A Clinical Practice Guideline for Prevention, Diagnosis and Management of Intraoperative Spinal Cord Injury: Recommendations for Use of Intraoperative Neuromonitoring and for the Use of Preoperative and Intraoperative Protocols for Patients Undergoing Spine Surgery

This study developed guidelines for using intraoperative neuromonitoring (IONM) to detect spinal cord injuries during spine surgery. It identifies patients at higher risk and suggests protocols for prevention, diagnosis, and management. The guidelines recommend using IONM for high-risk patients undergoing spine surgery. They also suggest proactively identifying high-risk patients, having multi-disciplinary team discussions, and implementing an intraoperative protocol including IONM. The goal is to standardize the use of neuromonitoring and encourage surgeons to use it in an evidence-based manner to improve patient care and reduce the risk of complications.

• 1
  Intraoperative neurophysiologic monitoring is recommended for high-risk patients undergoing spine surgery, based on a review of 164 studies.
• 2
  The sensitivity of MEP was found to be 90% (95% CI 86.1-92.9, Heterogeneity: I2 = 32%, τ2 = 1.91, P < .01), while the specificity was found to be 95.6%.
• 3
  The GDG agreed that the following sub-entities of spinal pathologies are deemed high risk for the occurrence of an ISCI: (i) Rigid thoracic curve with high DAR; (ii) Revision surgery for congenital deformity with significant cord compression and myelopathy; (iii) extrinsic lesions with cord compression and myelopathy