Perioperative Management of Nonorthopaedic Devices in the Pediatric Neuromuscular Patient Population

Abstract

Pediatric patients with neuromuscular conditions often have nonorthopaedic implants that can pose a challenge for MRI acquisition and surgical planning. Treating physicians often find themselves in the position of navigating between seemingly overly risk-averse manufacturer's guidelines and an individual patient's benefits of an MRI or surgery. Most nonorthopaedic implants are compatible with MRI under specific conditions, though often require reprogramming or interrogation before and/or after the scan. For surgical procedures, the use of electrosurgical instrumentation poses a risk of electromagnetic interference and implants are thus often programmed or turned off for the procedures. Special considerations are needed for these patients to prevent device damage or malfunction, which can pose additional risk to the patient. Additional planning before surgery is necessary to ensure appropriate equipment, and staff are available to ensure patient safety. Patients with neuromuscular disorders often require surgical treatment to improve function, manage contractures, and correct deformity. Owing to underlying diagnoses or associated medical conditions, these patients may have medical implants to help manage muscle tone, control seizures, treat cardiac conditions, improve hearing, etc. Managing nonorthopaedic implants can cause delays and confusion when planning for advanced imaging studies and/or surgical intervention. Identifying these devices before MRI acquisition or surgical procedures is important to ensure the appropriate equipment, or support staff are available to maintain patient safety and device integrity.There is little guidance regarding the management of these implants, and manufacturer's recommendations may differ from practical application. Manufacturers' guidelines often make conservative recommendations accounting for rare worst case scenarios, but strict compliance to these guidelines may be impractical and could prevent medically necessary imaging or surgery for a patient. Treating physicians must navigate the conflict of risk-averse guidelines and patient's medical needs. Often, we rely on expert