Training activity information
Details
Review the evidence base for intraoperative neuromonitoring for spinal surgery warning criteria and establish the defined warning criteria for the modality being applied to include patients with:
- Patients without pre-identifiable deficit
- Pre-operative sensory loss
- Pre-operative motor disturbance
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What are the intended outcomes of being able to establish defined warning criteria based on the evidence base for IONM? Why is it crucial to differentiate criteria for patients without pre-identifiable deficits versus those with pre-operative sensory loss or motor disturbance?
- What specific knowledge regarding the pathophysiology of IONM signal changes—such as drops in amplitude and latency prolongation—do you need to accurately define alarm criteria? What national guidelines and position statements inform the evidence base for warning criteria in spinal surgery?
- What do you anticipate learning about the systematic evaluation of research and the role of evidence-based practice in setting clinical thresholds? How will you develop your skills in critical appraisal regarding the sensitivity and specificity of different warning criteria?
- What resources will you consult (e.g., peer-reviewed literature, university academic content) to ensure your criteria are scientifically robust? How will you prepare by identifying which clinical scenarios or pathologies might require more conservative alarm thresholds?
In action
- What specific literature or guidelines are you prioritising during this review and why?
- How are you deciding on the appropriate thresholds for patients with pre-existing sensory or motor deficits compared to those with no pre-identifiable deficits?
- How are you relating the pathophysiology of signal changes (e.g., amplitude drops vs. latency prolongation) to the specific surgical risks of the procedure?
- What aspects of the critical appraisal of these criteria require more conscious effort, and what feels intuitive based on your academic learning?
- Are you considering how different anaesthetic regimens might require you to adapt these warning criteria in real-time?
- Are you working within established national position statements, or do you need to seek further input from a senior colleague to formalise these thresholds?
On action
- How would you summarise the process of reviewing the evidence base for IONM warning criteria?
- What did you notice about the differences in established criteria for patients with pre-operative motor or sensory deficits versus those without pre-identifiable deficits?
- What did you learn about the pathophysiology of IONM signal changes (e.g., drops in amplitude or latency prolongation) and how these inform alarm criteria?
- Were there any unexpected challenges in establishing criteria for patients with pre-existing sensory loss?
- How does this activity relate to the requirement of critically evaluating the use of IONM in clinical practice?
- What areas for continued development in evidence appraisal have you identified?
- How will you apply this understanding of warning criteria to your routine practice in the operating room?
- What actions will you now take to support the assimilation of these criteria into your monitoring plans?
Beyond action
Have you revisited the experiences?
- Have you reviewed your initial findings regarding alarm criteria for patients with pre-operative motor or sensory deficits compared to those with no pre-identifiable deficits?
- Engage in professional storytelling with colleagues about cases where signal changes (e.g., amplitude drops or latency prolongation) occurred; has your perspective on the sensitivity and specificity of established criteria changed as a result of these discussions?
How have these experiences impacted upon current practice?
- How has your ability to critically appraise the evidence for IONM developed since this activity, and how does this foundational knowledge inform your real-time interpretation of signal changes during surgery?
How might these experiences contribute towards your future practice?
- Identify the transferable skills of critical appraisal and evidence-based practice you are developing.
- What clear actions will you take to stay updated on evolving national guidelines and position statements to ensure your practice remain robust?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Plan and prepare for intraoperative neuromonitoring for spinal surgery |
| # 3 |
Outcome
Identify other investigations and procedures required before spinal surgery is undertaken. |
| # 4 |
Outcome
Apply legislation and guidelines and manage risk in the performance of intraoperative neuro monitoring. |
| # 5 |
Outcome
Appraise the evidence base for the practice of intraoperative neuromonitoring. |
| # | Outcome |