Perioperative Blood Pressure Management for Patients Undergoing Spinal Fusion for Pediatric Spinal Deformity

Abstract

Posterior spinal instrumentation and fusion has become the gold standard for the definitive management of children and adolescents with spinal deformity. Despite continued innovations designed to improve the safety profile of this complex surgical undertaking, spinal cord injury and resulting loss of neurologic function remain a rare but devastating risk. The increasing power of instrumentation combined with more aggressive correction strategies puts the spinal cord at particular risk due to traction. While the surgeon has the luxury of complex neuromonitoring techniques to alert the team in the presence of a neurologic change during surgery, maintenance of spinal cord perfusion throughout surgery and in the early postoperative period should be considered to avoid spinal cord ischemia as it accommodates to its new position after deformity correction. This manuscript represents recommendations of the POSNA Quality, Value, and Safety Spine Committee for optimization of blood pressure in the perioperative period. Key Concepts • Surgeons should take an active role in establishing blood pressure parameters in patients undergoing spinal surgery in order to optimize spinal cord perfusion during all phases of care. • Spinal cord perfusion is critical during all portions of patient care and thus thoughtful blood pressure monitoring should occur postoperatively as well as intraoperatively. • Even relatively brief periods of hypotension may result in significant spinal cord ischemia.