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Review
. 2024 Feb 12;5(1):602.
doi: 10.55275/JPOSNA-2023-602. eCollection 2023 Feb.

Perioperative Blood Pressure Management for Patients Undergoing Spinal Fusion for Pediatric Spinal Deformity

Nicholas D Fletcher  1 , Ravi Ghag  2 , Daniel J Hedequist  3 , Meghan N Imrie  4 , James T Bennett  5 , Michael P Glotzbecker  6 ; POSNA QSVI Spine Committee; James T Bennett, Laurel C Blakemore, Nicholas D Fletcher, Lorena Floccari, Ravi Ghag, Michael P Glotzbecker, Daniel J Hedequist, Meghan N Imrie, Megan Johnson, Selena Poon, Peter F Sturm
Affiliations
Review

Perioperative Blood Pressure Management for Patients Undergoing Spinal Fusion for Pediatric Spinal Deformity

Nicholas D Fletcher et al. J Pediatr Soc North Am. .

Abstract

Posterior spinal instrumentation and fusion has become the gold standard for the definitive management of children and adolescents with spinal deformity. Despite continued innovations designed to improve the safety profile of this complex surgical undertaking, spinal cord injury and resulting loss of neurologic function remain a rare but devastating risk. The increasing power of instrumentation combined with more aggressive correction strategies puts the spinal cord at particular risk due to traction. While the surgeon has the luxury of complex neuromonitoring techniques to alert the team in the presence of a neurologic change during surgery, maintenance of spinal cord perfusion throughout surgery and in the early postoperative period should be considered to avoid spinal cord ischemia as it accommodates to its new position after deformity correction. This manuscript represents recommendations of the POSNA Quality, Value, and Safety Spine Committee for optimization of blood pressure in the perioperative period. Key Concepts•Surgeons should take an active role in establishing blood pressure parameters in patients undergoing spinal surgery in order to optimize spinal cord perfusion during all phases of care.•Spinal cord perfusion is critical during all portions of patient care and thus thoughtful blood pressure monitoring should occur postoperatively as well as intraoperatively.•Even relatively brief periods of hypotension may result in significant spinal cord ischemia.

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Figures

Figure 1
Figure 1
An 11-year-old boy with severe juvenile idiopathic scoliosis. His Coronal-Deformity Angular Ratio (C-DAR) was 131°/7 levels = 18.7 and his sagittal-DAR (S-DAR) was 80.5°/10 levels = 8.1 giving him a T-DAR of 26.8. He had a temporary decrease in nMEP during correction which responded to removal of apical screws and recontouring the convex rod.
Figure 2
Figure 2
Cross sectional T2 weighted MRI of the apical vertebrae from the child in Figure 1. The spinal cord is compressed against the pedicle wall with no intervening CSF. There is no significant flattening of the cord, consistent with a type 2 spinal cord.
Figure 3
Figure 3
(A) A 12 year old male with Soto syndrome, a coronal curve of 113°, sagittal curve of 103° and a T-DAR of 24.2 (C-DAR = 11.3 S-DAR = 12.9). (B) He was treated with 6 weeks of halo gravity traction, taking his coronal curve down to 84° and his sagittal curve to 68°. (C) He was then treated with PSF without IONM changes.
Figure 4
Figure 4
Example of standardized note in patients sustaining an intraoperative neuromonitoring change.
See this image and copyright information in PMC

References

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