Perioperative Care of Children with Severe Neurological Impairment and Neuromuscular Scoliosis-A Practical Pathway to...

Area of Science:

• Pediatric Orthopedics
• Neurology
• Healthcare Management

Background:

• Neuromuscular scoliosis is prevalent in children with severe neurological impairment (SNI), notably severe cerebral palsy.
• Surgical scoliosis correction is standard but associated with high complication rates in this complex patient group.
• Existing practice guidelines for SNI scoliosis surgery are lacking.

Purpose of the Study:

• To describe a hospital's established perioperative clinic and approach for children with SNI undergoing scoliosis corrective surgery.
• To outline a collaborative, team-based process for optimizing surgical candidates and their medical care.
• To share a model for shared decision-making in managing complex pediatric spinal deformity.

Main Methods:

• Development and implementation of a specialized perioperative clinic for SNI patients.
• Integration of surgical expertise, family-centered care, and pre/post-operative medical optimization.
• Step-by-step process description including clinical vignettes and proformas.

Main Results:

• The clinic evolved into a comprehensive service beyond perioperative care.
• The collaborative approach facilitates shared decision-making to identify optimal surgical candidates.
• The described process enhances medical care optimization for pediatric scoliosis patients with SNI.

Conclusions:

• A dedicated perioperative clinic and team-based approach can improve care for children with SNI undergoing scoliosis surgery.
• Shared decision-making and comprehensive medical optimization are crucial for this high-risk population.
• This model offers a pathway to manage complex pediatric spinal deformities effectively.