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  • Clinical Practice Guideline in Managing Perioperative Neurologic Deficits: Results from a Survey of the AOSpine International Community

    Final Number:
    1179

    Authors:
    Nater A(1); Murray JC(1); Martin AR(1); Nouri A(2); Tetreault L(3); Fehlings MG(1)

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: To date, there is no standardized approach to assess and manage perioperative neurologic deficits (PND) in patients undergoing spinal surgery. This survey aimed to: 1) evaluate the awareness and usage of clinical practice guidelines (CPGs) and investigate how spine surgeons (2) feel about and manage PND and (3) perceive the value of developing a CPG in the management of PND and their likelihood of using this CPG in their clinical practice.

    Methods: An invitation to participate to an online survey was sent to the AOSpine International community via email. Surgeons performing spine surgery were presented with two clinical scenarios describing PND. Results from the entire sample and differences between respondents were analyzed.

    Results: Of the 770 respondents, 85.6% reported being aware and 79.0% acknowledged using CPGs. Among 485 staff surgeons with at least 50% of their practice dedicated to spine surgery, the majority reported not feeling comfortable managing a patient who (1) who wakes up quadriplegic after an uneventful multilevel posterior cervical decompression with instrumented fusion, while 22.3% would consider an immediate return to the operating room, the others considered obtaining a MRI (67.6%) or administering steroids (40.2%); (2) had a complete loss of lower extremities somatosensory and motor evoked potentials after closing a pedicle subtraction osteotomy at T7 and 66.8% considered the release of the correction the most important intervention to maximize recovery. Among these surgeons, 90.3% believed that a CPG in the management of PND would be useful and 93.8% would be at least likely to use this CPG.

    Conclusions: The majority of respondents are aware and routinely use CPGs. Staff surgeons employ a wide range of strategies and most reported not feeling comfortable managing PND. However, they highly value the creation and are likely to use a CPG in the management of PND in their practice.

    Patient Care: To assist Spine Surgeons to the use of CPG in the management of PND.

    Learning Objectives: This survey aimed to: 1) evaluate the awareness and usage of clinical practice guidelines (CPGs) and investigate how spine surgeons (2) feel about and manage PND and (3) perceive the value of developing a CPG in the management of PND and their likelihood of using this CPG in their clinical practice.

    References:

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