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The Management of Intraoperative Spinal Cord Injury - A Scoping Review
Nader Hejrati1,2, Nisaharan Srikandarajah1, Mohammed Ali Alvi3
1Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Global Spine Journal
|March 25, 2024
Summary
Limited research exists on managing intraoperative spinal cord injuries (ISCIs) and neuromonitoring alerts. Standardized checklists and care pathways are needed to prevent neurological deficits.
Area of Science:
- Neuroscience
- Spinal Surgery
- Neuromonitoring
Background:
- Intraoperative neuromonitoring (IONM) alerts and intraoperative spinal cord injuries (ISCIs) require timely and effective management.
- Current literature lacks comprehensive guidelines for responding to IONM alerts and managing ISCIs.
Purpose of the Study:
- To review and synthesize existing literature on checklists and algorithms for managing IONM alerts.
- To summarize current strategies for the management of intraoperative spinal cord injuries (ISCIs).
Main Methods:
- A scoping review of MEDLINE and grey literature was conducted.
- Searches included guidelines and consensus statements from major neurological and spine surgery organizations.
- Included studies focused on management strategies for IONM alerts and ISCIs.
Main Results:
- Sixteen studies reported on ISCI management strategies, including consensus meetings and retrospective cohort studies.
- Six narrative reviews proposed intraoperative checklists and management strategies for IONM alerts.
- Management strategies were categorized into anesthesiologic, neurophysiological/technical, and surgical approaches.
Conclusions:
- There is a significant lack of literature on the comparative effectiveness and harms of different management strategies.
- A standardized checklist and care pathway are urgently needed to mitigate the risk of postoperative neurological sequelae.
