{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T06:40:44Z","timestamp":1781678444157,"version":"3.54.5"},"reference-count":28,"publisher":"SAGE Publications","issue":"3_suppl","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Mixed-methods approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Intra-operative spinal cord injury (ISCI) is a devastating complication of spinal surgery. Presently, a uniform definition for ISCI does not exist. Consequently, the reported frequency of ISCI and important risk factors vary in the existing literature. To address these gaps in knowledge, a mixed-methods knowledge synthesis was undertaken.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A scoping review was conducted to review the definitions used for ISCI and to ascertain the frequency of ISCI. The definition of ISCI underwent formal review, revision and voting by the Guidelines Development Group (GDG). A systematic review of the literature was conducted to determine the risk factors for ISCI. Based on this systematic review and GDG input, a table was created to summarize the factors deemed to increase the risk for ISCI. All reviews were done according to PRISMA standards and were registered on PROSPERO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The frequency of ISCI ranged from 0 to 61%. Older age, male sex, cardiovascular disease including hypertension, severe myelopathy, blood loss, requirement for osteotomy, coronal deformity angular ratio, and curve magnitude were associated with an increased risk of ISCI. Better pre-operative neurological status and use of intra-operative neuromonitoring (IONM) were associated with a decreased risk of ISCI. The risk factors for ISCI included a rigid thoracic curve with high deformity angular ratio, revision congenital deformity with significant cord compression and myelopathy, extrinsic intradural or extradural lesions with cord compression and myelopathy, intramedullary spinal cord tumor, unstable spine fractures (bilateral facet dislocation and disc herniation), extension distraction injury with ankylosing spondylitis, ossification of posterior longitudinal ligament (OPLL) with severe cord compression, and moderate to severe myelopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ISCI has been defined as \u201ca new or worsening neurological deficit attributable to spinal cord dysfunction during spine surgery that is diagnosed intra-operatively via neurophysiologic monitoring or by an intraoperative wake-up test, or immediately post-operatively based on clinical assessment\u201d. This paper defines clinical and imaging factors which increase the risk for ISCI and that could assist clinicians in decision making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682231190613","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T12:31:56Z","timestamp":1711369916000},"page":"80S-104S","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Definition, Frequency and Risk Factors for Intra-Operative Spinal Cord Injury: A Knowledge Synthesis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5722-6364","authenticated-orcid":false,"given":"Michael G.","family":"Fehlings","sequence":"first","affiliation":[{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada"},{"name":"Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada"},{"name":"Institute of Medical Science, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Quddusi","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea C.","family":"Skelly","sequence":"additional","affiliation":[{"name":"Aggregate Analytics, Inc., Fircrest, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika D.","family":"Brodt","sequence":"additional","affiliation":[{"name":"Aggregate Analytics, Inc., Fircrest, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Moghaddamjou","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada"},{"name":"Institute of Medical Science, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anahita","family":"Malvea","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8583-9849","authenticated-orcid":false,"given":"Nader","family":"Hejrati","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9578-508X","authenticated-orcid":false,"given":"Nisaharan","family":"Srikandarajah","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7131-079X","authenticated-orcid":false,"given":"Mohammed Ali","family":"Alvi","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8899-8941","authenticated-orcid":false,"given":"Shay","family":"Stabler-Morris","sequence":"additional","affiliation":[{"name":"Aggregate Analytics, Inc., Fircrest, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0216-8363","authenticated-orcid":false,"given":"Joseph R.","family":"Dettori","sequence":"additional","affiliation":[{"name":"Spectrum Research, Inc., Steilacoom, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A.","family":"Tetreault","sequence":"additional","affiliation":[{"name":"Department of Neurology, NYU Langone Medical Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-5224","authenticated-orcid":false,"given":"Nathan","family":"Evaniew","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian K.","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada"},{"name":"International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,3,25]]},"reference":[{"key":"bibr1-21925682231190613","doi-asserted-by":"publisher","DOI":"10.1177\/2192568216688188"},{"key":"bibr2-21925682231190613","doi-asserted-by":"publisher","DOI":"10.3171\/FOC.2008.25.11.E15"},{"key":"bibr3-21925682231190613","volume-title":"Methods Guide for Effectiveness and Comparative Effectiveness Reviews"},{"key":"bibr4-21925682231190613","volume-title":"Procedure Manual"},{"key":"bibr5-21925682231190613","volume-title":"Intraoperative Neurophysiological Monitoring","author":"Ghatol 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