Abstract
It is a historic and common practice while performing spine surgery on patients with a VNS has been to have the patient’s neurologist turn off the VNS generator in the pre-operative anesthetic care unit and to use bipolar rather than monopolar electrocautery. Here we report a case of a 16-year-old male patient with cerebral palsy and refractory epilepsy managed with an implanted VNS who had scoliosis surgery (and subsequent hip surgery) conducted with the use of monopolar cautery. Although VNS manufacturer guidelines suggest that monopolar cautery should be avoided, perioperative care providers should consider its selective use in high-risk instances (with greater risks of morbidity and mortality due to blood loss which outweigh the risk of surgical re-insertion of a VNS) such as cardiac or major orthopedic surgery. Considering the number of patients with VNS devices presenting for major orthopedic surgery is increasing, it is important to have an approach and strategy for perioperative management of VNS devices.
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Data availability
The data that support the findings of this study are available from the corresponding author, [RS], upon reasonable request.
Change history
03 August 2023
A Correction to this paper has been published: https://doi.org/10.1007/s43390-023-00729-3
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RS: made substantial contributions to the conception and design of the work; the acquisition, analysis, interpretation of data; MC: made substantial contributions to the conception and design of the work; the acquisition, analysis, interpretation of data; MJMV: made substantial contributions to the conception and design of the work; the acquisition, analysis, interpretation of data; JTR: made substantial contributions to the conception and design of the work.
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Dr Mark Camp is a consultant for OrthoPediatrics Inc. and 7D Surgical Inc. (SeaSpine).
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Approval was obtained from the ethics committee of The Hospital for Sick Children. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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The original online version of this article was revised: 1 Affiliations Details for authors Rajendra Sakhrekar and Mark Camp were incorrectly given twice as ‘Division of Orthopaedic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada’ but should have been ‘Division of Orthopaedic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada’ and ‘Division of Orthopaedics, Department of Surgery, University of Toronto 149 College Street, Room 508-A Toronto, ON M5T 1P5, Canada’. 2 Abstract and Conclusion The incorrect phrase “Although VNS manufacturer guidelines suggest that monopolar cautery should not be avoided” has been corrected to read “Although VNS manufacturer guidelines suggest that monopolar cautery should be avoided”. 3 Minor typographical corrections Missing blank spaces between words have been added at several places in the text.
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Sakhrekar, R., McVey, M.J., Rutka, J.T. et al. Use of monopolar cautery in patient with a vagal nerve stimulator during neuromuscular scoliosis surgery. Spine Deform 11, 1539–1542 (2023). https://doi.org/10.1007/s43390-023-00705-x
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DOI: https://doi.org/10.1007/s43390-023-00705-x