Establishing consensus: determinants of high-risk and preventative strategies for neurological events in complex spinal deformity surgery

Rajiv R. Iyer, Michael G. Vitale, Adam N. Fano, 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, Peter D. Angevine, Stephen J. Lewis, Lawrence G. Lenke

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

PURPOSE: To establish expert consensus on various parameters that constitute elevated risk during spinal deformity surgery and potential preventative strategies that may minimize the risk of intraoperative neuromonitoring (IONM) events and postoperative neurological deficits.

METHODS: Through a series of surveys and a final virtual consensus meeting, the Delphi method was utilized to establish consensus among a group of expert spinal deformity surgeons. During iterative rounds of voting, participants were asked to express their agreement (strongly agree, agree, disagree, strongly disagree) to include items in a final set of guidelines. Consensus was defined as ≥ 80% agreement among participants. Near-consensus was ≥ 60% but < 80% agreement, equipoise was ≥ 20% but < 60%, and consensus to exclude was < 20%.

RESULTS: Fifteen of the 15 (100%) invited expert spinal deformity surgeons agreed to participate. There was consensus to include 22 determinants of high-risk (8 patient factors, 8 curve and spinal cord factors, and 6 surgical factors) and 21 preventative strategies (4 preoperative, 14 intraoperative, and 3 postoperative) in the final set of best practice guidelines.

CONCLUSION: A resource highlighting several salient clinical factors found in high-risk spinal deformity patients as well as strategies to prevent neurological events was successfully created through expert consensus. This is intended to serve as a reference for surgeons and other clinicians involved in the care of spinal deformity patients.

LEVEL OF EVIDENCE: Level V.

Original languageEnglish (US)
Pages (from-to)733-744
Number of pages12
JournalSpine Deformity
Volume10
Issue number4
DOIs
StatePublished - Jul 2022

Bibliographical note

Funding Information:
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. 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. Angevine reports participation on a Data Safety Monitoring Board or Advisory Board with National Institutes of Health. 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. 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.

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

Keywords

  • Expert consensus
  • High-risk
  • Intraoperative neuromonitoring
  • Neurological deficit
  • Prevention
  • Spinal deformity

PubMed: MeSH publication types

  • Journal Article

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