Prevention, Diagnosis, and Management of Intraoperative Spinal Cord Injury in the Setting of Spine Surgery: A Proposed Care Pathway

Global Spine Journal, 2024 · DOI: 10.1177/21925682231217980 · Published: March 1, 2024

Simple Explanation

Intraoperative spinal cord injury (ISCI) is a complication during spine surgery. This study develops a care pathway for prevention, diagnosis, and management of ISCI. The care pathway includes initial assessment, pre-operative planning, surgical planning, intra-operative management, and post-operative management to reduce ISCI incidence. The study recommends using intraoperative neuromonitoring (IONM) in high-risk spine cases to detect changes in neural function and allow for action to be taken to reverse detected adverse changes.

Study Duration

Not specified

Participants

17,968 patients (for neuromonitoring meta-analysis)

Evidence Level

Not specified

Key Findings

1
The study established an operational definition and high-risk patient categories for ISCI, with intramedullary tumor spine surgery having a higher incidence of deficits.
2
Multimodality IONM has a high sensitivity (83.5%) and specificity (93.8%) for detecting ISCI.
3
A final recommendation was achieved through the GRADE process that intraoperative neurophysiologic monitoring be employed for “high risk” patients with 93% agreement.

Research Summary

This study presents an evidence-based comprehensive guideline and care pathway for ISCI, developed using the GRADE methodology. The care pathway includes a checklist for surgical, neurophysiological, and anesthetic management during surgery to address neuromonitoring signal changes. The guideline recommends the use of IONM in high-risk cases to facilitate early detection and management of ISCI.

Practical Implications

Improved Patient Safety

The care pathway and intraoperative checklist provide a structured approach to identify and manage reversible elements of ISCI, potentially reducing the incidence and improving outcomes.

Standardized Management

The guideline offers a consensus-based approach for managing ISCI, which can be implemented across multiple sites and evaluated prospectively to improve future versions.

Resource Allocation

The recommendation for IONM in high-risk cases helps prioritize resource allocation in institutions with limited availability, ensuring that patients with the greatest risk receive appropriate monitoring.

Study Limitations

1
The overall quality of evidence for risk factors for ISCI was assessed as low or very low for most factors across surgical conditions.
2
Resource limitations in certain institutions and regions may impact the ability to implement IONM.
3
The effectiveness of the care pathway needs to be prospectively evaluated in multi-center studies to obtain user feedback and improve future versions.

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