AllMed Helps Hospitals Evaluate the Appropriate Use of Intraoperative Monitoring to Prevent Complications During Spinal Surgery

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The marked increase in the number of spinal surgeries and the use of IOM has led to inconsistencies in the use of the procedures because the medical community has not reached a consensus about which procedures are most effective.

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Surgeons can assess the functional integrity of susceptible neural elements during surgery, potentially allowing them to address problems before any damage occurs.

There are numerous potential complications associated with spinal surgery, ranging from postoperative pain to paralysis, and even death. The number of spinal surgeries performed each year continues to increase, along with requests for IOM, despite these significant risks. In some cases, physicians may be driven by financial incentives to perform more lucrative procedures.

During a recent webinar hosted by AllMed Healthcare Management, Dr. Kim Sloan, a board-certified orthopedic surgeon, discussed the latest methods of intraoperative monitoring (IOM) to prevent complications during spinal surgery. Dr. Sloan stressed that although IOM reduces the incidence of complications, it does not completely eliminate them. In order to optimize the utility of IOM, it is critical that surgeons have a fundamental background in the neurophysiology of IOM so that they can identify and address problems as they arise.

The methods used for IOM vary with the type of surgery and the structures at risk. Intraoperative monitoring is indicated in select spinal surgeries when there is risk for additional spinal cord injury. Surgeons can assess the functional integrity of susceptible neural elements during surgery, potentially allowing them to address problems before any damage occurs. Intraoperative monitoring during spinal surgery is not indicated for routine indications (e.g., lumbar or cervical laminectomy or fusion).

Health plans state that IOM must be performed either by a licensed physician trained in clinical neurophysiology or by a trained technologist, and that IOM must be interpreted by a licensed physician trained in clinical neurophysiology, other than the operating surgeon, who is immediately available to interpret the recording and advise the surgeon. These criteria follow recommendations set forth by the American Academy of Neurology and other professional organizations.

The marked increase in the number of spinal surgeries and the use of IOM has led to inconsistencies in the use of the procedures because the medical community has not reached a consensus about which procedures are most effective. Clinical practice is often guided by an understanding of the principles of spinal biomechanics and knowledge of the generally accepted indications, contraindications, and controversies regarding spinal surgeries. As IOM for spinal surgery continues to evolve, hospitals must take extra care to ensure that surgeons are properly credentialed and have a solid background in the most up-to-date techniques and clinical applications.

About AllMed
AllMed Healthcare Management provides external peer review solutions to leading hospital groups and ASCs nationwide. AllMed offers MedEval (sm) and MedScore(sm), which help facilities improve physician performance through both periodic and ongoing case reviews at the individual or departmental levels. Services are deployed through PeerPoint®, AllMed’s state-of-the-art medical review portal. For more information on how AllMed can help your organization improve the quality and integrity of healthcare, contact us today at info(at)allmedmd(dot)com, or visit us at http://www.allmedmd.com.

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Kiki Grant
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