Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review

Abstract

Scoliosis is the most frequent spinal deformity in children. It is defined as a spine deviation of more than 10° in the frontal plane. Neuromuscular scoliosis is associated with a heterogeneous spectrum of muscular or neurological symptoms. Anesthesia and surgery for neuromuscular scoliosis have a higher risk of perioperative complications than for idiopathic scoliosis. However, patients and their relatives report improved quality of life after the surgery. The challenges for the anesthetic team result from the specifics of the anesthesia, the scoliosis surgery itself, or factors associated with neuromuscular disorders. This article includes details of preanesthetic evaluation, intraoperative management, and postoperative care in the intensive care unit from an anesthetic view. In summary, adequate care for patients who have neuromuscular scoliosis requires interdisciplinary cooperation. This comprehensive review covers information about the perioperative management of neuromuscular scoliosis for all healthcare providers who take care of these patients during the perioperative period, with an emphasis on anesthesia management.

Comparison of Motor Evoked Potentials Neuromonitoring Following Pre- and Postoperative Transcranial Magnetic Stimulation and Intraoperative Electrical Stimulation in Patients Undergoing Surgical Correction of Idiopathic Scoliosis

“…The same applies to the general idea of preoperative neurophysiological tests performed each time in treated patients with IS, enabling the accurate recognition of changes in efferent neural transmission through MEPs recordings and the functional ability of muscle motor units to a contraction in non-invasive sEMG recordings. They also include the recognition of the degree of asymmetry of the recordings and the level of neuromere in which there are the most significant deficits in the activities of the motor centres [48,49].…”

Bilateral Bi-Level Erector Spinae Plane Blocks as a Part of Opioid-Sparing Multimodal Analgesia in Scoliosis Surgery: A Case Series of Six Pediatric Patients

“…Patients undergoing posterior spinal fusion for correction of idiopathic scoliosis require intravenously administered opioids for the first 36 h and report moderate-to-severe pain in the days following surgery [ 13 , 14 ]. Also, neurogenic and congenital scoliosis treatment is associated with severe pain [ 15 , 16 , 17 ]. This brief report suggests that ESP blockade, in combination with the intraoperative use of multiple nonopioid analgesic therapies, can be useful in pain treatment following congenital and neurogenic scoliosis surgery.…”