. Kelly reports personal fees from Deputy Editor at Spine, grants from Setting Scoliosis Straight Foundation, outside the submitted work. Dr. Kim reports grants or contracts from ISSGF (paid to institution) and SI Bone (paid to institution), royalties or licenses from Zimmer Biomet (personal fees), Stryker (personal fees), and Acuity-Surgical (personal fees). Dr. Kim reports participation as a Nuvasive advisory board member, Aspen Medical advisory board member, and Vivex Biologics advisory board member. Dr. Sciubba reports consulting fees from Depuy-Synthes (personal fees). Medtronic (personal fees), Stryker (personal fees), and Baxter (personal fees). Dr. Sciubba reports a leadership or fiduciary role in AO Spine North America. Dr. Cho reports royalties or licenses from Globus Medical (IP royalties). Dr. Cho reports consulting fees from Stryker. Dr. Cho reports a leadership or fiduciary role in AAOS, American Orthopedic Association, AO Spine North America, Cervical Spine Research Society, North American Spine Society, and Scoliosis Research Society. Dr. Cho reports stock ownership in Aldentify. Dr. Polly reports grants or contracts Medtronic (to institution), MizuhoOSI (to institution). Dr. Polly reports royalties or licenses from SI Bone (personal) and Springer (personal). Dr. Polly reports consulting fees from SI Bone (personal) and Globus (personal). Dr. Polly reports patents (planned, issued, or pending) from SI bone (personal) and Globus (personal). Dr. Polly reports participation on a Data Safety Monitoring Board or Advisory Board with SI Bone. Dr. Polly reports a leadership or fiduciary role in American Spine Registry (executive committee), Scoliosis Research Society (committees), and North American Spine Society (committees). Dr. Lewis reports consulting fees from Stryker Spine (personal), L&K Biomed (personal). Dr. Lewis reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medtronic (personal), AO Spine (personal), Scoliosis Research Society (personal). Dr. Lewis reports support for attending meetings and/or travel from AO Spine (personal), Scoliosis Research Society (personal). Dr. Lewis reports participation on a Data Safety Monitoring Board or Advisory Board with AO Spine. Dr. Lewis reports a leadership or fiduciary role in AO Spine (Research Commission, Chair Knowledge Forum Deformity). Dr. Lewis reports stock ownership in Covr Medical and Augmedics. Dr. Lewis reports Medtronic fellowship support to institution, Depuy Synthes fellowship support to institution, and Stryker Spine fellowship support to institution. Dr. Angevine reports participation on a Data Safety Monitoring Board or Advisory Board with National Institutes of Health. Dr. Vitale reports grants and personal fees from Biomet, grants and non-financial support from Children's Spine Foundation, personal fees from East Coast Orthotics and Prosthetics, other from FOX, non-financial support from IPOS, grants from OREF, grants and non-financial support from POSNA, non-financial support from Project for Safety in Spine Surgery, grants from OSRF, grants from SRS, personal fees from Stryker, non-financial support from Wellinks, outside the submitted work.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Scoliosis Research Society.

Keywords

Best practice guideline
Expert consensus
High-risk
Intraoperative neuromonitoring
Neurological deficit
Spinal deformity

PubMed: MeSH publication types

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s43390-022-00485-w

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Cite this

Lenke, L. G., Fano, A. N., Iyer, R. R., Matsumoto, H., Sucato, D. J., Samdani, A. F., Smith, J. S., Gupta, M. C., Kelly, M. P., Kim, H. J., Sciubba, D. M., Cho, S. K., Polly, D. W., Boachie-Adjei, O., Lewis, S. J., Angevine, P. D., & Vitale, M. G. (2022). Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery. Spine Deformity, 10(4), 745-761. https://doi.org/10.1007/s43390-022-00485-w

