Skip to main content

Establishing consensus: determinants of high-risk and preventative strategies for neurological events in complex spinal deformity surgery

Abstract

Purpose

To establish expert consensus on various parameters that constitute elevated risk during spinal deformity surgery and potential preventative strategies that may minimize the risk of intraoperative neuromonitoring (IONM) events and postoperative neurological deficits.

Methods

Through a series of surveys and a final virtual consensus meeting, the Delphi method was utilized to establish consensus among a group of expert spinal deformity surgeons. During iterative rounds of voting, participants were asked to express their agreement (strongly agree, agree, disagree, strongly disagree) to include items in a final set of guidelines. Consensus was defined as ≥ 80% agreement among participants. Near-consensus was ≥ 60% but < 80% agreement, equipoise was ≥ 20% but < 60%, and consensus to exclude was < 20%.

Results

Fifteen of the 15 (100%) invited expert spinal deformity surgeons agreed to participate. There was consensus to include 22 determinants of high-risk (8 patient factors, 8 curve and spinal cord factors, and 6 surgical factors) and 21 preventative strategies (4 preoperative, 14 intraoperative, and 3 postoperative) in the final set of best practice guidelines.

Conclusion

A resource highlighting several salient clinical factors found in high-risk spinal deformity patients as well as strategies to prevent neurological events was successfully created through expert consensus. This is intended to serve as a reference for surgeons and other clinicians involved in the care of spinal deformity patients.

Level of evidence

Level V.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Lenke LG, Fehlings MG, Shaffrey CI et al (2016) Neurologic outcomes of complex adult spinal deformity surgery. Spine 41:204–212. https://doi.org/10.1097/BRS.0000000000001338

    Article  PubMed  Google Scholar 

  2. Kelly MP, Lenke LG, Godzik J et al (2017) Retrospective analysis underestimates neurological deficits in complex spinal deformity surgery: a Scoli-RISK-1 study. J Neurosurg Spine 27:68–73. https://doi.org/10.3171/2016.12.SPINE161068

    Article  PubMed  Google Scholar 

  3. Kato S, Fehlings MG, Lewis SJ et al (2018) An analysis of the incidence and outcomes of major versus minor neurological decline after complex adult spinal deformity surgery: a subanalysis of Scoli-RISK-1 study. Spine 43:905–912. https://doi.org/10.1097/BRS.0000000000002486

    Article  PubMed  Google Scholar 

  4. Fehlings MG, Kato S, Lenke LG et al (2018) Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. Spine J 18:1733–1740. https://doi.org/10.1016/j.spinee.2018.02.001

    Article  PubMed  Google Scholar 

  5. Coe JD, Smith JS, Berven S et al (2010) Complications of spinal fusion for scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine 35:99–103. https://doi.org/10.1097/BRS.0b013e3181c47f0f

    Article  PubMed  Google Scholar 

  6. Reames DL, Smith JS, Fu K-MG et al (2011) Complications in the surgical treatment of 19,360 cases of pediatric scoliosis. Spine 36:1484–1491. https://doi.org/10.1097/BRS.0b013e3181f3a326

    Article  PubMed  Google Scholar 

  7. Bridwell KH, Lenke LG, Baldus C et al (1998) Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients: Incidence and etiology at one institution. Spine 23:324–331

    CAS  Article  Google Scholar 

  8. Hamilton DK, Smith JS, Sansur CA et al (2011) Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine 36:1218–1228. https://doi.org/10.1097/BRS.0b013e3181ec5fd9

    Article  PubMed  Google Scholar 

  9. Leong JJH, Curtis M, Carter E et al (2016) Risk of neurological injuries in spinal deformity surgery. Spine 41:1022–1027. https://doi.org/10.1097/BRS.0000000000001366

    Article  PubMed  Google Scholar 

  10. Yagi M, Michikawa T, Hosogane N et al (2019) Risk, recovery, and clinical impact of neurological complications in adult spinal deformity surgery. Spine 44:1364–1370. https://doi.org/10.1097/BRS.0000000000003080

