The NASS Podcast

[4 of 12]

Hear Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, "What are the anesthetic recommendations for neuromonitoring in various spine surgeries and why?” 

The Co-Chairs discuss when and why they recommend total intravenous anesthesia (TIVA) vs 0.5 MAC. Is Ketamine really beneficial to MEPs? Why is Precedex contraindicated for MEPs? What train-of-four ratio is recommended for monitoring, when and why? They’ll answer all these questions and more.

Disclosures:

Doan, Adam: Private Investments (including venture capital, start-ups): Veridical RCM, LLC (D).

Vogel, Richard: Board of Directors: American Board Of Neurophysiologic Monitoring (Nonfinancial, Examiner for Board), American Society Of Neurophysiological Monitoring (Nonfinancial, President of the Society (2019-2020)); Consulting: Medicolegal Expert Witness Consulting (D); Other: NuVasive (Salary); Speaking and/or Teaching Arrangements: Neurophysiology Services Australia (None); Trips/Travel: North American Spine Society (Travel Expense Reimbursement), University Of Sydney (Travel Expense Reimbursement).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Featuring: Joseph H. Schwab, MD, Ilya Laufer, MD, Daniel M. Sciubba, MD

Disclosures: 

Laufer, Ilya: Consulting: BrainLab (A), DePuy Synthes (B), Globus (B), Medtronic (C), SpineWave (B).

Schwab, Joseph H.: Scientific Advisory Board: Chordoma Foundation (None); Speaking and/or Teaching Arrangements: AO Spine (Travel Expense Reimbursement, Outside 12-Month Requirement),  Stryker Spine (B, Outside 12-Month Requirement).

Sciubba, Daniel M.: Consulting: Baxter (B), DePuy Synthes (B), Globus (B), Medtronic (C), NuVasive (B), Stryker (C).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Featuring: Paul R. Gause, MD, Sandeep N. Gidvani, MD 

Disclosures:

Gause, Paul R.: Speaking and/or Teaching Arrangements: Medtronic (C).

Gidvani, Sandeep N.: Consulting: Xenco Medical  (B), Seaspine  (None), Spinal Balance  (None), SI Bone (None), Nuvasive (None).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

[3 of 12]

Hear Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, “Why does IONM need access to my patients and their charts before and after surgery?” 

It’s not uncommon for hospitals/surgeons to prohibit the IONM team from interfacing with the patient before surgery. In addition to needing informed consent, the team needs to assess the patient’s neuro status and history to interpret the IONM data. Imaging/charts help to develop an appropriate IONM plan. Facesheets are essential to reimbursement. When the IONM team is unable to access patient records, they are monitoring in the dark (and for free).

Disclosures:

Doan, Adam: Private Investments (including venture capital, start-ups): Veridical RCM, LLC (D).

Vogel, Richard: Board of Directors: American Board Of Neurophysiologic Monitoring (Nonfinancial, Examiner for Board), American Society Of Neurophysiological Monitoring (Nonfinancial, President of the Society (2019-2020)); Consulting: Medicolegal Expert Witness Consulting (D); Other: NuVasive (Salary); Speaking and/or Teaching Arrangements: Neurophysiology Services Australia (None); Trips/Travel: North American Spine Society (Travel Expense Reimbursement), University Of Sydney (Travel Expense Reimbursement).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Featuring: Michael Y. Wang, MD, Michael P. Steinmetz, MD 

Disclosures:

Steinmetz, Michael P.: Royalties: Biomet Spine (B); Consulting: Intellirod (A), Stryker Spine (B), Globus (B); Speaking and/or Teaching Arrangements: Stryker (B); Board of Directors: AANS/CNS Section on Disorders of the Spine (Chair Exhibits Committee), Council of State Neurosurgical Societies (Vice Chair); Scientific Advisory Board: Intellirod (B).

Wang, Michael Y.: Royalties: DePuy Synthes Spine (F); Stock Ownership: ISD (<1%), Medical Device Partners (<1%); Consulting: Stryker (C), Spineology (C), K2M (C), DePuy Synthes (C); Scientific Advisory Board: Vallum (A).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Featuring: Gregory L. Whitcomb, DC, F. Todd Wetzel, MD 

Disclosures:

Wetzel, F. Todd: Stock Ownership: Relievant Medical (<1%).