Lenke, LG, Fano, AN, Iyer, RR, Matsumoto, H, Sucato, DJ, Samdani, AF, Smith, JS, Gupta, MC, Kelly, MP, Kim, HJ, Sciubba, DM, Cho, SK, Polly, DW, Boachie-Adjei, O, Lewis, SJ, Angevine, PD & Vitale, MG 2022, 'Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery', Spine Deformity, vol. 10, no. 4, pp. 745-761. https://doi.org/10.1007/s43390-022-00485-w

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title = "Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery",

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.",

keywords = "Best practice guideline, Expert consensus, High-risk, Intraoperative neuromonitoring, Neurological deficit, Spinal deformity",

author = "Lenke, {Lawrence G.} and Fano, {Adam N.} and Iyer, {Rajiv R.} and Hiroko Matsumoto and Sucato, {Daniel J.} and Samdani, {Amer F.} and Smith, {Justin S.} and Gupta, {Munish C.} and Kelly, {Michael P.} and Kim, {Han Jo} and Sciubba, {Daniel M.} and Cho, {Samuel K.} and Polly, {David W.} and Oheneba Boachie-Adjei and Lewis, {Stephen J.} and Angevine, {Peter D.} and Vitale, {Michael G.}",

note = "Funding Information: Dr. Lenke reports personal fees from Medtronic, non-financial support from Broadwater, grants and non-financial support from Scoliosis Research Society, grants from EOS, grants from Setting Scoliosis Straight Foundation, other from Evans Family Donation, other from Fox Family Foundation, grants and non-financial support from AOSpine, personal fees from Abryx, personal fees from EOS Technologies, personal fees from Acuity Surgical. Dr. Matsumoto reports personal fees from Pediatric Spine Study Group, grants from POSNA, grants from SRS, outside the submitted work. Dr. Samdani reports personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet, outside the submitted work. Dr. Smith reports personal fees from Stryker, personal fees from Cerapedics, personal fees from Carlsmed, personal fees from Zimmer Biomet, grants and personal fees from NuVasive, personal fees from Thieme, grants from DePuy Synthes/ISSGF, personal fees from DePuy Synthes, grants from AOSpine, outside the submitted work. Dr. Smith reports stock ownership in Alphatec and NuVasive. Dr. Gupta reports personal fees, non-financial support and other from DePuy, personal fees from Innomed, personal fees and non-financial support from Medtronic, personal fees and non-financial support from Globus, non-financial support from Scoliosis Research Society, personal fees and non-financial support from AO Spine, non-financial support from National Health Spine Foundation, other from J&J, other from P&G, personal fees from Malaysia Spine Society, personal fees from Louisiana State Univ, personal fees and non-financial support from Alphatec, non-financial support from Mizuho, non-financial support from Medicrea, outside the submitted work. Dr. Kelly reports personal fees from Deputy Editor at Spine, grants from Setting Scoliosis Straight Foundation, outside the submitted work. Dr. Kim reports grants or contracts from ISSGF (paid to institution) and SI Bone (paid to institution), royalties or licenses from Zimmer Biomet (personal fees), Stryker (personal fees), and Acuity-Surgical (personal fees). Dr. Kim reports participation as a Nuvasive advisory board member, Aspen Medical advisory board member, and Vivex Biologics advisory board member. Dr. Sciubba reports consulting fees from Depuy-Synthes (personal fees). Medtronic (personal fees), Stryker (personal fees), and Baxter (personal fees). Dr. Sciubba reports a leadership or fiduciary role in AO Spine North America. Dr. Cho reports royalties or licenses from Globus Medical (IP royalties). Dr. Cho reports consulting fees from Stryker. Dr. Cho reports a leadership or fiduciary role in AAOS, American Orthopedic Association, AO Spine North America, Cervical Spine Research Society, North American Spine Society, and Scoliosis Research Society. Dr. Cho reports stock ownership in Aldentify. Dr. Polly reports grants or contracts Medtronic (to institution), MizuhoOSI (to institution). Dr. Polly reports royalties or licenses from SI Bone (personal) and Springer (personal). Dr. Polly reports consulting fees from SI Bone (personal) and Globus (personal). Dr. Polly reports patents (planned, issued, or pending) from SI bone (personal) and Globus (personal). Dr. Polly reports participation on a Data Safety Monitoring Board or Advisory Board with SI Bone. Dr. Polly reports a leadership or fiduciary role in American Spine Registry (executive committee), Scoliosis Research Society (committees), and North American Spine Society (committees). Dr. Lewis reports consulting fees from Stryker Spine (personal), L&K Biomed (personal). Dr. Lewis reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medtronic (personal), AO Spine (personal), Scoliosis Research Society (personal). Dr. Lewis reports support for attending meetings and/or travel from AO Spine (personal), Scoliosis Research Society (personal). Dr. Lewis reports participation on a Data Safety Monitoring Board or Advisory Board with AO Spine. Dr. Lewis reports a leadership or fiduciary role in AO Spine (Research Commission, Chair Knowledge Forum Deformity). Dr. Lewis reports stock ownership in Covr Medical and Augmedics. Dr. Lewis reports Medtronic fellowship support to institution, Depuy Synthes fellowship support to institution, and Stryker Spine fellowship support to institution. Dr. Angevine reports participation on a Data Safety Monitoring Board or Advisory Board with National Institutes of Health. Dr. Vitale reports grants and personal fees from Biomet, grants and non-financial support from Children's Spine Foundation, personal fees from East Coast Orthotics and Prosthetics, other from FOX, non-financial support from IPOS, grants from OREF, grants and non-financial support from POSNA, non-financial support from Project for Safety in Spine Surgery, grants from OSRF, grants from SRS, personal fees from Stryker, non-financial support from Wellinks, outside the submitted work. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Scoliosis Research Society.",

