Spine Surgery and Intraoperative Monitoring

Abstract

Major spine surgery involves multiple spine levels and may involve anterior/posterior procedures often with extensive instrumentation. This carries significant patient risk of higher morbidity and even mortality due to in part the reality that these patients may have multiple co-morbid conditions. Anesthesia management necessitates careful preoperative evaluation and intraoperative planning. Spine surgery poses potential risk to the spinal cord and nerves, consequently intraoperative neuromonitoring (IONM), somatosensory-evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMG), are used to test neurological function and hopefully avoid injury. Prone positioning is commonly used for posterior spinal decompression and fusion surgery. Pathophysiologic challenges of the prone position complicate the intraoperative anesthesia care of patients. Reduction in blood loss and goal directed fluid therapy during surgery improves patient outcome. Postoperatively, good pain control is very important to ensure a quick patient recovery. Both anesthesiologist and surgeon should be aware of postoperative vision loss (POVL), a rare but devastating complication commonly associated with extensive prone spine surgery. This chapter details the anesthetic management of severe cervical spinal stenosis. The questions in the chapter discuss preoperative evaluation, intraoperative management, IOM, and postoperative pain management. Controversial issues such as airway management with cervical pathology, IONM, intraoperative fluid and blood management, and prevention of POVL are emphasized.