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

  • Consensus Review
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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.

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Funding

No funding was received to conduct this study.

Author information

Authors and Affiliations

  1. Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA

    Rajiv R. Iyer, Michael G. Vitale, Adam N. Fano & Hiroko Matsumoto

  2. Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA

    Michael G. Vitale

  3. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

    Hiroko Matsumoto

  4. Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Daniel J. Sucato

  5. Shriners Hospitals for Children, Philadelphia, PA, USA

    Amer F. Samdani

  6. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA

    Justin S. Smith

  7. Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Munish C. Gupta & Michael P. Kelly

  8. Hospital for Special Surgery, New York, NY, USA

    Han Jo Kim

  9. Department of Neurosurgery, Long Island Jewish Medical Center, North Shore University Hospital of Northwell Health, New York, NY, USA

    Daniel M. Sciubba

  10. Department of Orthopedic Surgery, Mount Sinai Medical Center, New York, NY, USA

    Samuel K. Cho

  11. Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA

    David W. Polly

  12. FOCOS Orthopedic Hospital, Patang, Accra, Ghana

    Oheneba Boachie-Adjei

  13. The Daniel and Jane Och Spine Hospital at New York-Presbyterian/Allen, New York, NY, USA

    Peter D. Angevine & Lawrence G. Lenke

  14. Division of Spinal Surgery, Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA

    Peter D. Angevine

  15. Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada

    Stephen J. Lewis

  16. Division of Spinal Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA

    Lawrence G. Lenke

Authors
  1. Rajiv R. Iyer
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  2. Michael G. Vitale
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  3. Adam N. Fano
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  4. Hiroko Matsumoto
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  5. Daniel J. Sucato
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  6. Amer F. Samdani
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  7. Justin S. Smith
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  8. Munish C. Gupta
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  9. Michael P. Kelly
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  10. Han Jo Kim
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  11. Daniel M. Sciubba
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  12. Samuel K. Cho
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  14. Oheneba Boachie-Adjei
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  15. Peter D. Angevine
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Contributions

RRI, MGV, ANF, HM, DJS, AFS, JSS, MCG, MPK, HJK, DMS, SKC, DWP, OB-A, PDA, SJL, LGL: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Hiroko Matsumoto.

Ethics declarations

Conflict of interest

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.

Ethical approval

This study was approved by the Columbia University Institutional Review Board (Protocol AAAT4317) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Iyer, R.R., Vitale, M.G., Fano, A.N. et al. Establishing consensus: determinants of high-risk and preventative strategies for neurological events in complex spinal deformity surgery. Spine Deform 10, 733–744 (2022). https://doi.org/10.1007/s43390-022-00482-z

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