Moderators: Richard Vogel, PhD, DABNM, Adam Doan, DC, DABNM
Somatosensory evoked potentials were first introduced to spine surgery in order to identify and correct impending spinal cord dysfunction under general anesthesia, thereby reducing neurologic deficits and negating the need for routine wake-up testing. This technique paved the way for the emergence of intraoperative neurophysiological monitoring (IONM) as a basic science and clinical practice focused on reducing the incidence and/or severity of neurologic deficits following surgery. The use of IONM has spread to include both routine and complex surgical and interventional procedures throughout the body. Additionally, new techniques have emerged to permit monitoring of specific structures and functions throughout the nervous system. Despite widespread use and continued growth, the utility and value of neuromonitoring in spine surgery remain matters of debate. Spine surgeons, neurophysiologists, a neurologist and an economist will discuss evidence, cost-effectiveness, research challenges, and barriers to quality in the performance of IONM in spine surgery.
Upon completion of this session, participants should gain strategies to:
- Practice evidence- and value-based medicine relative to neuromonitoring in spine care;
- Recognize contexts where neuromonitoring may be more or less cost-effective;
- Differentiate between levels of evidence for neuromonitoring;
- Identify barriers to quality and safety in neuromonitoring.
Agenda
Point-Counterpoint: On the Utility of Neuromonitoring in Spine Surgery
Joshua E. Heller, MD and Steven M Theiss, MD
What Represents Good Study Design and Good Evidence in Neuromonitoring and Why?
Robert N. Holdefer, PhD
Cost-effectiveness Modeling and Surgical Risk in Neuromonitoring
John P. Ney, MD, MPH and David N. van der Goes, PhD
Barriers to Quality and Safety in the Performance of Neuromonitoring
Richard Vogel, PhD
Neuromonitoring and Precision Medicine: The Problem of Heterogeneity
Anthony K. Sestokas, PhD
International Speaker IONM Experience
Abdul Karim Msaddi, MD