Intraoperative neuromonitoring in destabilized spine: development of an intraoperative checklist to optimize response. A Delphi consensus report

Purpose: Neurological complications are among the most frightening risks in spine surgery. Intraoperative neuromonitoring (IONM) aims to quickly detect changes in the patient’s neurology, allowing for actions that can reverse neurological deficits before they become irreversible. A checklist was proposed in 2014 in response to changes in neuromonitoring for correcting deformities in spine surgery; however, it was designed specifically for procedures on stable spines, which are different from oncological and degenerative spine surgery. The goal of this project is to provide a checklist for oncological and degenerative spine surgery to improve the quality of surgical treatment and patient’s safety. Methods: To revise and implement the existing checklist a study group of 27 people was created, including: 8 surgeons from five hospitals, 7 anesthetists, 7 IONM operators and 5 operating room nurses. To achieve consensus the Delphi method was used with 2 surveys and 3 consensus rounds, which occurred from February 2022 to February 2023, when the new checklist was approved. Results: Initial survey and Round I: 22 items of the existing checklist considered appropriate. Thirty new items proposed, focusing particularly on unstable spine procedures. Second survey and Round II: 28 items considered suitable; 24 items deemed as unnecessary. Round III and final survey: discussion about the participants’ experience with the new checklist. One item was added: “Evaluate D-Wave response (if applicable)” and the final version of the checklist was approved. Conclusion: A new checklist based on IONM changes during oncological and degenerative spine surgery was created. Its implementation can potentially improve surgical results and patient’s safety in spine surgery.