    Article  PubMed  Google Scholar 

  11. Bin WX, Lenke LG, Thuet E et al (2016) Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine 41:1447–1455. https://doi.org/10.1097/BRS.0000000000001547

    Article  Google Scholar 

  12. Sielatycki JA, Cerpa M, Baum G et al (2020) A novel MRI-based classification of spinal cord shape and CSF presence at the curve apex to assess risk of intraoperative neuromonitoring data loss with thoracic spinal deformity correction. Spine Deform 8:655–661. https://doi.org/10.1007/s43390-020-00101-9

    Article  PubMed  Google Scholar 

  13. Schwartz DM, Auerbach JD, Dormans JP et al (2007) Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Jt Surg Am 89:2440–2449. https://doi.org/10.2106/JBJS.F.01476

    Article  Google Scholar 

  14. Vitale MG, Moore DW, Matsumoto H et al (2010) Risk factors for spinal cord injury during surgery for spinal deformity. J Bone Jt Surg Am 92:64–71. https://doi.org/10.2106/JBJS.H.01839

    Article  Google Scholar 

  15. Lee BH, Hyun SJ, Han S et al (2018) Total deformity angular ratio as a risk factor for complications after posterior vertebral column resection surgery. J Korean Neurosurg Soc 61:723–730. https://doi.org/10.3340/jkns.2018.0125

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lewis NDH, Keshen SGN, Lenke LG et al (2015) The deformity angular ratio: Does it correlate with high-risk cases for potential spinal cord monitoring alerts in pediatric 3-column thoracic spinal deformity corrective surgery? Spine 40:E879–E885. https://doi.org/10.1097/BRS.0000000000000984

    Article  PubMed  Google Scholar 

  17. Suk SI, Chung ER, Kim JH et al (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine 30:1682–1687. https://doi.org/10.1097/01.brs.0000170590.21071.c1

    Article  PubMed  Google Scholar 

  18. Lenke LG, Sides BA, Koester LA et al (2010) Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468:687–699. https://doi.org/10.1007/s11999-009-1037-x

    Article  PubMed  Google Scholar 

  19. Kim SS, Cho BC, Kim JH et al (2012) Complications of posterior vertebral resection for spinal deformity. Asian Spine J 6:257–265. https://doi.org/10.4184/asj.2012.6.4.257

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kelly MP, Lenke LG, Shaffrey CI et al (2014) Evaluation of complications and neurological deficits with three column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK 1 study. Neurosurg Focus 36:E17

    Article  Google Scholar 

  21. Smith JS, Shaffrey CI, Lafage R et al (2017) Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients. Eur Spine J 26:2128–2137. https://doi.org/10.1007/s00586-017-5071-1

    Article  PubMed  Google Scholar 

  22. Devlin VJ, Schwartz DM (2007) Intraoperative neurophysiologic monitoring during spinal surgery. J Am Acad Orthop Surg 15:549–560

    Article  Google Scholar 

  23. Shilian P, Zada G, Kim AC et al (2016) Overview of intraoperative neurophysiological monitoring during spine surgery. J Clin Neurophysiol 33:333–339. https://doi.org/10.1097/WNP.0000000000000132

    Article  PubMed  Google Scholar 

  24. Feng B, Qiu G, Shen J et al (2012) Impact of multimodal intraoperative monitoring during surgery for spine deformity and potential risk factors for neurological monitoring changes. J Spinal Disord Tech 25:108–114

    Article  Google Scholar 

  25. Lewis SJ, Wong IHY, Strantzas S et al (2019) Responding to intraoperative neuromonitoring changes during pediatric coronal spinal deformity surgery. Glob Spine J 9:15S-21S. https://doi.org/10.1177/2192568219836993

    Article  Google Scholar 

  26. Jarvis JG, Strantzas S, Lipkus M et al (2013) Responding to neuromonitoring changes in 3-column posterior spinal osteotomies for rigid pediatric spinal deformities. Spine 38:E493-503. https://doi.org/10.1097/BRS.0b013e3182880378

