Care plans, monitoring (MEPs, SSEPs) during spinal surgery

[stevierae]

I am trying to get a feel for what the trend is in different parts of the country for a standardized intaraoperative care plan for spinal surgery.

To my colleagues who do spinal surgery (I know there are a lot of you:: Zoe, spineCNOR, Shodobe...)

Do you routinely monitor MEPs (motor evoked potentials) and/or SSEPs (somatosensory evoked potentials) during spinal surgery?

How LONG have you been doing it?

Do you do it during ALL spinal surgeries, or just the ones using instrumentation (i.e, TSRH, Moss Miami, Synthes...)

Do you do it just on C-spines, or on L and T spines as well?

Who brings, hooks up and watches the monitoring equipment? Is it an outside vendor, or do you have something in house like a neurophysiology lab?

Does anyone know if AORN has specific guidelines on the intraoperative care of the patient undergoing spinal surgery, and have your ORs developed care plans along those guidelines?

Do most ORs usually use intraoperative navigation systems such as the Stealth, or do you rely on pre-op X-rays, CTs and MRIs?

When you do get intraop films during spinal cases, especially during instrumentation cases, do you usually use fluoro, or do you get occasional cross-table laterals?

When you DO do intaop monitoring of MEPs and SSEPs, do you still do a "wake-up" test at some point during the surgery, and ask the patient to wiggle his toes?

Does your protocol vary depending on whether the operating surgeon is an orthopod or a neurosurgeon?

Thanks. I am very interested in hearing from any and all who do spine surgery. Please feel free to offer any bits of wisdom or tips that make your job easier.

[spineCNOR]

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.