Preparation for Surgery for Cervical Spine Anomalies in Children

Indications for Surgery

• Spinal instability
• Progressive spinal deformity
• Neurological deficit

Preoperative Orders

• Routine

Anesthetic Considerations

• Difficult airway: Anesthesia is planned so that the needs for a difficult airway or unstable cervical spine are met.  Up-front tracheostomy is occasionally required to manage extremely difficult airways. 
• Plan to accommodate oral approach, if anticipated: If a transoral or transnasal endoscopic procedure is required, usually oral intubation is sufficient.

Devices to Be Implanted

• Anticipate needs: Preoperative review of the radiographs is mandatory to become intimately familiar with the patient’s anatomy and ensure that needs for surgery are met.  Instrumentation, bone grafts, and fusion augmentation products must be considered and ordered.

Ancillary/Specialized Equipment

• IOM when decompression and reduction anticipated: Intraoperative monitoring is not routinely necessary. However, in cases where significant spinal cord compression is involved or the spine must undergo intraoperative reduction, it may be beneficial.