    Article  PubMed  Google Scholar 

  27. Vitale MG, Skaggs DL, Pace GI et al (2014) Best practices in intraoperative neuromonitoring in spine deformity surgery: development of an intraoperative checklist to optimize response. Spine Deform 2:333–339. https://doi.org/10.1016/j.jspd.2014.05.003

    Article  PubMed  Google Scholar 

  28. Vitale MG, Riedel MD, Glotzbecker MP et al (2013) Building consensus: development of a best practice guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop 33:471–478. https://doi.org/10.1097/BPO.0b013e3182840de2

    Article  PubMed  Google Scholar 

  29. Vitale M, Minkara A, Matsumoto H et al (2017) building consensus: development of best practice guidelines on wrong level surgery in spinal deformity. Spine Deform 6:121–129. https://doi.org/10.1016/j.jspd.2017.08.005

    Article  PubMed  Google Scholar 

  30. Roye BD, Campbell ML, Matsumoto H et al (2019) establishing consensus on the best practice guidelines for use of halo gravity traction for pediatric spinal deformity. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000001379

    Article  PubMed  Google Scholar 

  31. Roye BD, Simhon ME, Matsumoto H et al (2020) Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis. Spine Deform 8:597–604. https://doi.org/10.1007/s43390-020-00060-1

    Article  PubMed  Google Scholar 

  32. Pelosi L, Lamb J, Grevitt M et al (2002) Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol 113:1082–1091

    Article  Google Scholar 

  33. Sutter M, Eggspuehler A, Grob D et al (2007) The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients. Eur Spine J 16:162–170. https://doi.org/10.1007/s00586-007-0418-7

    Article  PubMed Central  Google Scholar 

  34. Quraishi NA, Lewis SJ, Kelleher MO et al (2009) Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine 34:1504–1512. https://doi.org/10.1097/BRS.0b013e3181a87b66

    Article  PubMed  Google Scholar 

  35. Lewis SJ, Gray R, Holmes LM et al (2011) Neurophysiological changes in deformity correction of adolescent idiopathic scoliosis with intraoperative skull-femoral traction. Spine 36:1627–1638. https://doi.org/10.1097/BRS.0b013e318216124e

    Article  PubMed  Google Scholar 

  36. Cho SK, Lenke LG, Bolon SM et al (2015) Progressive myelopathy patients who lack spinal cord monitoring data have the highest rate of spinal cord deficits following posterior vertebral column resection surgery. Spine Deform 3:352–359

    Article  Google Scholar 

  37. Ferguson J, Hwang SW, Tataryn Z et al (2014) Neuromonitoring changes in pediatric spinal deformity surgery: a single-institution experience: clinical article. J Neurosurg Pediatr 13:247–254. https://doi.org/10.3171/2013.12.PEDS13188

    Article  PubMed  Google Scholar 

  38. Zuccaro M, Zuccaro J, Samdani AF et al (2017) Intraoperative neuromonitoring alerts in a pediatric deformity center. Neurosurg Focus 43:E8

    Article  Google Scholar 

  39. Qiu Y, Wang S, Wang B et al (2008) Incidence and risk factors of neurological deficits of surgical correction for scoliosis: analysis of 1373 cases at one Chinese institution. Spine 33:519–526. https://doi.org/10.1097/BRS.0b013e3181657d93

    Article  PubMed  Google Scholar 

  40. Samdani AF, Hwang SW, Singla A et al (2017) Outcomes of patients with syringomyelia undergoing spine deformity surgery: do large syrinxes behave differently from small? Spine J 17:1406–1411. https://doi.org/10.1016/j.spinee.2017.04.006

    Article  PubMed  Google Scholar 

  41. Wang G, Sun J, Jiang Z et al (2015) One-stage correction surgery of scoliosis associated with syringomyelia. J Spinal Disord Tech 28:E260–E264. https://doi.org/10.1097/BSD.0b013e3182821303

