PERIOPERATIVE MANAGEMENT IN SCOLIOSIS SURGERY: SPINAL MUSCULAR ATROPHY TYPE II/III VERSUS ADOLESCENT IDIOPATHIC SCOLIOSIS

Mehmet Anı lSüzer

doi:10.4274/jtss.galenos.2023.72691

Objective: Patients with spinal muscular atrophy (SMA) often require spinal surgery to slow pulmonary decline due to scoliosis restricting the pulmonary capacity. This study evaluated perioperative anesthetic management for scoliosis surgery in SMA patients and to compare it with adolescent idiopathic scoliosis (AIS). Materials and Methods: After obtaining hospitals ethic committee approval, retrospective data between 2014 and 2023 were collected. The primary outcome measure was perioperative variables. The secondary outcome was to determine predictive factors for postoperative intensive care unit (ICU) admission. Results: One hundred twenty five (66 female/59 male) ASA I-III patients (13.1±4.2 years) were included in the study. Of them, 49 had SMA (20 type II and 29 type III) and 76 had AIS. Forty-four SMA patients had mild to moderate restrictive lung disease and one patient was mechanical ventilation dependent. Mean age and body mass index (BMI) were lower and Cobb’s angle was higher in SMA patients than in AIS patients (p<0.05). Instrumentation level (number of vertebrae fused) and the number of osteotomized vertebrae was higher in SMA patients (p<0.05). Mean duration of the surgery, estimated blood loss (EBL), EBL/total blood volume (TBV) ratio, and blood transfusion rate were higher in SMA patients (p<0.05). The ICU admission rate was higher in the SMA group (24.5%) compared to the AIS groups (24.5% >1.3%; p<0.05). Among SMA patients, five required postoperative mechanical ventilation. Hospital discharge time and complication rate was also higher in SMA patients (p<0.05). Receiver operation characteristics analysis revealed that preoperative poor respiratory function, prolonged surgery (>6 hours), multiple vertebral fusion (>6 levels), EBL/TBV >33%, massive transfusion, and low BMI were predictive for ICU admission. Conclusion: SMA patients are at higher risk for major blood loss, massive transfusion, and ICU admission due to higher instrumentation level, longer operation time, and lower BMI. Preoperative risk analysis and preventive measures should be considered to enhance the success of the procedure in SMA patients due to respiratory compromise combined with complicated surgical procedures.

PERIOPERATIVE MANAGEMENT IN SCOLIOSIS SURGERY: SPINAL MUSCULAR ATROPHY TYPE II/III VERSUS ADOLESCENT IDIOPATHIC SCOLIOSIS

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