The NASS Podcast

Section on IONM: How to Optimize Neuromonitoring Episode 2

An episode of The NASS Podcast

By North American Spine Society
NASS podcasts are a great way to consume education content on-the-go!

Podcasts offer in-depth discussions of many topics, including: 3D Printing; ACDF vs. Cervical Disc Replacement; Complications; Laminoplasty vs. ACDF; Neuromonitoring During Spine Surgery; Cellular-Based Allografts; Is Surgery for Axial Back Pain Still an Option?; Surgical Management of Degenerative Spondylolisthesis; SpineLine Author Discussions
More places to listen

More places to listen

Section on IONM: How to Optimize Neuromonitoring Episode 6
[6 of 12] Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, “How can you use neuromonitoring to guide and optimize positioning for spine surgery?” The patient is finally in position and neuromonitoring can’t get baselines. What do you do? If you elect to intervene, it’s a long process to retest baselines in a neutral position. Then, you have to reposition all over again. Here the Co-Chairs present a fast, efficient, systematic way to position a patient for any spine surgery to ensure the spinal cord is stable, and all peripheral nerves and plexi are not compressed or stretched. Also, they talk about positioning possibilities for all patients; not just those with unstable spines
08:39
August 13, 2019
Ask The Experts: Endoscopic Spine Surgery and its Future
Featuring: Peter Witt, MD, Michael Y. Wang, MD
08:49
August 6, 2019
Ask The Experts: Cervical Disc Arthroplasty - Surgeon Reluctance To Adopt The Technology
Featuring: Mark M. Mikhael, MD, Christopher F. Wolf, MD, Nick Shamie, MD, Lisa A. Ferrara, PhD
10:40
July 23, 2019
Ask The Experts: Treatment Options for L4-5 Mobile Degenerative Lumbar Spondylolisthesis: Open or MI
Featuring: Nathaniel P. Brooks, MD, Khoi D. Than, MD, Michael P. Steinmetz, MD
13:40
July 9, 2019
Ask The Experts: Avoiding Unnecessary Lumbar Surgery While Improving Surgical Outcomes
Featuring: Ronald G. Donelson, MD, MS, Ryan A. Tauzell, PT, MA, MDT, F. Todd Wetzel, MD
08:08
June 25, 2019
Spotlight on SpineLine: A Biopsychosocial Approach in the Management of Chronic Low Back Pain
Moderator Chad Patton, MD, interviews SpineLine authors Sarah C. Rispinto, PhD and Kush Goyal, MD, to discuss their article, “A Biopsychosocial Approach in the Management of Chronic Low Back Pain in a Large Hospital System: Program Feasibility and Initial Outcomes.”  The article first appeared in the July/August 2018 edition of SpineLine.  A link to the original article can be found here. 
31:11
June 18, 2019
Ask The Experts: Spinal Diagnostics: The Benefit of Identifying Patterns of Pain Response
Featuring: Ronald G. Donelson, MD, MS, Ryan Tauzell, PT, MA, MDT, F. Todd Wetzel, MD
08:21
June 11, 2019
Section on IONM: How to Optimize Neuromonitoring Episode 5
[5 of 12] Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, “Does use of IONM necessarily add time to your surgery?”  The short answer is yes, but a closer look will show that it is negligible if the IONM team can work efficiently and in collaboration with the rest of the patient care team in the operating room. We’ll discuss how setup can be optimized, and how baselines can be acquired in as little as 30 seconds. We’ll also show how improved communication can reduce false positives and keep the surgery moving smoothly. 
