Section on IONM: How to Optimize Neuromonitoring Episode 1
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
[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
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.
[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.
[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.
[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).
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
[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.
[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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.