Perioperative Optimization of Patients With Neuromuscular Disorders Undergoing Scoliosis Corrective Surgery: A Multidisciplinary Team Approach

Abstract

Study Design: Narrative review. Objective: The high rate of complications associated with the surgical management of neuromuscular spinal deformities is well documented in the literature. This is attributed to attenuated protective physiological responses in multiple organ systems. Methods: Review and synthesis of the literature pertaining to optimization of patients with neuromuscular scoliosis undergoing surgery. Our institutional practice in the perioperative assessment and management of neuromuscular scoliosis is also described along with a clinical vignette. Results: Respiratory complications are the most common to occur following surgery for neuromuscular disorders. Other categories include gastrointestinal, cardiac, genitourinary, blood loss, and wound complications. A multidisciplinary approach is required for perioperative optimization of these patients and numerous strategies are described, including respiratory management. Conclusion: Perioperative optimization for patients with neuromuscular disorders undergoing corrective surgery for spinal deformity is multifaceted and complex. It requires a multidisciplinary evidence-based approach. Preadmission of patients in advance of surgery for assessment and optimization may be required in certain instances to identify key concerns and formulate a tailored treatment plan.

The Early and Late Postoperative Complications of Pediatric Neuromuscular Scoliosis at King Abdulaziz Medical City, Riyadh, Saudi Arabia: A Case Series

“…However, in our sample of patients, respiratory poor outcomes were much less prevalent compared with other outcomes such as blood loss. All of our patients were intubated during the procedure and most of them were extubated immediately after the surgery, which might have contributed to achieving better respiratory outcomes [ 20 ]. Also, some major postoperative measures, that were taken in our hospital, such as giving adequate analgesia and early involvement of a physiotherapist might have played a big role in preventing pulmonary poor outcomes [ 20 ].…”

Respiratory prehabilitation in pediatric anesthesia in children with muscular and neurologic disease

“…Wound healing may be impaired in malnutrition, 58 and malnourished patients are more at risk for pressure ulcers. Furthermore, nutritional status is closely associated with lung function in several respiratory diseases; poor nutrition may impact respiratory muscle strength and may contribute to fatigue and reintubation 59 . Thus, careful evaluation by a nutritionist is advisable in the perioperative period.…”

Neuromuscular Scoliosis: A Neurological Point of View

“…44 Gastrointestinal disorders are attributed to paralytic ileus by medications such as opioids or during anesthetic procedures, presence of gastroesophageal reflux or in patients with poor nutritional conditions, with high risk of superior mesenteric artery compression syndrome. 45 In debilitated patients below the fifth weight percentile, nutritional support is recommended weeks to months before surgery. 9 Infections after the surgical procedure are associated with high or low body mass index, lymphocyte count below 1500 mm 3 or serum albumin levels below 3.5 g/dl.…”

“…9 Infections after the surgical procedure are associated with high or low body mass index, lymphocyte count below 1500 mm 3 or serum albumin levels below 3.5 g/dl. 45 Among the agents most involved in the infection of surgical wounds are S. Aureus, P. aeruginosa and E.coli. 46 It is important not to confuse fever of infectious origin with fever due to the release of inflammatory cytokines such as IL-6 and TNF-α from the extensive surgical procedure to correct scoliosis.…”

“…44 The Stagnara test or awakening test can be difficult to perform in individuals with neuromuscular scoliosis and intellectual dysfunction in the absence of intraoperative monitoring. 45 The test consists of reducing sedation and mobilizing the lower limbs during surgery. Failure to mobilize may indicate neurological injury requiring suspension of the procedure.…”