Case Reports in Orthopedics / 2016 / Article / Tab 2

Case Report

Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case

Table 2

Risks of scoliosis surgery in patients with CF and perioperative management.

Perioperative risksAction

Cystic fibrosisPoor pulmonary reserve/restrictive lung disease(1) Preoperative chest physiotherapy and increase in exercise
(2) Noninvasive ventilation, chest physiotherapy, early mobilisation postoperatively
Recurrent infections(1) Perioperative antibiotics
Poor nutrition(1) Emphasis on adequate oral diet
(2) Nutritional supplements
Poor bone quality(1) Bisphosphonate treatment

Major surgical insultIncreased intraoperative blood loss(1) Hypotensive anaesthesia
(2) Local haemostats used
(3) Meticulous, sequential spinal exposure
(4) Use of less implants
(5) Use of cell saver
(6) Use of allograft (no need for harvesting autologous bone from other sites)
Reducing surgical time(1) Use of single rod construct
Pain effect on(1) Limited use of IV opioids
 (i) chest,(2) Aggressive chest physiotherapy
 (ii) mobilisation, (3) Early postoperative mobilisation
 (iii) gastrointestinal system(4) Supportive GI medication (including antiemetics and laxatives)

Scoliosis correctionNeurological (1) Use of a single rod construct (less implant density)
Infection(1) Use of a single rod construct
(2) Prophylactic antibiotics
Respiratory compromise(1) Thoracoplasty not performed
Nonunion(1) Extensive bone grafting
(2) Postoperative support with spinal jacket
Superior mesenteric artery syndrome(1) Early instigation of oral diet
(2) Nutritional supplements before and after surgery
(3) Early postoperative mobilisation

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