The role of minimally invasive techniques in the treatment of adult spinal deformity.

Many surgeons use minimally invasive surgery (MIS) approaches for treatment of patients with adult degenerative spinal deformity. The feasibility and efficacy of these techniques in the treatment of certain subtypes of degenerative deformities have been reported. In this article, several MIS techniques are discussed and an established 6-level treatment algorithm (MiSLAT) is presented, to help guide spinal surgeons in the use of MIS techniques for the treatment of patients with degenerative deformity. MIS treatment of MiSLAT level I to IV deformities is recommended, whereas level V and VI deformities require more traditional open approaches for adequate deformity correction.

The design, development, and implementation of a checklist for intraoperative neuromonitoring changes.

OBJECT: The purpose of this study was to provide an evidence-based algorithm for the design, development, and implementation of a new checklist for the response to an intraoperative neuromonitoring alert during spine surgery. METHODS: The aviation and surgical literature was surveyed for evidence of successful checklist design, development, and implementation. The limitations of checklists and the barriers to their implementation were reviewed. Based on this review, an algorithm for neurosurgical checklist creation and implementation was developed. Using this algorithm, a multidisciplinary team surveyed the literature for the best practices for how to respond to an intraoperative neuromonitoring alert. All stakeholders then reviewed the evidence and came to consensus regarding items for inclusion in the checklist. RESULTS: A checklist for responding to an intraoperative neuromonitoring alert was devised. It highlights the specific roles of the anesthesiologist, surgeon, and neuromonitoring personnel and encourages communication between teams. It focuses on the items critical for identifying and correcting reversible causes of neuromonitoring alerts. Following initial design, the checklist draft was reviewed and amended with stakeholder input. The checklist was then evaluated in a small-scale trial and revised based on usability and feasibility. CONCLUSIONS: The authors have developed an evidence-based algorithm for the design, development, and implementation of checklists in neurosurgery and have used this algorithm to devise a checklist for responding to intraoperative neuromonitoring alerts in spine surgery.