Seminars in Spine Surgery
Volume 21, Issue 1 , Pages 24-32 , March 2009

Anesthetic Management for Adult Spine Deformity Surgery

  • Thai T. Nguyen, MD, PhD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Thai T. Nguyen, MD, Department of Anesthesiology and Critical Care Medicine, Division of Neuroanesthesia, Johns Hopkins Medical Institution, 600 N. Wolfe St., Baltimore, MD 21287
  • ,
  • Marek A. Mirski, MD, PhD

References 

  1. Kelen ER, Schmidt MH. Rheumatoid arthritis of the cervical spine. Semin Neurol. 2002;22:179–182
  2. Winfield J, Cooke D, Corbett M. A prospective study of the radiological changes in the cervical spine in early rheumatoid disease. Ann Rheum Dis. 1981;40:109–114
  3. Raw DA, Beattie JK, Hunter JM. Anesthesia for spine surgery in adults. Br J Anaesth. 2003;91(6):886–904
  4. Wazeka AN, DiMaio MF, Boachie-Adjei O. Outcome of pediatric patients with severe restrictive lung disease following reconstructive spine surgery. Spine. 2004;29(5):528–535
  5. Yuan N, Fraire JA, Margetis MM, et al. The effect of scoliosis surgery on lung function in the immediate postoperative period. Spine. 2005;30(19):2182–2185
  6. Eagle KA, Brundage BH, Chaitman BR, et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery (Report of the American College of Cardiology/American Heart Association Task Force on Practice Guideline. Committee on Perioperative Cardiovascular Evaluation for Noncardiac cardiac Surgery). Circulation. 1996;93:1278
  7. Horlocker TT, Wedel DJ. Clinical anesthesia. In:  Barash PG,  Cullen BF,  Stoelting RK editor. Philadelphia, PA: Lippincott Williams & Wilkins; 2006;p. 1114
  8. Hambly PR, Martin B. Anaesthesia for chronic spinal cord lesions. J Anesth. 1998;53:273–289
  9. Rampersaud YR, Eduardo M, Neary MA, et al. Intraoperative adverse events and related postoperative complications in spine surgery: Implications for enhancing patient safety founded on evidence-base protocols. Spine. 2006;31:1503–1510
  10. Vauzelle C, Stagnara P, Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop. 1973;93:173
  11. Nuwer MR, Dawson EG, Carlson LG, et al. Somatosensory evoked potential spinal cord monitoring reduces neurological deficits after scoliosis surgery: Results of a large multicenter survey. Electroencephalogr Clin Neurophysiol. 1995;96:6–11
  12. Dawson EG, Sherman JE, Kanim LE, et al. Spinal cord monitoring (Results of the Scoliosis Research Society and the European Spinal Deformity Society survey). Spine. 1991;16(8):S361–S364(suppl)
  13. Meyer PR, Colter HB, Gireesan GT. Operative neurological complications resulting from thoracic and lumbar spine internal fixation. Clin Orthop Relat Res. 1988;237:125–131
  14. Epstein NE, Danto J, Nardi D. Evaluation of intraoperative somatosensory-evoked potential monitoring during 100 cervical operations. Spine. 1993;18(6):737–747
  15. Lesser RP, Raudzens P, Luders H, et al. Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials. Ann Neurol. 1986;19:22–25
  16. Jones SJ, Buonamassa S, Crockard HA. Two cases of quadriparesis following anterior cervical discectomy, with normal perioperative somatosensory evoked potentials. J Neurol Neurosurg Psych. 2003;44:273–276
  17. Kelleher MO, Tan G, Sarjeant R, et al. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: A prospective analysis of 1055 consecutive patients. J Neurosurg Spine. 2008;8(3):215–221
  18. Sala F, Albino B, Franco F, et al. Surgery for intramedullary spinal cord tumors: The role of intraoperative (neurophysiological) monitoring. Eur Spine J. 2007;10(S2):S130z–S139
  19. Owen JH. The application of intraoperative monitoring during surgery for spinal deformity. Spine. 1999;24(24):2649–2662
  20. Sloan TB, Heyer EJ. Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol. 2002;19(5):430–443
  21. Langeron O, Vivien B, Paqueron X, et al. Effects of propofol, propofol-nitrous oxide and midazolam on cortical somatosensory evoked potentials during sufentanil anesthesia for major spinal surgery. Br J Anaesth. 1999;82:340–345
  22. Warner ME, Warner MA, Garrity JA, et al. The frequency of perioperative vision loss. Anesth Analg. 2001;93:1417
  23. Meyers MA, Hamilton SR, Bogosian AJ, et al. Visual loss as a complication of spine surgery (A review of 37 cases). Spine. 1997;22:1325
  24. Seyal M, Mull B. Mechanisms of signal change during intraoperative somatosensory evoked potential monitoring of the spinal cord. J Clin Neurophysiol. 2002;19(5):409–415
  25. Taylor BA, Fennelly ME, Taylor A, et al. Temporal summation-the key to motor evoked potential spinal cord monitoring in humans. J Neurol Neurosurg Psychiatry. 1993;56:104–106