    Article  PubMed  Google Scholar 

  42. Ahuja K, Ifthekar S, Mittal S et al (2021) Is detethering necessary before deformity correction in congenital scoliosis associated with tethered cord syndrome: a meta-analysis of current evidence. Eur Spine J 30:599–611. https://doi.org/10.1007/s00586-020-06662-7

    Article  PubMed  Google Scholar 

  43. Shen J, Zhang J, Feng F, Wang Y, Qiu G, Li Z (2016) Corrective surgery for congenital scoliosis associated with split cord malformation: it may be safe to leave Diastematomyelia untreated in patients with intact or stable neurological status. J Bone Joint Surg Am 98(11):926–36. https://doi.org/10.2106/JBJS.15.00882 PMID:27252437

    Article  PubMed  Google Scholar 

  44. White KK, White KK, Bober MB et al (2020) Best practice guidelines for management of spinal disorders in skeletal dysplasia. Orphanet J Rare Dis 15:1–12. https://doi.org/10.1186/s13023-020-01415-7

    Article  Google Scholar 

  45. Drummond JC, Krane EJ, Tomatsu S et al (2015) Paraplegia after epidural-general anesthesia in a Morquio patient with moderate thoracic spinal stenosis. Can J Anesth 62:45–49. https://doi.org/10.1007/s12630-014-0247-1

    Article  PubMed  Google Scholar 

  46. Tong CKW, Chen JCH, Cochrane DD (2012) Spinal cord infarction remote from maximal compression in a patient with Morquio syndrome. J Neurosurg Pediatr 9:608–612. https://doi.org/10.3171/2012.2.PEDS11522

    Article  PubMed  Google Scholar 

  47. Cheh G, Lenke LG, Padberg AM et al (2008) Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: Why does it occur and what should you do? Spine 33:1093–1099. https://doi.org/10.1097/BRS.0b013e31816f5f73

    Article  PubMed  Google Scholar 

  48. Thuet ED, Padberg AM, Raynor BL et al (2005) Increased risk of postoperative neurologic deficit for spinal surgery patients with unobtainable intraoperative evoked potential data. Spine 30:2094–2103. https://doi.org/10.1097/01.brs.0000178845.61747.6a

    Article  PubMed  Google Scholar 

  49. Leung YL, Grevitt M, Henderson L et al (2005) Cord monitoring changes and segmental vessel ligation in the “at risk” cord during anterior spinal deformity surgery. Spine 30:1870–1874. https://doi.org/10.1097/01.brs.0000173902.68846.73

    Article  PubMed  Google Scholar 

  50. Tsirikos AI, Howitt SPMM (2008) Segmental vessel ligation in patients undergoing surgery for anterior spinal deformity. J Bone Jt Surg Br 90:474–479

    CAS  Article  Google Scholar 

  51. Tan T, Rutges J, Marion T et al (2020) The safety profile of intentional or iatrogenic sacrifice of the artery of Adamkiewciz and its Vicinity’s spinal segmental arteries: a systematic review. Glob Spine J 10:464–475. https://doi.org/10.1177/2192568219845652

    Article  Google Scholar 

  52. Orchowski J, Bridwell KH, Lenke LG (2005) Neurological deficit from a purely vascular etiology after unilateral vessel ligation during anterior thoracolumbar fusion of the spine. Spine 30:406–410. https://doi.org/10.1097/01.brs.0000153391.55608.72

    Article  PubMed  Google Scholar 

  53. Clark JP, Diab M (2020) Neurophysiologic detection of spinal cord ischemia during anterior vertebral tethering. Spine 45:E1703–E1706. https://doi.org/10.1097/BRS.0000000000003688

    Article  PubMed  Google Scholar 

  54. Kato S, Kawahara N, Tomita K et al (2008) Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of adamkiewicz an experimental study using a dog model. Spine 33:1533–1541. https://doi.org/10.1097/BRS.0b013e318178e5af

