Scoliosis Correction

Airway: ETT as prone
Access: 2× large IV for most cases
Pain: Substantial
Position: Mostly prone, may be supine
Time: Hours
Blood loss: May be substantial; consider cell-saver, autologous transfusion, or normovolaemic haemodilution
Special:

Scoliosis:

• Describes lateral curvature and rotation of the thoraco-lumbar spine
  Often with a secondary thoracic cage deformity.
• Is defined as a Cobb angle > 10°
  Perpendicular lines drawn from the upper and lower maximally tilted vertebrae. The angle of intersection of these lines is the Cobb angle.

Scoliosis surgery:

• May be indicated when the Cobb angle >40°
• Aims to correct curvature and posture, improving:
  • Pain
  • Respiratory function
  • Cardiac function

Considerations

• B
  • Restrictive lung disease
    May be difficult to interpret in patients with non-idiopathic disease (e.g. CP related).
• C
  • Exercise tolerance/cardiac reserve
  • Right heart disease
    Secondary to respiratory disease.
    • Pulmonary hypertension may occur with Cobb angle >100°
• D
  • Associated neuromuscular disease
  • May require nerve monitoring
• E
  • Hypothermia common

Preparation

Induction

• Standard ANZCA monitoring
• Ensure G+H available
• Arterial line
• Consider central line
• Consider cell saver

Intraoperative

Surgical Stages

Surgery:

• May have a number of approaches
  • Anterior
    ↑ morbidity.
  • Posterior
    Commonest.
  • Combined
• May require bone grafting

Emergence

Postoperative

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References

1. Entwistle MA, Patel D. Scoliosis surgery in children. Contin Educ Anaesth Crit Care Pain. 2006;6(1):13-16. doi:10.1093/bjaceaccp/mki063