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. 2024 Dec 1;49(23):1636-1644.
doi: 10.1097/BRS.0000000000005061. Epub 2024 Jun 11.

Development of Consensus-Based Best Practice Guidelines for the Perioperative and Postoperative Care of Pediatric Patients With Spinal Deformity and Programmable Implanted Devices

Walter H Truong  1   2 , Hiroko Matsumoto  3   4 , Jaysson T Brooks  5   6 , Tenner J Guillaume  1 , Lindsay M Andras  7 , Patrick J Cahill  8   9 , Ryan E Fitzgerald  10   11 , Ying Li  12 , Brandon A Ramo  5   6 , Benhoor Soumekh  13 , Laurel C Blakemore  14   15 , Christopher Carter  16 , Michelle R Christie  17 , Daniel Cortez  18 , V Vivian Dimas  19   20 , Christina K Hardesty  21   22 , Luv R Javia  23   24 , Benjamin C Kennedy  25   26 , Peter D Kim  27 , Robert F Murphy  28 , Joseph H Perra  1   29 , David W Polly Jr  2   30 , Jeffrey R Sawyer  31 , Brian Snyder  4   32 , Paul D Sponseller  33 , Peter F Sturm  34 , Burt Yaszay  35 , Tim Feyma  36 , Sara J Morgan  37   38
Affiliations

Development of Consensus-Based Best Practice Guidelines for the Perioperative and Postoperative Care of Pediatric Patients With Spinal Deformity and Programmable Implanted Devices

Walter H Truong et al. Spine (Phila Pa 1976). .

Abstract

Study design: Modified Delphi consensus study.

Objective: To develop consensus-based best practices for the care of pediatric patients who have implanted programmable devices (IPDs) and require spinal deformity surgery.

Summary of background data: Implanted programmable devices (IPDs) are often present in patients with neuromuscular or syndromic scoliosis who require spine surgery. Guidelines for monitoring and interrogating these devices during the perioperative period are not available.

Methods: A panel was assembled consisting of 25 experts (i.e., spinal deformity surgeons, neurosurgeons, neuroelectrophysiologists, cardiologists, and otolaryngologists). Initial postulates were based on a literature review and results from a prior survey. Postulates addressed the following IPDs: vagal nerve stimulators (VNS), programmable ventriculoperitoneal shunts (VPS), intrathecal baclofen pumps (ITBP), cardiac pacemakers and implantable cardioverter-defibrillators (ICD), deep brain stimulators (DBS), and cochlear implants. Cardiologist and otolaryngologist participants responded only to postulates on cardiac pacemakers or cochlear implants, respectively. Consensus was defined as ≥80% agreement, items that did not reach consensus were revised and included in subsequent rounds. A total of 3 survey rounds and 1 virtual meeting were conducted.

Results: Consensus was reached on 39 total postulates across 6 IPD types. Postulates addressed general spine surgery considerations, the use of intraoperative monitoring and cautery, the use of magnetically controlled growing rods (MCGRs), and the use of an external remote controller to lengthen MCGRs. Across IPD types, consensus for the final postulates ranged from 94.4% to 100%. Overall, experts agreed that MCGRs can be surgically inserted and lengthened in patients with a variety of IPDs and provided guidance for the use of intraoperative monitoring and cautery, which varied between IPD types.

Conclusion: Spinal deformity correction surgery often benefits from the use of intraoperative monitoring, monopolar and bipolar cautery, and MCGRs. The final postulates from this study can inform the perioperative and postoperative practices of spinal deformity surgeons who treat patients with both scoliosis and IPDs.

Level of evidence: V-Expert opinion.

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Conflict of interest statement

J.T.B. has consulted for Orthopediatrics Corporation, Medtronic, Inc., and Medical Devices Business Services, Inc. T.J.G. has consulted for NuVasive. L.M.A. has consulted/served as a speaker for Medtronic, Inc. and NuVasive. R.E.F. has consulted for Medical Devices Business Services, Inc. L.Y. has consulted for Medtronic, Inc. L.C.B. has consulted for Stryker Corp., Medtronic, Inc., and SeaSpine Orthopedics Corp. C.K.H. has consulted/served as a speaker for Medtronic, Inc. V.V.D. is a proctor and consultant for the following companies: Medtronic, Inc., Edwards Lifesciences, B. Braun and Abbott Vascular. J.H.P. received royalties/license fees and is a consultant for Medtronic, Inc. D.W.P. received royalties/license fees and has consulted for SI-BONE. He has also consulted for Globus Medical, Inc. J.R.S. has consulted for Orthopediatrics and Medtronic, Inc. P.D.S. received royalties/license fees from Globus Medical and has served as a consultant for the following companies: Medical Devices Business Services, Inc., Orthopediatrics, and NuVasive. P.F.S. has consulted for NuVasive. B.Y. received royalties/license fees from NuVasive, Stryker Corp, and Globus Medical. He has also consulted for Stryker, Pacira Pharmaceuticals Inc., Medical Device Business Services, Inc., and Orthopediatrics Corp. The remaining authors report no conflicts of interest.

References

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