Module information
Details
- Title
- Planning for Intraoperative Neuromonitoring
- Type
- Specialist
- Module code
- S-NI-S2-R
- Credits
- 10
- Requirement
- Compulsory
Aim of this module
This module will provide trainees with the ability to plan intraoperative neuromonitoring for spinal surgery using multi-modality monitoring techniques.
Work-based content
Competencies
| # | Learning outcome | Competency | Action |
|---|---|---|---|
| # 1 | Learning outcome 1, 2, 3,4 |
Competency
Produce plans for intraoperative neuromonitoring for spinal surgery to include cases that require:
|
Action View |
| # 2 | Learning outcome 1, 2, 3 |
Competency
Identify pathological areas of interest relevant to planned spinal surgeries to determine required modalities. To include indications for:
|
Action View |
| # 3 | Learning outcome 1, 2, 3, 4, 6 |
Competency
Assess the requirement for pre-operative baseline neurophysiology for spinal surgeries including practicalities of performing for patients requiring:
|
Action View |
| # 4 | Learning outcome 1, 3, 4, 5, |
Competency
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:
|
Action View |
| # 5 | Learning outcome 1, 3, 4 |
Competency
Complete a risk assessment for performing intraoperative neuromonitoring for spinal surgery. |
Action View |
| # 6 | Learning outcome 1, 2, 3, 4, |
Competency
Complete a risk assessment for a specified patient who requires intraoperative neuromonitoring for spinal surgery considering the patient’s clinical history and all relevant pre-operative findings. To include patients that require:
|
Action View |
| # 7 | Learning outcome 1, 2, 4, 6 |
Competency
Present an intraoperative neuromonitoring plan for spinal surgery to the multidisciplinary team |
Action View |
| # 8 | Learning outcome 1 |
Competency
Prepare electrodes and other consumables for intraoperative neuromonitoring for spinal surgery. To include cases requiring:
|
Action View |
| # 9 | Learning outcome 1 |
Competency
Prepare the recording and stimulating system (machine) for performing intraoperative neuromonitoring for spinal surgery. To include checking modalities:
|
Action View |
| # 10 | Learning outcome 1 |
Competency
Programme the intraoperative monitoring system (machine) used for spinal surgeries for:
|
Action View |
Assessments
Complete 2 Case-Based Discussions
Complete 2 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Perform internal calibration / pre-recording machine checks on the intraoperative neuromonitoring equipment used for spinal surgeries
- Modify a motor evoked potential or free-running electromyography recording programme used for spinal surgeries to show additional muscles
- Modify a sensory evoked potential programme used for intraoperative neuromonitoring equipment for spinal surgeries
- Prepare a set of electrodes for performing standard spinal intraoperative neuromonitoring
Observed Clinical Event Titles
- Obtain and present/discuss a patient history in the context of intraoperative neuromonitoring for spinal surgery to another healthcare professional
- Explain intraoperative neuro monitoring for spinal surgery to a patient and/or a carer/relative
- Explain intraoperative neuro monitoring for spinal surgery to another healthcare professional
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Plan and prepare for intraoperative neuromonitoring for spinal surgery |
| 2 | Obtain clinical histories for patients undergoing intraoperative neuromonitoring. |
| 3 | Identify other investigations and procedures required before spinal surgery is undertaken. |
| 4 | Apply legislation and guidelines and manage risk in the performance of intraoperative neuro monitoring. |
| 5 | Appraise the evidence base for the practice of intraoperative neuromonitoring. |
| 6 | Demonstrate effective and compassionate communication skills with all stakeholders, including patients and the multi-disciplinary team. |
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
- Apply integrative understanding of the anatomy and physiology of the central and peripheral nervous system.
- Evaluate the fundamentals of evoked potentials, nerve conduction and electromyography techniques, the types of potentials that can be obtained and the range of surgical procedures that can be monitored.
- Describe the surgical steps and pathophysiology of IONM signal changes during spinal surgery, and how to reduce neurological deficits.
- Critically evaluate the use of intraoperative neuromonitoring.
- Critically analyse the sources of error encountered and the non-pathological effects in the recording of evoked potentials and EMG in the operating room.
Indicative content
- Anatomy of the Central and Peripheral (somatic) Nervous System. Cerebral cortex, brainstem, spinal cord, spinal nerves, peripheral nerves. Innervation targets.
- Brain and spinal cord blood supply anatomy.
- Technical considerations for motor/sensory evoked potentials: motor and sensory modalities, electrode placement and montages, instrumentation, stimulation and recording parameters.
- Technical considerations for EMG studies: triggered and free-running EMG, electrode placement and montages, instrumentation, stimulation and recording parameters
- Selection of electrodes and stimulation probes
- Adapting modalities (monitoring and/or mapping) and recording/stimulation parameters according to the surgical plan.
- Pathophysiological changes in EPs and EMG studies: drops in amplitude, latency prolongation, EMG spontaneous and induced discharges. Alarm criteria.
- Non-pathological sources of changes in EPs and EMG: errors in measurements and reproducibility of results, effects of anaesthesia and systemic factors (temperature, blood pressure, oxygenation, blood loss).
- Common artefacts in IONM.
- Disorders of the CNS and PNS that affect IONM recordings (e.g., myelopathies, cerebral palsy, diabetes, ataxia)
- Application of EP modalities and EMG in IONM: spinal deformity correction, spinal cord malformations, arteriovenous malformations, tumours, (neuro)vascular surgeries
- Spinal surgery approaches
- Value of preoperative studies
- Safety measures and infection control
- Risks, benefits, and pitfalls in intraoperative neuromonitoring
- National guidelines and position statements. IONM best practice for spinal surgery
- Medicolegal framework for IONM in the UK
Clinical experiences
Important information
Clinical experiential learning is the range of activities trainees may undertake in order to gain the experience and evidence to demonstrate their achievement of module competencies and assessments. The list is not definitive or mandatory, but training officers should ensure, as best training practice, that trainees gain as many of these clinical experiences as possible. They should be included in training plans, and once undertaken they should support the completion of module assessments and competencies within the e-portfolio.
Activities
- Attend a pre-operative clinic for spinal surgeries, for example a scoliosis clinic.
- Observe the consent and pre-op assessment process for a patient who will have intraoperative neuromonitoring for spinal surgeries.
- Observe the acquisition of spinal radiology for example, pre-operative scoliosis spinal MRI, bending films
- Observe the reporting of spinal radiology for example, pre-operative scoliosis spinal MRI, bending films