Our Summary

This research paper discusses the anesthesia process for a common adolescent surgery: posterior spinal fusion for idiopathic scoliosis. This surgery can lead to serious complications, both during and after the procedure. One of the main issues is the risk of pressure injuries due to the patient’s position during surgery. Another important aspect of patient care during this surgery is neuromonitoring, a technique used to evaluate the patient’s neurological status and alert the medical team to any issues that may require immediate action. The causes of signal loss in neuromonitoring must be well understood to ensure patient safety.

The anesthesia plan must also consider that the patient may need to be awakened during the surgery to assess their neurological function. There is a high risk of bleeding during this surgery due to the extensive exposure of the spine and the potentially long duration of the operation. Therefore, the medical team should have strategies in place to minimize blood loss and prevent coagulation disorders.

Pain management is another challenge for adolescents undergoing spinal fusion. Inadequate pain relief can delay recovery, affect patient and family satisfaction, increase the risk of chronic pain or disability after surgery, and lead to prolonged use of opioids. However, most of the major complications associated with this surgery can be avoided with careful planning and by using evidence-based approaches.

FAQs

  1. What complications can arise from posterior spinal fusion surgery for adolescent idiopathic scoliosis?
  2. What is the role of neuromonitoring during spinal fusion surgery and how does it contribute to patient care?
  3. How can the risk of perioperative bleeding be managed during posterior spinal fusion surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal surgery is to follow postoperative instructions carefully, including proper wound care, medication management, and physical therapy exercises. It is important to communicate any concerning symptoms or changes in pain levels to your healthcare provider immediately. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can support the healing process and improve overall outcomes.

Suitable For

Patients who are typically recommended for spinal surgery include those with severe spinal deformities such as scoliosis, kyphosis, or lordosis, as well as those with spinal fractures, herniated discs, spinal stenosis, or other spinal conditions that have not responded to conservative treatments. Additionally, patients who experience severe and persistent back pain, weakness, numbness, or tingling in the extremities may also be candidates for spinal surgery. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if surgery is the best course of treatment for their specific condition.

Timeline

  • Before surgery:
  1. Patient undergoes preoperative evaluation to assess overall health and determine anesthesia risks.
  2. Anesthesia plan is developed based on patient’s medical history and surgical needs.
  3. Patient is informed about the surgery, risks, benefits, and postoperative care.
  4. Patient may undergo preoperative testing such as blood work, imaging, and consultations with other specialists.
  • During surgery:
  1. Patient is brought into the operating room and positioned for the procedure.
  2. Anesthesia is induced, and the patient is monitored throughout the surgery.
  3. Neuromonitoring is used to assess neurologic function and alert providers to any potential issues.
  4. Blood loss is carefully managed to prevent complications.
  5. Pain management is addressed to ensure patient comfort during and after the surgery.
  • After surgery:
  1. Patient is transferred to the recovery room for monitoring and pain management.
  2. Patient may be moved to a regular hospital room once stable.
  3. Patient is encouraged to start moving and walking as soon as possible to prevent complications.
  4. Pain management is continued to ensure patient comfort.
  5. Follow-up appointments are scheduled to monitor recovery and address any concerns or complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with spinal surgery?

  2. How long is the recovery process expected to be and what can I do to aid in my recovery?

  3. What type of anesthesia will be used during the surgery and what are the potential side effects?

  4. How will my neurologic function be monitored during the surgery?

  5. What steps will be taken to reduce blood loss during the surgery?

  6. How will pain be managed postoperatively and what are the potential side effects of pain medications?

  7. What is the success rate of this type of surgery for my specific condition?

  8. Are there any alternative treatment options to consider before proceeding with surgery?

  9. What is the expected outcome of the surgery in terms of pain relief and improvement in function?

  10. What is the long-term prognosis for my condition after undergoing spinal surgery?

Reference

Authors: Hammon DE, Chidambaran V, Templeton TW, Pestieau SR. Journal: Paediatr Anaesth. 2023 Nov;33(11):894-904. doi: 10.1111/pan.14735. Epub 2023 Aug 1. PMID: 37528658