Anaesthetic management of posterior lumbar osteotomy

Sixty-four cases of posterior lumbar extension osteotomy performed at the Toronto East General Hospital between 1969 and 1983 are reviewed. The anaesthetic management is presented. The procedure was performed with local infiltration anaesthesia, heavy sedation and a brief period of general anaesthesia induced with nitrous oxide, halothane or ketamine. Five stages in the anaesthetic management are distinguished, each in relation to a phase of the surgical procedure and drug usage. A method of supporting these deformed patients in the prone position in moulded plaster casts is described. Anaesthetic and surgical complications and postoperative psychological disturbances are described and discussed. It is suggested that caudal epidural opioid or local anaesthetic analgesia be explored as an aid in the management of these patients.