    Article  PubMed  Google Scholar 

  55. Li XJ, Lenke LG, Jin L et al (2020) Surgeon-specific risk stratification model for early complications after complex adult spinal deformity surgery. Spine Deform 8:97–104

    Article  Google Scholar 

  56. Smith JS, Shaffrey CI, Klineberg E et al (2017) Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: Retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up. J Neurosurg Spine 27:444–457. https://doi.org/10.3171/2016.10.SPINE16849

    Article  PubMed  Google Scholar 

  57. Lenke LG, Newton PO, Sucato DJ et al (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine 38:119–132. https://doi.org/10.1097/BRS.0b013e318269fab1

    Article  PubMed  Google Scholar 

  58. Gum JL, Lenke LG, Bumpass D et al (2016) Does planned staging for posterior-only vertebral column resections in spinal deformity surgery increase perioperative complications? Spine Deform 4:131–137

    Article  Google Scholar 

  59. Bixby EC, Skaggs K, Marciano GF et al (2021) Resection of congenital hemivertebra in pediatric scoliosis: the experience of a two-specialty surgical team. J Neurosurg Pediatr. https://doi.org/10.3171/2020.12.PEDS20783

    Article  PubMed  Google Scholar 

  60. Shrader MW, Wood W, Falk M et al (2018) The effect of two attending surgeons on the outcomes of posterior spine fusion in children with cerebral palsy. Spine Deform 6:730–735

    Article  Google Scholar 

  61. Lak AM, Abunimer AM, Goedmakers CMW et al (2021) Single-versus dual-attending surgeon approach for spine deformity: a systematic review and meta-analysis. Oper Neurosurg 20:233–241. https://doi.org/10.1093/ons/opaa393

    Article  Google Scholar 

  62. Nemani VM, Kim HJ, Bjerke-Kroll BT et al (2015) Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications, and results. Spine 40:153–161. https://doi.org/10.1097/BRS.0000000000000675

    Article  PubMed  Google Scholar 

  63. Sponseller PD, Takenaga RK, Newton P et al (2008) The use of traction in the treatment of severe spinal deformity. Spine 33:2305–2309. https://doi.org/10.1097/BRS.0b013e318184ef79

    Article  PubMed  Google Scholar 

  64. Shimizu T, Lenke LG, Cerpa M et al (2020) Preoperative halo-gravity traction for treatment of severe adult kyphosis and scoliosis. Spine Deform 8:85–95

    Article  Google Scholar 

Download references

Funding

No funding was received to conduct this study.

Author information

Authors and Affiliations

Authors

Contributions

RRI, MGV, ANF, HM, DJS, AFS, JSS, MCG, MPK, HJK, DMS, SKC, DWP, OB-A, PDA, SJL, LGL: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Hiroko Matsumoto.

