Spinal Cord Protection during Stabilization of Severe Thoraco–Lumbal Scoliosis with 90 Degree Cobb Angle

Abstract

Introduction: Scoliosis correction surgery requires careful anesthetic management because of potential perioperative complications, including excessive bleeding, hypothermia, complications related to patient positioning, and the need for spinal cord protection.
Case: A 23-year-old woman weighing 32 kg with a height of 140 cm presented with a chief complaint of spinal deformity that had been present since childhood. On physical examination, her blood pressure was 119/79 mmHg, pulse rate was 112 beats/minute, respiratory rate was 20 breaths/minute, and SpO2 was 97% on room air and a Cobb angle of 90°. Anesthesia induction using propofol 70 mg, while tracheal intubation was facilitated with atracurium 0.5 mg/kg. Analgesia with fentanyl 2 µg/kg, and anesthesia with O2/air, sevoflurane, and atracurium infusion at 0.5 mg/kg/hour. Intravenous tranexamic acid 500 mg to minimize intraoperative bleeding. Intraoperative monitoring consisted of standard monitoring modalities, without the use of spinal cord monitoring. The surgical procedure lasted 4 hours and 20 minutes, with the patient positioned prone throughout the operation.
Discussion: The most important principle of anesthetic management in spinal surgery is a comprehensive and meticulous approach to patient positioning, ensuring safe alignment while maintaining adequate spinal cord perfusion pressure. Spinal cord protection was provided with methylprednisolone, hemodynamic stable, normothermia, good patient position.
Conclusion: Spinal cord protection did with avoid excessive bleeding, hypothermia, complications related to patient positioning, and maintaining adequate spinal cord perfusion pressure.