PDF(Pubmed)
Abstract：
METHODS: Scoping Review.
OBJECTIVE: To review the literature and summarize information on checklists and algorithms for responding to intraoperative neuromonitoring (IONM) alerts and management of intraoperative spinal cord injuries (ISCIs).
METHODS: MEDLINE® was searched from inception through January 26, 2022 as were sources of grey literature. We attempted to obtain guidelines and/or consensus statements from the following sources: American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), American Academy of Neurology (AAN), American Clinical Neurophysiology Society, NASS (North American Spine Society), and other spine surgery organizations.
RESULTS: Of 16 studies reporting on management strategies for ISCIs, two were publications of consensus meetings which were conducted according to the Delphi method and eight were retrospective cohort studies. The remaining six studies were narrative reviews that proposed intraoperative checklists and management strategies for IONM alerts. Of note, 56% of included studies focused only on patients undergoing spinal deformity surgery. Intraoperative considerations and measures taken in the event of an ISCI are divided and reported in three categories of i) Anesthesiologic, ii) Neurophysiological/Technical, and iii) Surgical management strategies.
CONCLUSIONS: There is a paucity of literature on comparative effectiveness and harms of management strategies in response to an IONM alert and possible ISCI. There is a pressing need to develop a standardized checklist and care pathway to avoid and minimize the risk of postoperative neurologic sequelae.
OBJECTIVE: To review the literature and summarize information on checklists and algorithms for responding to intraoperative neuromonitoring (IONM) alerts and management of intraoperative spinal cord injuries (ISCIs).
METHODS: MEDLINE® was searched from inception through January 26, 2022 as were sources of grey literature. We attempted to obtain guidelines and/or consensus statements from the following sources: American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), American Academy of Neurology (AAN), American Clinical Neurophysiology Society, NASS (North American Spine Society), and other spine surgery organizations.
RESULTS: Of 16 studies reporting on management strategies for ISCIs, two were publications of consensus meetings which were conducted according to the Delphi method and eight were retrospective cohort studies. The remaining six studies were narrative reviews that proposed intraoperative checklists and management strategies for IONM alerts. Of note, 56% of included studies focused only on patients undergoing spinal deformity surgery. Intraoperative considerations and measures taken in the event of an ISCI are divided and reported in three categories of i) Anesthesiologic, ii) Neurophysiological/Technical, and iii) Surgical management strategies.
CONCLUSIONS: There is a paucity of literature on comparative effectiveness and harms of management strategies in response to an IONM alert and possible ISCI. There is a pressing need to develop a standardized checklist and care pathway to avoid and minimize the risk of postoperative neurologic sequelae.
摘要：
方法：范围审查。
目的：回顾文献并总结关于术中神经监测（IONM）警报和术中脊髓损伤（ISCI）管理的检查表和算法的信息。
方法：从开始到2022年1月26日搜索MEDLINE®，以及灰色文献的来源。我们试图从以下来源获得指南和/或共识声明：美国神经肌肉和电诊断医学协会（AANEM），美国神经病学会（AAN），美国临床神经生理学会，NASS（北美脊柱协会），和其他脊柱外科组织。
结果：在报告ISCI管理策略的16项研究中，两个是根据Delphi方法进行的共识会议的出版物,八个是回顾性队列研究.其余六项研究是叙述性综述，提出了术中检查清单和IONM警报的管理策略。值得注意的是，56％的纳入研究仅关注接受脊柱畸形手术的患者。术中考虑因素和在ISCI事件中采取的措施分为三类：i）麻醉学，ii)神经生理学/技术，和iii)手术管理策略。
结论：关于针对IONM警报和可能的ISCI的管理策略的比较有效性和危害的文献很少。迫切需要开发标准化的检查表和护理途径，以避免和最大程度地减少术后神经系统后遗症的风险。
目的：回顾文献并总结关于术中神经监测（IONM）警报和术中脊髓损伤（ISCI）管理的检查表和算法的信息。
方法：从开始到2022年1月26日搜索MEDLINE®，以及灰色文献的来源。我们试图从以下来源获得指南和/或共识声明：美国神经肌肉和电诊断医学协会（AANEM），美国神经病学会（AAN），美国临床神经生理学会，NASS（北美脊柱协会），和其他脊柱外科组织。
结果：在报告ISCI管理策略的16项研究中，两个是根据Delphi方法进行的共识会议的出版物,八个是回顾性队列研究.其余六项研究是叙述性综述，提出了术中检查清单和IONM警报的管理策略。值得注意的是，56％的纳入研究仅关注接受脊柱畸形手术的患者。术中考虑因素和在ISCI事件中采取的措施分为三类：i）麻醉学，ii)神经生理学/技术，和iii)手术管理策略。
结论：关于针对IONM警报和可能的ISCI的管理策略的比较有效性和危害的文献很少。迫切需要开发标准化的检查表和护理途径，以避免和最大程度地减少术后神经系统后遗症的风险。