  26. Toleikis JR, Skelly JP, Carlvin AO, et al. Spinally elicited peripheral nerve responses are sensory rather than motor. Clin Neurophysiol. 2000;117:2093–2101
  27. Minahan RE, Sepkuty JP, Lesser RP, et al. Anterior spinal cord injury with preserved neurogenic “motor” evoked potentials. Clin Neurophysiol. 2001;112:1442–1450
  28. Deletis V. The “motor” inaccuracy in neurogenic motor evoked potentials. Clin Neurophysiol. 2001;112:1365–1366
  29. Pelosi L, Lamb J, Grevitt M, et al. Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol. 2002;113:1082–1091
  30. Reuter DG, Tacker WA, Badylak SF, et al. Correlation of motor-evoked potentials response to ischemic spinal cord damage. J Thorac Cardiovasc Surg. 1992;104:262–272
  31. MacDonald DB, Janusz M. An approach to intraoperative monitoring of thoracoabdominal aneurysm surgery. J Clin Neurophysiol. 2002;19(1):43–54
  32. Schwartz DM, Auerbach JD, Dormans JP, et al. Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Jt Surg Am. 2007;89:2440–2449
  33. Deletis V, Sala F. Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: A review focus on the corticospinal tracts. Clin Neurophysiol. 2008;119:248–264
  34. Jameson LC, Janik DJ, Sloan TD. Electrophysiologic monitoring in neurosurgery. Anesthesiol Clin. 2007;25:605–630
  35. Kellegher MO, Tan G, Sarjeant R. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: A prospective analysis of 1055 consecutive patients. J Neurosurg Spine. 2008;8(3):215–221
  36. Fan D, Schwartz DM, Vaccaro AR, et al. Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy. Spine. 2002;27(22):2499–2502
  37. Eggspuehler A, Sutter MA, Grob D, et al. Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients. Eur Spine J. 2007;16(S2):S188–S196
  38. Sala F, Lanteri P, Bricolo A. Motor evoked potential monitoring for spinal cord and brainstem surgery. Adv Tech Stand Neurosurg. 2004;29:133–169
  39. Ulkatan S, Neuwirth M, Bitan F. Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D WAVE) revealed false results. Clin Neurophysiol. 2006;117:2093–2101
  40. Kawaguchi M, Sakamoto T, Ohnishi H, et al. Intraoperative myogenic motor evoked potentials induced by direct electrical stimulation of the exposed motor cortex under isoflurane and sevoflurane. Anesth Analg. 1996;82:593–599
  41. Pechstein U, Nadstawek J, Zentner J, et al. Isoflurane plus nitrous oxide versus propofol for recording of motor evoked potentials after high frequency repetitive electrical stimulation. Electroencephalogr Clin Neurophysiol. 1998;108(2):175–181
  42. Chen Z. The effects of isoflurane and propofol on intraoperative neurophysiological monitoring during spinal surgery. J Clin Monit Comput. 2004;18(4):303–308
  43. Kano T, Shimoji K. The effects of ketamine and neuroleptanalgesia on the evoked electrospinogram and electromyogram in man. Anesthesiology. 1992;76:502–509
  44. Schubert A, Licina MG, Lineberry PJ. The effect of ketamine on human somatosensory evoked potentials and its modification by nitrous oxide. Anesthesiology. 1990;72:33–39
  45. Pajewski TN, Arlet V, Phillips LH. Current approach on spinal cord monitoring: The point of view of the neurologist, the anesthesiologist and the spine surgeon. Eur Spine J. 2007;16(S2):S115–S129
  46. Leppanen RE. Intraoperative monitoring of segmental spinal nerve root function with free-run and electrically-triggered electromyography and spinal cord function with reflexes and F-responses (A Position Statement by The American Society of Neurophysiological Monitoring). J Clin Monit Comput. 2005;19:437–461
  47. Nuttall GA, Horlocker TT, Santrach PJ, et al. Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine. 2000;25:596–601
  48. Mittermayr M, Streif W, Haas T, et al. Hemostatic changes after crystalloid or colloid fluid administration during major orthopedic surgery: The role of fibrinogen administration. Anesth Analg. 2007;105:905–917
  49. Horlocker TT, Nuttall GA, Dekutoski MB, et al. The accuracy of coagulation tests during spinal fusion and instrumentation. Anesth Analg. 2001;93:33–38
  50. Ho VT, Newman NJ, Song S, et al. Ischemic optic neuropathy following spine surgery. J Neurosurg Anesthesiol. 2005;17:38–44
  51. Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens. Ann Surg. 2003;238:641–648
  52. Sachs B, Delacy D, Green J, et al. Recombinant activated factor VII in spinal surgery (A multicenter, randomized, double-blind, placebo-controlled, dose-escalation trial). Spine. 2007;32:2285–2293
  53. Mayer PJ, Gehlsen JA. Coagulopathies associated with major spinal surgery. Clin Orthop Relat Res. 1989;245:83–88
