Perioperative Management for Patients With Spinal Muscular Atrophy Undergoing Scoliosis Surgery: A Single-Center...

Area of Science:

• Neurology
• Orthopedic Surgery
• Anesthesiology

Background:

• Spinal muscular atrophy (SMA) often leads to progressive scoliosis, necessitating complex surgical correction.
• Perioperative management for SMA patients is challenging due to respiratory compromise, difficult airways, and high complication risks.

Purpose of the Study:

• To analyze perioperative strategies and outcomes in SMA patients undergoing posterior spinal fusion for scoliosis correction.

Main Methods:

• Retrospective review of SMA patients undergoing posterior spinal fusion (January 2018 - December 2024).
• Primary outcomes: intraoperative blood loss, postoperative complications, perioperative hypokalemia.
• Secondary outcomes: ventilation duration, ICU/hospital length of stay, radiographic results.

Main Results:

• Forty-three SMA patients (72.1% type 2, 27.9% type 3) with severe scoliosis (mean Cobb angle 113.2°) were included.
• High incidence of challenging intubations (93.0%) and perioperative hypokalemia (intraoperative 65.1%, postoperative 79.1%).
• Successful surgery with significant Cobb angle correction (49.0%), no operative mortality, and low overall complication rate (2.3%).

Conclusions:

• This largest Asian case series highlights the complexity of perioperative care for SMA patients undergoing scoliosis surgery.
• Meticulous multidisciplinary care, including advanced airway planning, hemodynamic support, blood management, and electrolyte correction, is vital.
• Scoliosis surgery in SMA patients can be safely performed with appropriate planning, yielding structural and functional benefits.