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Neuromonitoring at NASS

Posted By Richard W. Vogel, Monday, November 19, 2018

ASNM Members Formally Represent Neuromonitoring at NASS:

The North American Spine Society (NASS) is a global, multidisciplinary medical society that utilizes education, research and advocacy to foster the highest quality, ethical, value- and evidence-based spine care for patients. Many people think that NASS is a “spine surgeon society”, but that’s not exactly true. Members actually come from a wide variety of backgrounds, including neuromonitoring, and a common interest in “spine” is the tie that binds all NASS members.

In 2017, after 40 years of working in spine surgery, neuromonitoring had no representation within NASS. That all changed in 2018, thanks to the leadership of ASNM members Dr. Rich Vogel (President -Elect) and Dr. Adam Doan (member, Representation and Advocacy Committee). Drs. Vogel and Doan submitted an application to NASS (later approved) to form a Section on Intraoperative Neurophysiological Monitoring (IONM). A “Section” is like a Committee, but with a more specific focus. NASS’s mission to advance global spine care is accomplished, at least in part, through the collective works of its Councils, Committees and Sections.

As Co-Founders and Co-Chairs of the new Section on IONM, Drs. Vogel and Doan are now part of NASS’s leadership, representing the neuromonitoring community and helping to advance global spine care. Many of the founding members of the NASS Section on IONM are also members of the ASNM, including: Dr. Robert Holdefer, Dr. Nancy Mirarchi, Dr. John Ney (ASNM Board) and Dr. Anthony Sestokas. Other founding members include Dr. David van der Goes (health economist) and Dr. Todd Wetzel (spine surgeon and neuromonitoring advocate). This group has been very successful in their first year as a Section representing IONM in NASS.

NASS 2018 Annual Meeting:

The 33rd Annual Meeting of NASS was held Sep 24 - 29, 2018 in Los Angeles, Ca. At this meeting the Section on Intraoperative Neurophysiological Monitoring took part in the following events:

Neuromonitoring Symposium:

Drs. Vogel and Doan hosted NASS’s first symposium devoted specifically to IONM, which was planned entirely by the Section’s founding members. The Symposium was entitled, Analyzing the Utility, Evidence & Value of Neuromonitoring in Spine Surgery. Drs. Vogel and Doan served as moderators, introducing speakers and keeping the agenda running on time. Here are the lectures the we planned and the speakers we invited:

  • Point-Counterpoint: On the Utility of Neuromonitoring in Spine Surgery
    • Joshua E. Heller, MD and Steven M. Theiss, MD
  • What Represents Good Study Design and Good Evidence in Neuromonitoring and Why?
    • Robert N. Holdefer, PhD
  • Cost-Effectiveness Modeling and Surgical Risk in Neuromonitoring
    • John P. Ney, MD, MPH and David N. van der Goes, PhD
  • Barriers to Quality and Safety in the Performance of Neuromonitoring
    • Richard Vogel, PhD
  • Neuromonitoring and Precision Medicine: The Problem of Heterogeneity
    • Anthony K. Sestokas, PhD
  • International Speaker IONM Experience
    • Abdul Karim Msaddi, MD (Dubai, UAE)

At the end of the day, this Symposium was a great success. We went 45 overtime with Q&A from the audience. We’re already in the beginning stages of planning the next Symposium for the 2019 meeting.

Abstract Session:

Drs. Vogel and Doan also had the opportunity to moderate an abstract session. The topic was chosen by NASS based on research abstracts submitted to the meeting. This particular abstract session was entitled, Navigation and Intraoperative Neuromonitoring. Once again, Drs. Vogel and Doan served as moderators, introducing speakers and keeping the agenda running on time. They also had the opportunity to choose a “best abstract” and award the presenting author with a certificate.

The best abstract in this session was: 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 by Drs. Sielatycki, Makhni, Lehman and Lenke from Columbia University/NY Presbyterian.

The authors used a novel, MRI-based spinal cord risk classification scheme (Type 1, 2, or 3) to identify patients at risk of losing monitoring data during surgery. Results demonstrated patients with a spinal cord deformed against the apical concave pedicle (Type 3) had 28 times greater odds of losing monitoring data during surgery vs. Type 1 (normal cord with adequate CSF) and Type 2 (normal cord without CSF between cord and concave pedicle).

Ask the Experts:

NASS has a topical video series called As the Experts in which experts in various fields go on camera to discuss a specific topic. At this meeting, Drs. Vogel, Doan and Sestokas went on camera to tackle the question, What are the real criteria for a neuromonitoring alert in spine surgery?

Surgeons may think pedicle screw thresholds below 10 mA are an alert, or apply the old 50%/10% rule for SSEPs, or use presence/absence for MEPs, but all of examples are wrong for one reason or another. The experts stressed the importance of precision medicine, treating each patient as an individual, and considering data changes in the context of various factors. In this video, Dr. Vogel served as a moderator and posed a series of questions to Drs. Doan and Sestokas. We hope the video will ultimately be made publicly available for all to see.

Dr. W. Bryan Wilent Won a Best Paper Award:

The NASS 2018 Scientific Program Committee received an overwhelming 1,200 abstract submissions, but only the 21 highest-rated abstracts earned the coveted “Best Paper” designation. This year, two neuromonitoring abstracts were named best paper, and one was authored by ASNM Board Member and Research Committee Chair Dr. Bryan Wilent.

This Best Paper abstract was entitled: Diagnostic Accuracy And Clinical Impact Of Motor Evoked Potential (MEP) Monitoring During 4425 Posterior Extradural Lumbosacral Procedures Involving The L5 Vertebra.

Dr. Wilent’s study is the largest of many recently-published studies demonstrating the utility of MEPs in lumbar spine surgery.

Looking to 2019:

The IONM Section is already at work developing proposals for the 2019 NASS Annual Meeting, which will be held in Chicago September 25-28. You can support these endeavors by joining NASS and/or submitting your research when abstract submission open in 2019. For more information, contact Rich Vogel.

 

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Comments on this post...

Jeremy S. Wertz says...
Posted Tuesday, December 4, 2018
Congratulations on this ground-breaking initiative to represent IONM more fully in the spine world. With leadership from the ASNM, hopefully the proper utilization and appreciation of IONM will continue to grow in the coming years.
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