  54. Park CK. The effect of patient positioning on intraabdominal pressure and blood loss in spinal surgery. Anesth Analg. 2000;91:552–557
  55. Othman Z, Lenke LG, Bolon SM, et al. Hypotension-induced loss of intraoperative monitoring data during surgical correction of Scheuermann kyphosis: A case report. Spine. 2004;29:E258–E265
  56. Wang LC, Liou JT, Liu FC, et al. Fatal ischemia stroke in a patient with an asymptomatic carotid artery occlusion after lumbar spine surgery-a case report. Acta Anaesthesiol Taiwan. 2004;42:179–182
  57. Epstein NE. Bloodless spinal surgery: A review of the normovolemic hemodilution technique. Surg Neurol. 2008;70:614–618
  58. Epstein NE, Peller A, Korsh J, et al. Normovolemic hemodilution: An effective method for limiting postoperative transfusion following complex lumbar spinal decompression with instrumented fusion. Spinal Surgery. 2004;18:179–188
  59. Epstein NE, Peller A, Korsh J, et al. Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion. Spine. 2006;31:2227–2230
  60. Chanda A, Smith DR, Nanda A. Autotransfusion by cell saver technique in surgery of lumbar and thoracic spinal fusion with instrumentation. J Neurosurg. 2002;96:298–303
  61. Gause PR, Siska PA, Westrick ER. Efficacy of intraoperative cell saver in decreasing postoperative blood transfusions in instrumented posterior lumbar fusion patients. Spine. 2008;33:571–575
  62. Reitman CA, Watters WC, Sassard WR. The cell saver in adult lumbar fusion surgery. Spine. 2004;29:1580–1584
  63. Cha CW, Deible C, Muzzonigro T. Allogeneic transfusion requirements after autologous donations in posterior lumbar surgeries. Spine. 2002;27:99–104
  64. Brookfield KF, Brown MD, Henriques SM, et al. Allogeneic transfusion after predonation of blood for elective spine surgery. Clin Orthop Relat Res. 2008;466:1949–1953
  65. Henry DA, Carless PA, Moxey AJ, et al. Antifibrinolytic use for minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007;4:CD001886
  66. Zufferey P, Merquiol F, Laporte S, et al. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?. Anesthesiology. 2006;105:1034–1046
  67. Okubadejo GO, Bridwell K, Lenke LG, et al. Aprotinin may decrease blood loss in complex adult spinal deformity surgery, but it may also increase the risk of acute renal failure. Spine. 2007;32:2265–2271
  68. Samama CM, Langeron O, Rosencher N, et al. Aprotinin versus placebo in major orthopedic surgery: A randomized, double-blinded, dose-ranging study. Anesth Analg. 2002;95:287–293
  69. Mangano DT, Tudor IC, Dietzel C, et al. The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006;354:353–365
  70. Mangano DT, Miao Y, Vuylsteke A, et al. Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery. JAMA. 2007;297:471–479
  71. Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979;50:149–151
  72. Boezaart AP, Eksteen JA, Spuy GV, et al. Intrathecal morphine (Double-blind evaluation of optimal dosage for analgesia after major lumbar spinal surgery). Spine. 1999;24:1131–1137
  73. Gwirtz KH, Young JV, Byers RS, et al. The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: Seven years' experience with 5969 surgical patients at Indiana University Hospital. Anesth Analg. 1999;88:599–604
  74. Pfeifer BL, Sernaker HL, Ter Horst UM. Pain scores and ventilatory and circulatory sequelae of epidural morphine in cancer patients with and without prior narcotic therapy. Anesth Analg. 1988;67:838–842
  75. Urban MK, Jules-Elysee K, Urquhart B, et al. Reduction in postoperative pain after spinal fusion with instrumentation using intrathecal morphine. Spine. 2002;5:535–537
  76. Borgeat A, Blumenthal S. Postoperative pain management following scoliosis surgery. Curr Opin Anesthesiology. 2008;21:313–316
  77. Gajraj NM, Joshi GP. Role of cyclooxygenase-2 inhibitors in postoperative pain management. Anesthesiol Clin North Am. 2005;23:49–72
  78. Jirarattanaphochai K, Thienthong S, Sriraj W, et al. Effect of parecoxib on postoperative pain after lumbar spine surgery (A bicenter, randomized, double-blinded, placebo-controlled trial). Spine. 2008;33:132–139
  79. Reuben SS, Connelly NR. Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery. Anesth Analg. 2000;91:1221–1225
  80. Jirarattanaphochai K, Jung S. Nonsteroidal anti-inflammatory drugs for postoperative pain management after lumbar spine surgery: A meta-analysis of randomized controlled trials. J Neurosurg Spine. 2008;9:22–31
  81. Fitzgerald GA. Coxibs and cardiovascular disease. N Engl J Med. 2004;351:1709–1711

PII: S1040-7383(08)00092-0

doi: 10.1053/j.semss.2008.11.004

Seminars in Spine Surgery
Volume 21, Issue 1 , Pages 24-32 , March 2009