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Hemodynamic instability of myelomeningocele patients during anterior spinal surgery
L A Karol1, B S Richards, E Prejean
1University of California, Davis, Department of Orthopaedics, Sacramento 95817.
Insights
Spinal fusion surgery for myelomeningocele patients has high complication rates. Six patients experienced sudden hemodynamic instability during surgery, with four showing latex allergy, necessitating procedure abortion.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Pediatric Surgery
Background:
- Myelomeningocele is a complex congenital condition requiring multidisciplinary surgical management.
- Spinal fusion is a common procedure for scoliosis in myelomeningocele patients, but carries significant risks.
- Intraoperative complications can severely impact patient outcomes and surgical success.
Observation:
- Six cases of sudden intraoperative hemodynamic instability during anterior spinal fusion for myelomeningocele are reported.
- These events led to the abortion of the surgical procedures in all affected patients.
- Four of the six patients demonstrated positive skin and serum allergy tests to latex.
Findings:
- Sudden intraoperative hemodynamic instability is a critical complication during anterior spinal fusion in myelomeningocele.
- Latex allergy may be a contributing factor to intraoperative instability in this patient population.
- Despite initial surgical abortion, successful anterior and posterior spinal fusion was achieved in four patients post-resuscitation.
Implications:
- The findings highlight the need for vigilant hemodynamic monitoring during spinal fusion in myelomeningocele.
- Investigating and managing potential latex allergy is crucial for patient safety in this cohort.
- Alternative surgical approaches or pre-operative management may be considered to mitigate risks.
Abstract:
Surgery for spinal fusion for patients with myelomeningocele is accompanied by a high rate of complications. The authors report six cases of sudden intra-operative hemodynamic instability which occurred during anterior spinal fusion; the procedures had to be aborted. All children were successfully resuscitated and four patients subsequently underwent successful anterior and posterior spinal fusion. Four of the children had positive skin and serum allergy tests to latex.