Neuromuscular Scoliosis Spinal Fusion — Intraoperative Considerations — Clinical Pathway

Neuromuscular Scoliosis Spinal Fusion Clinical Pathway — ICU, Inpatient, Outpatient Specialty Care

Intraoperative Considerations for OR Team

Component Goals Rationale
Neuro-monitoring
  • Only if patient has motor signals
    • Baseline presence of signals should be checked before flip
 Patients without motor signals do not require monitoring
Infection Prevention
  • Limit traffic in/out of room
  • Instruments not opened until anesthesia induction near completion
    • Within 15 minutes of flipping prone
  • Implants open 1 hour before expected instrumentation
  • Dosing for Perioperative Antibiotics
  • Standard measures to prevent intraoperative surgical site infections
  • Surgical Site Infection (SSI)  , CDC and National Health Safety Network (NHSN) Definition
Surgical Skin Prep
  • Electric clipper if excessive hair
  • Chlorhexidine skin preparation
    • Full 3-minute dry time
  • Ioban™ drape
  • Foley placement
Spine Cavity Irrigation
  • Debride devitalized muscle
  • Wash with 3 L betadine + normal saline solution (NSS) then 3 L NSS
 Minimizes infection risk
Drains and Wound Closure
  • Plastic surgery consult to close wound at surgeon's discretion
  • Incisional vacuum-assisted closure (VAC), Prevena™ dressing, or Mepilex® Border Ag dressing
  • Large Jackson-Pratt drains SubQ
Surgery Duration
  • At 6 hours, consider stopping procedure based on:
    • Procedure progress
    • Patient general condition
      • Consider stopping/staging if blood loss exceeds 1.5 liters
  • Excessive bleeding places the patient at risk for DIC
  • Some curvatures may require traction before full correction