06:50
June 4, 2019
Ask The Experts: Definitive Radiation for Oligo Metastatic Disease
Featuring: Joseph H. Schwab, MD, Ilya Laufer, MD, Daniel M. Sciubba, MD
07:57
May 28, 2019
Ask The Experts: Trends in Decision Making for Biologics
Featuring: Joseph S. Butler, PhD, FRCS, Gregory D. Schroeder, MD
09:49
May 14, 2019
Section on IONM: How to Optimize Neuromonitoring Episode 4
[4 of 12] Hear Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, "What are the anesthetic recommendations for neuromonitoring in various spine surgeries and why?”  The Co-Chairs discuss when and why they recommend total intravenous anesthesia (TIVA) vs 0.5 MAC. Is Ketamine really beneficial to MEPs? Why is Precedex contraindicated for MEPs? What train-of-four ratio is recommended for monitoring, when and why? They’ll answer all these questions and more.
09:37
May 7, 2019
Ask The Experts: Separation Surgery Along with Stereotactic Radio Surgery for Metastatic Disease
Featuring: Joseph H. Schwab, MD, Ilya Laufer, MD, Daniel M. Sciubba, MD 
05:28
April 30, 2019
Ask The Experts: Ideal Treatment For a Symptomatic Grade I/II L4-5 Spondylolisthesis
Featuring: Paul R. Gause, MD, Sandeep N. Gidvani, MD 
08:58
April 16, 2019
Section on IONM: How to Optimize Neuromonitoring Episode 3
[3 of 12] Hear Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, “Why does IONM need access to my patients and their charts before and after surgery?”  It’s not uncommon for hospitals/surgeons to prohibit the IONM team from interfacing with the patient before surgery. In addition to needing informed consent, the team needs to assess the patient’s neuro status and history to interpret the IONM data. Imaging/charts help to develop an appropriate IONM plan. Facesheets are essential to reimbursement. When the IONM team is unable to access patient records, they are monitoring in the dark (and for free).
08:52
April 4, 2019
Ask The Experts: Minimally Invasive Spine Deformity Surgery
Featuring: Michael Y. Wang, MD, Michael P. Steinmetz, MD 
08:33
April 2, 2019
Ask The Experts: How Does Psychologically Informed Practice Influence Outcome?
Featuring: Gregory L. Whitcomb, DC, F. Todd Wetzel, MD 
08:48
March 19, 2019
Spotlight on SpineLine: Drowning in Denials: The Insurance Denial & Appeal Process
Diana Wiseman, MD (Public Affairs Committee Member) and Donna Lahey, RNFA, CNOR (Author) discuss the Socioeconomics & Politics article, "Drowning in Denials: The Insurance Denial & Appeal Process," which was published in the May/June 2018 issue of NASS' SpineLine magazine. Read the article here: https://www.spineline-digital.org/spineline/may_june_2018/MobilePagedArticle.action?articleId=1404531#articleId1404531
40:30
March 15, 2019
Section on IONM: How to Optimize Neuromonitoring Episode 2
[2 of 12] Hear from Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, "Neuromonitoring in spine surgery, can't anyone cover the case?" Did you know IONM is learned through on-the-job training, licensure does not exist, and certifications are not required for the technologist in your OR? After initial training, technologists can monitor very basic cases (e.g., PLIF), but they should spend years in training to learn more complex procedures (deformity, tumors). If a surgery isn’t booked accurately, the surgeon might get a very junior person assigned to a very complex case. Here we inform the listener of common practices around determining “competency” for performing IONM in spine surgery. 
07:54
March 6, 2019
Ask The Experts: What Are The Real Criteria for a Neuromonitoring Alert In Spine Surgery?
Featuring: Richard Vogel, PhD, DABNM, Adam Doan, DC, DABNM, Anthony K. Sestokas, PhD, DABNM 
11:33
March 5, 2019
Ask The Experts: Benefits of an Interdisciplinary Spine Practice
Featuring: Eeric Truumees, MD, E. Kano Mayer, MD, John Stokes, MD, Enrique B. Pena, MD 
11:25
February 19, 2019
Ask The Experts: Spine Surgery In The Elderly
Featuring: Jack Jallo, MD, PhD, FACS, Srinivas K. Prasad, MD, Joshua E. Heller, MD, MBA 
09:20
February 5, 2019
Lumbar Spine Fusion: The Patient's Perspective
Dr. Vivek Mohan discusses Lumbar Spine Fusion with one of his former patients.
