Neuromuscular blocking agent use in adolescent idiopathic scoliosis surgery: a safety assessment

Non-depolarizing neuromuscular blocking agents (nNMBAs) have been subjectively reported to make spinal exposure more efficient. However, there is concern that neuromonitoring may be compromised, even with reversal, and may mask neuromonitoring alerts or result in an increased risk of postoperative neurological complications. We sought to describe the safety of using nNMBAs to facilitate exposure in pediatric posterior spine fusion surgery (PSF).

All consecutive adolescent idiopathic scoliosis (AIS) patients who underwent PSF at a single institution between 2014 and 2022 were included. Baseline patient comorbidities, utilization of nNMBAs and reversal agents, neuromonitoring changes, surgical details, postoperative neurological deficits, and surgical complications were recorded. Patients were grouped based on nNMBA utilization (-nNMBA or +nNMBA) and their outcomes were compared using univariable and multivariable techniques. Significance was set at α = 0.05.

Three hundred twenty-seven patients met all selection criteria and were included. Of these, 49 (15%) did not receive any nNMBA (-nNMBA) and 278 (85%) did receive a nNMBA (+nNMBA). Baseline patient characteristics were not different between the two groups. There were no significant differences in the rate of intraoperative neuromonitoring changes (6.1% -nNMBA versus 8.6% +nNMBA, p = 0.78), postoperative neurological deficits (6.1% -nNMBA versus 5.8% +nNMBA, p = 0.25), or postoperative complications (22.4%, -nNMBA; 21.6%, +nNMBA; p = 0.85). Modified Clavien-Dindo-Sink complication grades were not different between groups (p = 0.81).

The study found no difference in the rate or severity of complications, rate of neuromonitoring alerts, or rate postoperative neurological changes between -nNMBA and +nNMBA groups.

Level III, therapeutic.