Ethics declarations

Conflict of interest

Dr. Vitale reports grants and personal fees from Biomet, grants and non-financial support from Children's Spine Foundation, personal fees from East Coast Orthotics and Prosthetics, other from FOX, non-financial support from IPOS, grants from OREF, grants and non-financial support from POSNA, non-financial support from Project for Safety in Spine Surgery, grants from OSRF, grants from SRS, personal fees from Stryker, non-financial support from Wellinks, outside the submitted work. Dr. Matsumoto reports personal fees from Pediatric Spine Study Group, grants from POSNA, grants from SRS, outside the submitted work. Dr. Samdani reports personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet, outside the submitted work. Dr. Smith reports personal fees from Stryker, personal fees from Cerapedics, personal fees from Carlsmed, personal fees from Zimmer Biomet, grants and personal fees from NuVasive, personal fees from Thieme, grants from DePuy Synthes/ISSGF, personal fees from DePuy Synthes, grants from AOSpine, outside the submitted work. Dr. Smith reports stock ownership in Alphatec and NuVasive. Dr. Gupta reports personal fees, non-financial support and other from DePuy, personal fees from Innomed, personal fees and non-financial support from Medtronic, personal fees and non-financial support from Globus, non-financial support from Scoliosis Research Society, personal fees and non-financial support from AO Spine, non-financial support from National Health Spine Foundation, other from J&J, other from P&G, personal fees from Malaysia Spine Society, personal fees from Louisiana State Univ, personal fees and non-financial support from Alphatec, non-financial support from Mizuho, non-financial support from Medicrea, outside the submitted work. Dr. Kelly reports personal fees from Deputy Editor at Spine, grants from Setting Scoliosis Straight Foundation, outside the submitted work. Dr. Kim reports grants or contracts from ISSGF (paid to institution) and SI Bone (paid to institution), royalties or licenses from Zimmer Biomet (personal fees), Stryker (personal fees), and Acuity-Surgical (personal fees). Dr. Kim reports participation as a Nuvasive advisory board member, Aspen Medical advisory board member, and Vivex Biologics advisory board member. Dr. Sciubba reports consulting fees from Depuy-Synthes (personal fees). Medtronic (personal fees), Stryker (personal fees), and Baxter (personal fees). Dr. Sciubba reports a leadership or fiduciary role in AO Spine North America. Dr. Cho reports royalties or licenses from Globus Medical (IP royalties). Dr. Cho reports consulting fees from Stryker. Dr. Cho reports a leadership or fiduciary role in AAOS, American Orthopedic Association, AO Spine North America, Cervical Spine Research Society, North American Spine Society, and Scoliosis Research Society. Dr. Cho reports stock ownership in Aldentify. Dr. Polly reports grants or contracts Medtronic (to institution), MizuhoOSI (to institution). Dr. Polly reports royalties or licenses from SI Bone (personal) and Springer (personal). Dr. Polly reports consulting fees from SI Bone (personal) and Globus (personal). Dr. Polly reports patents (planned, issued, or pending) from SI bone (personal) and Globus (personal). Dr. Polly reports participation on a Data Safety Monitoring Board or Advisory Board with SI Bone. Dr. Polly reports a leadership or fiduciary role in American Spine Registry (executive committee), Scoliosis Research Society (committees), and North American Spine Society (committees). Dr. Angevine reports participation on a Data Safety Monitoring Board or Advisory Board with National Institutes of Health. Dr. Lewis reports consulting fees from Stryker Spine (personal), L&K Biomed (personal). Dr. Lewis reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medtronic (personal), AO Spine (personal), Scoliosis Research Society (personal). Dr. Lewis reports support for attending meetings and/or travel from AO Spine (personal), Scoliosis Research Society (personal). Dr. Lewis reports participation on a Data Safety Monitoring Board or Advisory Board with AO Spine. Dr. Lewis reports a leadership or fiduciary role in AO Spine (Research Commission, Chair Knowledge Forum Deformity). Dr. Lewis reports stock ownership in Covr Medical and Augmedics. Dr. Lewis reports Medtronic fellowship support to institution, Depuy Synthes fellowship support to institution, and Stryker Spine fellowship support to institution. Dr. Lenke reports personal fees from Medtronic, non-financial support from Broadwater, grants and non-financial support from Scoliosis Research Society, grants from EOS, grants from Setting Scoliosis Straight Foundation, other from Evans Family Donation, other from Fox Family Foundation, grants and non-financial support from AOSpine, personal fees from Abryx, personal fees from EOS Technologies, personal fees from Acuity Surgical.

Ethical approval

This study was approved by the Columbia University Institutional Review Board (Protocol AAAT4317) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Iyer, R.R., Vitale, M.G., Fano, A.N. et al. Establishing consensus: determinants of high-risk and preventative strategies for neurological events in complex spinal deformity surgery. Spine Deform 10, 733–744 (2022). https://doi.org/10.1007/s43390-022-00482-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-022-00482-z

Keywords

  • Spinal deformity
  • Intraoperative neuromonitoring
  • Neurological deficit
  • High-risk
  • Prevention
  • Expert consensus