year = "2022",

month = jul,

doi = "10.1007/s43390-022-00485-w",

language = "English (US)",

volume = "10",

pages = "745--761",

journal = "Spine Deformity",

issn = "2212-134X",

publisher = "Elsevier BV",

number = "4",

}

TY - JOUR

T1 - Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery

AU - Lenke, Lawrence G.

AU - Fano, Adam N.

AU - Iyer, Rajiv R.

AU - Matsumoto, Hiroko

AU - Sucato, Daniel J.

AU - Samdani, Amer F.

AU - Smith, Justin S.

AU - Gupta, Munish C.

AU - Kelly, Michael P.

AU - Kim, Han Jo

AU - Sciubba, Daniel M.

AU - Cho, Samuel K.

AU - Polly, David W.

AU - Boachie-Adjei, Oheneba

AU - Lewis, Stephen J.

AU - Angevine, Peter D.

AU - Vitale, Michael G.

N1 - Funding Information: Dr. Lenke reports personal fees from Medtronic, non-financial support from Broadwater, grants and non-financial support from Scoliosis Research Society, grants from EOS, grants from Setting Scoliosis Straight Foundation, other from Evans Family Donation, other from Fox Family Foundation, grants and non-financial support from AOSpine, personal fees from Abryx, personal fees from EOS Technologies, personal fees from Acuity Surgical. Dr. Matsumoto reports personal fees from Pediatric Spine Study Group, grants from POSNA, grants from SRS, outside the submitted work. Dr. Samdani reports personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet, outside the submitted work. Dr. Smith reports personal fees from Stryker, personal fees from Cerapedics, personal fees from Carlsmed, personal fees from Zimmer Biomet, grants and personal fees from NuVasive, personal fees from Thieme, grants from DePuy Synthes/ISSGF, personal fees from DePuy Synthes, grants from AOSpine, outside the submitted work. Dr. Smith reports stock ownership in Alphatec and NuVasive. Dr. Gupta reports personal fees, non-financial support and other from DePuy, personal fees from Innomed, personal fees and non-financial support from Medtronic, personal fees and non-financial support from Globus, non-financial support from Scoliosis Research Society, personal fees and non-financial support from AO Spine, non-financial support from National Health Spine Foundation, other from J&J, other from P&G, personal fees from Malaysia Spine Society, personal fees from Louisiana State Univ, personal fees and non-financial support from Alphatec, non-financial support from Mizuho, non-financial support from Medicrea, outside the submitted work. Dr. Kelly reports personal fees from Deputy Editor at Spine, grants from Setting Scoliosis Straight Foundation, outside the submitted work. Dr. Kim reports grants or contracts from ISSGF (paid to institution) and SI Bone (paid to institution), royalties or licenses from Zimmer Biomet (personal fees), Stryker (personal fees), and Acuity-Surgical (personal fees). Dr. Kim reports participation as a Nuvasive advisory board member, Aspen Medical advisory board member, and Vivex Biologics advisory board member. Dr. Sciubba reports consulting fees from Depuy-Synthes (personal fees). Medtronic (personal fees), Stryker (personal fees), and Baxter (personal fees). Dr. Sciubba reports a leadership or fiduciary role in AO Spine North America. Dr. Cho reports royalties or licenses from Globus Medical (IP royalties). Dr. Cho reports consulting fees from Stryker. Dr. Cho reports a leadership