23:24
February 4, 2019
Ask The Experts: Epidural Abscess
Featuring: Christopher M. Bono, MD, F. Todd Wetzel, MD, William C. Watters, MD, MS
07:23
January 22, 2019
Section on IONM: How to Optimize Neuromonitoring Episode 1
[1 of 12] Hear Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, “What information is critical to communicate to the IONM team and how far in advance of surgery?” It’s not uncommon for the IONM team to learn the details of the surgical procedure after incision, as it unfolds. This poses a number of problems. The IONM team needs to know detailed surgical plan, diagnosis and patient insurance information at least 48-hours in advance for non-emergent surgery. This will make IONM less likely to fail because the IONM team can make sure the correct equipment/electrodes/people are in the room, and the correct tests are being run with optimized anesthesia. This will also limit common issues with insurance. 
05:01
January 15, 2019
How to Manage Acute Pain for Patients
Dr. Zaman, Chair of the Patient Education Committee, discusses acute back pain.
11:24
December 13, 2018
Degenerative Disc Disease for Patients
Dr. Zaman, Chair of the Patient Education Committee, discusses causes and treatments for degenerative disc disease.
13:34
October 8, 2018
Spotlight on SpineLine: Physician and Hospital Reputation Management
Douglas Pahl, MD (Public Affairs Committee Chair), William Sullivan, MD (SpineLine Medical Editor) and Andrew Pugely, MD (Author) discuss the Value in Spine Care article, "Physician and Hospital Reputation Management: How to Navigate the Quagmire of Public Quality Rankings, Patient Satisfaction and Online Review," which was published in the March/April 2018 issue of NASS' SpineLine magazine.
56:22
September 17, 2018
Spotlight on SpineLine: Invited Review- "Risk Stratification and the Future of Spine Surgery"
Chad Patton, MD (Public Affairs Committee Chair), William Sullivan, MD (SpineLine Medical Editor) and Emily Miller, MD (Review Author) discuss the Invited Review article on "Risk Stratification and the Future of Spine Surgery," which was published in the January/February 2018 issue of NASS' SpineLine magazine.
36:30
September 10, 2018
Women's Issues in Spine Care
Saralyn Mark, MD (iGIANT, Yale University, Georgetown University), Kimberly J. Templeton, MD (University of Kansas) and Gregory Whitcomb, DC (Medical College of Wisconsin) discuss women’s issues in spine care.
09:02
September 10, 2018
Will We Still Be Doing PSO's (Pedicle Subtraction Osteotomy) in 10 Years?
Sigurd Berven, MD (University of California San Francisco) and Michael Y. Wang, MD, FACS (The University of Miami) discuss the practice of and future of pedicle subtraction osteotomies.
11:52
September 10, 2018
Surgical Management of Degenerative Spondylolisthesis
Daniel Resnick, MS, MD (Madison, WI), Eeric Truumees, MD (Austin, TX), Zoher Ghogawala, MD (Boston, MA) and Jeffrey Wang, MD (Los Angeles, CA) discuss the trends in treatment of degenerative spondylolisthesis.
10:52
September 10, 2018
Quality of Life Surgery in Metastatic Disease of the Spine
Chris Steyn, MD (McMaster University) and Christina Goldstein MD, FRCSC (University of Missouri) discuss quality of life for patients with metastatic disease of the spine.
10:50
September 10, 2018
Proximal Junctional Kyphosis
Sigurd Berven, MD (University of California San Francisco) and Michael Y. Wang, MD, FACS (The University of Miami) review proximal junctional kyphosis.
08:52
September 10, 2018
Physical Therapy: Pre- or Post-Planned Spine Surgery
Thomas E. Dreisinger, PhD, FACSM, Ezequiel D. Gherscovici, PT and Evan K. Johnson, PT, DPT, OCS discuss physical therapy before and after spine surgery.
