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

Rajiv R. Iyer, Michael G. Vitale, Adam N. Fano, Hiroko Matsumoto, Daniel J. Sucato, Amer F. Samdani, Justin S. Smith, Munish C. Gupta, Michael P. Kelly, Han Jo Kim, Daniel M. Sciubba, Samuel K. Cho, David W. Polly, Oheneba Boachie-Adjei, Peter D. Angevine, Stephen J. Lewis, Lawrence G. Lenke

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish
Pages (from-to)733-744
Number of pages12
JournalSpine Deformity
Issue number4
StatePublished - Jul 2022


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


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