Whitcomb, Gregory L.: Nothing to Disclose

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+  

Diana Wiseman, MD (Public Affairs Committee Member) and Donna Lahey, RNFA, CNOR (Author) discuss the Socioeconomics & Politics article, "Drowning in Denials: The Insurance Denial & Appeal Process," which was published in the May/June 2018 issue of NASS' SpineLine magazine.

Access the article here.

Disclosures:

Lahey, Donna M.: Speaking and/or Teaching Arrangements: NASS (B, Paid directly to institution/employer); Trips/Travel: NASS (Travel Expense Reimbursement, Paid directly to institution/employer).

Wiseman, Diana Barrett: Nothing to Disclose  

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

[2 of 12]

Hear from Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, "Neuromonitoring in spine surgery, can't anyone cover the case?"

Did you know IONM is learned through on-the-job training, licensure does not exist, and certifications are not required for the technologist in your OR? After initial training, technologists can monitor very basic cases (e.g., PLIF), but they should spend years in training to learn more complex procedures (deformity, tumors). If a surgery isn’t booked accurately, the surgeon might get a very junior person assigned to a very complex case. Here we inform the listener of common practices around determining “competency” for performing IONM in spine surgery. 

Disclosures:

Doan, Adam: Private Investments (including venture capital, start-ups): Veridical RCM, LLC (D).

Vogel, Richard: Board of Directors: American Board Of Neurophysiologic Monitoring (Nonfinancial, Examiner for Board), American Society Of Neurophysiological Monitoring (Nonfinancial, President of the Society (2019-2020)); Consulting: Medicolegal Expert Witness Consulting (D); Other: NuVasive (Salary); Speaking and/or Teaching Arrangements: Neurophysiology Services Australia (None); Trips/Travel: North American Spine Society (Travel Expense Reimbursement), University Of Sydney (Travel Expense Reimbursement).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Featuring: Richard Vogel, PhD, DABNM, Adam Doan, DC, DABNM, Anthony K. Sestokas, PhD, DABNM 

Disclosures:

Doan, Adam: Private Investments (including venture capital, start-ups): Veridical RCM, LLC (D).

Sestokas, Anthony K.: Other Office: Journal Of Clinical Monitoring And Computing (Editorial board), NASS Section On Intraoperative Neuromonitoring (Member of Section on IONM), SpecialtyCare (F, Chief Clinical Officer - IONM; Salary); Stock Ownership: KSPC Holdings (C)

Vogel, Richard: Board of Directors: American Board Of Neurophysiologic Monitoring (Nonfinancial, Examiner for Board), American Society Of Neurophysiological Monitoring (Nonfinancial, President of the Society (2019-2020)); Consulting: Medicolegal Expert Witness Consulting (D); Other: NuVasive (Salary); Speaking and/or Teaching Arrangements: Neurophysiology Services Australia (None); Trips/Travel: North American Spine Society (Travel Expense Reimbursement), University Of Sydney (Travel Expense Reimbursement).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Featuring: Eeric Truumees, MD, E. Kano Mayer, MD, John Stokes, MD, Enrique B. Pena, MD 

Disclosures:

Mayer, E. Kano A.: Stock Ownership: Infinite Orthopedics (less than 1%); Private Investments: Lanai Health Solutions (30%); Speaking and/or Teaching Arrangements: North America Spine Society (B); Trips/Travel: NASS (B).

Pena, Enrique B.: Nothing to Disclose

Stokes, John: Royalties: Genesys Orthopedics (F); Stock Ownership: SMV Scientific (50871 Shares, 1%, Ownership is 0.52%), DiFusion Technologies, Inc. (16235 Shares); Scientific Advisory Board: DiFusion Technologies, Inc. (Nonfinancial, 15000 options were awarded for work related to the Scientific Advisory Board.).

Truumees, Eeric: Board of Directors: Seton Family of Doctors (No additional pay, part of base compensation); Other Office: AAOS Communications Cabinet (E); Research Support (Staff and/or materials): Dova Pharmaceuticals (A, Paid directly to institution/employer), Medtronic (C, Paid directly to institution/employer), Pfizer (E, Paid directly to institution/employer), Relievant (F, Paid directly to institution/employer), Stryker Spine (B, Paid directly to institution/employer), Vertex Pharma (D, Study cancelled, Outside 12-Month Requirement, Paid directly to institution/employer); Trips/Travel: AAOS (Travel Reimbursement).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+