10:00
September 10, 2018
Management and Complications of Spine Instrumentation in Patients with Osteoporosis
A. Jay Khanna, MD (Johns Hopkins University) and Charles A. Reitman, MD (The Medical University of South Carolina Charleston) discuss management and complication of spine instrumentations in the treatment of osteoporosis.
11:56
September 10, 2018
Is Surgery for Axial Back Pain Still an Option?
Scott L. Blumenthal, MD (Texas Back Institute), Rolando Garcia Jr., MD, MPH (Miami, FL) and Gregory D. Schroeder, MD (The Rothman Institute) answer the question of whether surgery is an option for axial back pain.
12:37
September 10, 2018
The Impact of Gender-Sex on Innovation and Novel Technologies
Saralyn Mark, MD (iGIANT, Yale University, Georgetown University) and Gregory Whitcomb, DC (Medical College of Wisconsin) discuss the impact of gender on new technology in spine care.
05:37
September 10, 2018
Cervical Myelopathy Anterior vs. Posterior
Scott L. Blumenthal, MD, Rolando Garcia Jr., MD, MPH and Gregory D. Schroeder, MD debate anterior versus posterior cervical myelopathy.
10:00
September 10, 2018
Cellular-Based Allografts
Brandon Lawrence, MD (University of Utah) and Harvey E. Smith, MD (University of Pennsylvania Department of Orthopaedic Surgery) discuss cellular-based allografts.
06:16
September 10, 2018
Biomaterials of Structural Cages
Zorica Buser, PhD (University of Southern California), Christina Goldstein MD, FRCSC (University of Missouri) Wellington K. Hsu, MD (Northwestern Memorial Hospital) discuss biomaterials of structural cages.
09:35
September 10, 2018
Who Is the Ideal Patient for SI Fusion? Who Is Not?
Matthew Smuck, MD (Stanford University) and Joshua E. Heller, MD (Thomas Jefferson University) discuss patient selection for sacroiliac dysfunction.
11:39
September 10, 2018
What is the Best Operation for My Patient with Cervical Myelopathy?
Zoher Ghogawala, MD, FACS (Lahey Clinic and Tufts University School of Medicine) and Srinivas K. Prasad, MD (Thomas Jefferson University) address decision making process regarding cervical myelopathy.
11:29
September 10, 2018
Laminoplasty vs. ACDF
Jeffrey C. Wang, MD (University of Southern California Spine Center), Raymond J. Hah, MD (Keck School of Medicine at University of Southern California), John C. France, MD (West Virginia University) and Sheeraz A. Qureshi, MD, MBA (Mount Sinai School of Medicine) discuss laminoplasty vs. anterior cervical fusion.
10:10
September 10, 2018
Is Surgery Indicated for a Type II Odontoid Fracture?
Alexander R. Vaccaro, MD, PhD (Thomas Jefferson University), Rick C. Sasso, MD (Indiana Spine Group and Indiana University School of Medicine), Carlo Bellabarba, MD (University of Washington and Harborview Medical Center) and Christopher K. Kepler, MD, MBA (Thomas Jefferson University) discuss type II odontoid fractures.
10:35
September 10, 2018
How to Handle Degenerative Scoliosis
Charles A. Reitman, MD (Medical University of South Carolina Department of Orthopaedics), Michael Y. Wang, MD (University of Miami Hospital) and Michael D. Daubs, MD (University of Nevada Las Vegas School of Medicine) discuss degenerative scoliosis.
12:49
September 10, 2018
Complications
Norman B. Chutkan, MD, FACS (University of Arizona College of Medicine and The CORE Institute), Michael J. Vives, MD (Rutgers University, New Jersey Medical School) and F. Todd Wetzel, MD (Temple University School of Medicine) address complications.
10:43
September 10, 2018
3D Printing
Alan Dang, MD (University of California San Francisco) and Wellington K. Hsu, MD (Northwestern University Feinberg School of Medicine) address 3D printing.
08:21
September 10, 2018
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