Pediatric Spine Surgery

In children, the most common indication for spinal fusion is significant scoliotic curvature, either idiopathic or as a result of neuromuscular disease. Spinal fusion is high-risk surgery, which can be further complicated by comorbid disease. It carries substantial risk for significant fluid shifts, high intraoperative blood loss, physiologic strain secondary to duration and positioning, severe postoperative pain, and potential spinal cord injury. To mitigate risk and optimize outcomes, these patients should be carefully evaluated by the anesthetic team preoperatively and a comprehensive perioperative plan established. To protect the spinal cord and predict poor neurologic outcomes, the majority of these cases employ intraoperative neuromonitoring. The specific anesthetic agents to allow maximal neuromonitoring signals while ensuring adequate anesthetic depth and pain control should also be established collaboratively. These patients experience severe postoperative pain, and a multimodal approach to therapy should be employed to allow for expedited recovery and decreased length of stay.