Preparation for Surgery for Thoracolumbar Trauma in Children

Indications for Surgery

• Spinal instability: Patients with unstable fractures could have worsening of the injury with mobilization.  Stabilization surgery will allow earlier mobilization of the patients.
• Neurological deficit: In patients with neurological deficits caused by compression of the spine or nerve roots, surgery should be considered for decompression of the neural elements.
• Deformity: Spine injury can cause acute spinal deformity, such as kyphosis.  In patients with significant deformity, surgery should be considered to restore more anatomic alignment of the spine.

Preoperative Orders

• Lab tests: Necessary test include hemoglobin, platelet, electrolytes, kidney function, and coagulation panel.
• Blood: If necessary, the patient should have a blood type and screen evaluation and have blood on hold for use during surgery.

Anesthetic Considerations

• Intubation: Patients with unstable cervical spine fractures may require awake fiberoptic intubation. Extension should be limited during intubation.
• Hypotension: Hypotension should be avoided during induction in patients with spinal cord injury.
• Intraoperative neurophysiologic monitoring: Inhalational agents and neuromuscular blockade must be avoided if MEPs are utilized.

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

• Intraoperative monitoring
• Fluoroscopy
• Image guidance