Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul;10(4):733-744.
doi: 10.1007/s43390-022-00482-z. Epub 2022 Feb 23.

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

Affiliations

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

Rajiv R Iyer et al. Spine Deform. 2022 Jul.

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.

Keywords: Expert consensus; High-risk; Intraoperative neuromonitoring; Neurological deficit; Prevention; Spinal deformity.

PubMed Disclaimer

References

    1. Lenke LG, Fehlings MG, Shaffrey CI et al (2016) Neurologic outcomes of complex adult spinal deformity surgery. Spine 41:204–212. https://doi.org/10.1097/BRS.0000000000001338 - DOI - PubMed
    1. Kelly MP, Lenke LG, Godzik J et al (2017) Retrospective analysis underestimates neurological deficits in complex spinal deformity surgery: a Scoli-RISK-1 study. J Neurosurg Spine 27:68–73. https://doi.org/10.3171/2016.12.SPINE161068 - DOI - PubMed
    1. Kato S, Fehlings MG, Lewis SJ et al (2018) An analysis of the incidence and outcomes of major versus minor neurological decline after complex adult spinal deformity surgery: a subanalysis of Scoli-RISK-1 study. Spine 43:905–912. https://doi.org/10.1097/BRS.0000000000002486 - DOI - PubMed
    1. Fehlings MG, Kato S, Lenke LG et al (2018) Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. Spine J 18:1733–1740. https://doi.org/10.1016/j.spinee.2018.02.001 - DOI - PubMed
    1. Coe JD, Smith JS, Berven S et al (2010) Complications of spinal fusion for scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine 35:99–103. https://doi.org/10.1097/BRS.0b013e3181c47f0f - DOI - PubMed

LinkOut - more resources