or fiduciary role in AAOS, American Orthopedic Association, AO Spine North America, Cervical Spine Research Society, North American Spine Society, and Scoliosis Research Society. Dr. Cho reports stock ownership in Aldentify. Dr. Polly reports grants or contracts Medtronic (to institution), MizuhoOSI (to institution). Dr. Polly reports royalties or licenses from SI Bone (personal) and Springer (personal). Dr. Polly reports consulting fees from SI Bone (personal) and Globus (personal). Dr. Polly reports patents (planned, issued, or pending) from SI bone (personal) and Globus (personal). Dr. Polly reports participation on a Data Safety Monitoring Board or Advisory Board with SI Bone. Dr. Polly reports a leadership or fiduciary role in American Spine Registry (executive committee), Scoliosis Research Society (committees), and North American Spine Society (committees). Dr. Lewis reports consulting fees from Stryker Spine (personal), L&K Biomed (personal). Dr. Lewis reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medtronic (personal), AO Spine (personal), Scoliosis Research Society (personal). Dr. Lewis reports support for attending meetings and/or travel from AO Spine (personal), Scoliosis Research Society (personal). Dr. Lewis reports participation on a Data Safety Monitoring Board or Advisory Board with AO Spine. Dr. Lewis reports a leadership or fiduciary role in AO Spine (Research Commission, Chair Knowledge Forum Deformity). Dr. Lewis reports stock ownership in Covr Medical and Augmedics. Dr. Lewis reports Medtronic fellowship support to institution, Depuy Synthes fellowship support to institution, and Stryker Spine fellowship support to institution. Dr. Angevine reports participation on a Data Safety Monitoring Board or Advisory Board with National Institutes of Health. Dr. Vitale reports grants and personal fees from Biomet, grants and non-financial support from Children's Spine Foundation, personal fees from East Coast Orthotics and Prosthetics, other from FOX, non-financial support from IPOS, grants from OREF, grants and non-financial support from POSNA, non-financial support from Project for Safety in Spine Surgery, grants from OSRF, grants from SRS, personal fees from Stryker, non-financial support from Wellinks, outside the submitted work. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Scoliosis Research Society.

PY - 2022/7

Y1 - 2022/7

N2 - 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.

AB - 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.

KW - Best practice guideline

KW - Expert consensus

KW - High-risk

KW - Intraoperative neuromonitoring

KW - Neurological deficit

KW - Spinal deformity

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UR - http://www.scopus.com/inward/citedby.url?scp=85126345284&partnerID=8YFLogxK

U2 - 10.1007/s43390-022-00485-w

DO - 10.1007/s43390-022-00485-w

M3 - Article

C2 - 35290626

AN - SCOPUS:85126345284

SN - 2212-134X

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SP - 745

EP - 761

JO - Spine Deformity

JF - Spine Deformity

IS - 4

ER -

Development of consensus-based best practice guidelines for response to intraoperative neuromonitoring events in high-risk spinal deformity surgery

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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