Intraoperative Neurophysiological Monitoring in Spine Surgery

Daniel, Jefferson Walter; Botelho, Ricardo Vieira; Milano, Jerônimo Buzetti; Dantas, François; Onishi, Franz Jooji; Neto, Eloy Rusafa; Bertolini, Eduardo de Freitas; Borgheresi, Marcelo Antonio Duva; Joaquim, Andrei Fernandes

doi:10.1097/brs.0000000000002575

Cited by 66 publications

(41 citation statements)

References 14 publications

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“…Considering the high incidence of complications in spine surgery, during the last years several authors focused their attention on the risk factors related to the onset of complications and on predictive models of complications after spine surgery [12][13][14][15][16]. Moreover, several preventive measures have been studied and recently described in order to reduce complications in spine surgery, concerning intraoperative neuromonitoring, blood loss reduction, and infections and thrombosis prophylaxis [19][20][21][22][23]. Sethi et al [24] reported their experience concerning the application of Lean methodology in orthopedic surgery and specifically in spine surgery.…”

Section: Preventive Measures To Improve Safety: the Who Surgical Safementioning

confidence: 99%

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Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

et al. 2019

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Purpose To investigate whether the World Health Organization Safety Surgical Checklist (SSC) is an effective tool to reduce complications in spinal surgery. Methods We retrospectively evaluated the clinical and radiological charts prospectively collected from patients who underwent a spinal surgery procedure from January 2010 to December 2012. The aim of this study was to compare the incidence of complications between two periods, from January to December 2010 (without checklist) and from January 2011 and December 2012 (with checklist), in order to assess the checklist's effectiveness. Results The sample size was 917 patients with an average of 30-month follow-up. The mean age was 52.88 years. The majority of procedures were performed for oncological diseases (54.4%) and degenerative diseases (39.8%). In total, 159 complications were detected (17.3%). The overall incidence of complications for trauma, infectious pathology, oncology, and degenerative disease was 22.2%, 19.2%, 18.4%, and 15.3%, respectively. No correlation was observed between the type of pathology and the complication incidence. We observed a reduction in the overall incidence of complications following the introduction of the SSC: In 2010 without checklist, the incidence of complications was 24.2%, while in 2011 and 2012, following the checklist introduction, the incidence of complications was 16.7% and 11.7%, respectively (mean 14.2%). Conclusions The SSC seems to be an effective tool to reduce complications in spinal surgery. We propose to extend the use of checklist system also to the preoperative and postoperative phases in order to further reduce the incidence of complications.

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Section: Preventive Measures To Improve Safety: the Who Surgical Safementioning

confidence: 99%

“…In spinal surgery, many preventive measures were investigated to reduce complications [19][20][21][22][23][24], but there is no report on the effectiveness of the WHO checklist in reducing complications.…”

Section: Introductionmentioning

confidence: 99%

Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

et al. 2019

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“…The overall confidence in the results of the 28 reviews was rated as “low” in 2 SRs 9 , 10 and “critically low” in the rest 11 - 36 ( Table 3 ). Critical appraisal of each SR is found in Table S2 in the supplemental material.…”

Section: Resultsmentioning

confidence: 99%

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Dettori

Skelly

Brodt

2020

Global Spine Journal

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Study Design: A systematic cross-sectional survey of systematic reviews (SRs). Objective: To evaluate the methodological quality of spine surgery SRs published in 2018 using the updated AMSTAR 2 critical appraisal instrument. Methods: We identified the PubMed indexed journals devoted to spine surgery research in 2018. All SRs of spine surgical interventions from those journals were critically appraised for quality independently by 2 reviewers using the AMSTAR 2 instrument. We calculated the percentage of SRs achieving a positive response for each AMSTAR 2 domain item and assessed the levels of confidence in the results of each SR. Results: We identified 28 SRs from 4 journals that met our criteria for inclusion. Only 49.5% of the AMSTAR 2 domain items satisfied the AMSTAR 2 criteria. Critical domain items were satisfied less often (39.1%) compared with noncritical domain items (57.3%). Domain items most poorly reported include accounting for individual study risk of bias when interpreting results (14%), list and justification of excluded articles (18%), and an a priori establishment of methods prior to the review or registered protocol (18%). The overall confidence in the results was rated “low” in 2 SRs and “critically low” in 26. Conclusions: The credibility of a SR and its value to clinicians and policy makers are dependent on its methodological quality. This appraisal found significant methodological limitations in several critical domains, such that the confidence in the findings of these reviews is “critically low.”

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“…For intramedullary tumor resection, intraoperative electrophysiological monitoring can reduce the risk of neurological damage. [ 33 , 37 , 38 ] However, some scholars have pointed out that intraoperative monitoring may limit the scope of tumor resection. [ 39 ] The lesions may have solid and cystic components.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary cervical spinal cord teratoma

Wang

Gong

et al. 2020

Medicine

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Background: Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature on the diagnosis and treatment of ICT. Method: The presentation, imaging manifestations, diagnosis, management, surgery findings, prognosis and histology were reviewed following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. English-language studies and case reports published from inception to 2018 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, surgery findings, outcomes, and histopathology were extracted. Results: Ten articles involving 10 patients were selected. The lesions were located in the upper cervical vertebrae in 4 cases, whereas in the lower cervical vertebrae in the remaining 6 cases. In 5 cases, the lesions were located on the dorsal side of the spinal cord, and in the center of the spinal cord in the remaining 5 cases. Quadriparesis (60%), paraplegia (30%), monoplegia (10%), and neck pain (50%) were the main presentations. The lesion appeared as a intramedullary heterogeneous signal during an MRI scan, and the lesion signal would be partially enhanced after the contrast medium was applied. All patients underwent surgical intervention through a posterior approach. Neurological function improved postoperatively in all patients. Two patients with pathology confirmed to be immature teratomas experienced recurrence. Conclusion: ICTs are extremely rare entities that are mainly located in the center or dorsal part of the spinal cord which mainly manifest as quadriplegia and neck pain. MRI is a useful modality that provides diagnostic clues. Surgery from a posterior approach is the primary treatment, and the effect of adjuvant therapy remains uncertain. The prognosis is mainly related to the pathological nature of the tumor and not the method of resection.

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Intraoperative Neurophysiological Monitoring in Spine Surgery

Abstract: 2.

Cited by 66 publications

References 14 publications

Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Intramedullary cervical spinal cord teratoma

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