At my facility we have 4 surgeons who do spines - 3 ortho, 2 who have completed a formal spine fellowship and only do spines, and one who is a general orthopedic doc who does everything--spines, totals, sports medicine, etc. The ortho docs all do instrumented and non-instrumented cases.
The one neurosurgeon does non-instrumented ACFs, microdiscectomies, and cervical & lumbar decompressions.
The spine docs used to use SSEP on lumbar instrumented cases, but no longer do- after years of doing this they did not feel that it gave them any useful information. The techs who did the monitoring were from the hospital's neurophysiology lab.
Yhe only exception to this was scoliosis cases- they continued to use SSEP on these cases. They no longer do scoli cases because they weren't doing them often enough to maintain a high level of proficiency--this hospital has no pediatricians on staff, and they very rarely got referrals for these cases. I understand most of these go to the local childrens' hospital.
The ONLY time these surgeons did a "wake-up" during surgery was during scoliosis cases, after they de-rotated the spine.
The only doc who uses a navigation system (Stealth) is the neurosurgeon, and he only uses this for crainiotomies. I don't know if he would use it for a spinal turmour or not, as I never work with him (thank God!). The Stealth is always operated by its vendor.
For lumbar and thoracic cases, for confirmation of operative level, and for instrumentation placement, the ortho docs use cross-table lateral plain X-rays.
For cervical cases, the spine surgeons use C-arm to confirm operative level, and to confirm placement of the graft and hardware. The general ortho doc uses Cross-table lateral films.
To my knowledge--AORN has no specific guidelines for spine patients, but I could be mistaken. I am not familiar with AAOS guidelines (I think this is the name of the spine surgeons professional organization.
Have you seen the December 2002 AORN issue- it had an article on ACFs . http://www.aorn.org/journal/homestudy/dec02a.pdf
Hope I answered your questions.