Some Diagnoses Predict Cardiac Risk in Pediatric Spine Surgery

Research from Johns Hopkins Children’s Center is showing that some neuromuscular conditions may fuel the risk of cardiac arrest during pediatric spine surgery. The study, published in Spine, is believed to be the first to quantify the risk of this potentially lethal complication among children.

As indicated in the news release, “The study results stem from an analysis of outcomes in some 2, 600 spinal surgeries performed at the Johns Hopkins Children’s Center and Texas Scottish Rite Hospital for Children in Dallas between 2004 and 2014. The authors are quick to point out that the absolute risk of cardiac arrest in children during spine surgery is minuscule. Indeed, of the 2, 639 patients in the study, 11 had one—less than 0.5%. A single patient died. Ten of the eleven children were successfully resuscitated.”

“Specifically, the results showed that children with such neuromuscular disorders as cerebral palsy, spina bifida and muscular dystrophy were three times more likely to suffer cardiac arrest during surgeries that straighten the spine. Six of the eleven children who had a cardiac arrest had a neuromuscular disorder. In 8 of the 11 cases, cardiac arrest was triggered by electrolyte imbalances or circulatory problems—not a surprising finding, the researchers say, given that young children have less blood and lower blood pressure, and are thus more vulnerable to circulatory shock. Children also tend to develop electrolyte imbalance more rapidly than adults. Other causes of cardiac arrest included allergic anaphylaxis, irregular heartbeat, and respiratory and airway problems.”

“Our findings are reassuring: Spinal surgeries in children are overwhelmingly safe, but even so, some risk remains, ” says lead investigator Paul Sponseller, M.D., M.B.A., director of pediatric orthopedics at the Johns Hopkins Children’s Center, in the November 17, 2015 news release. “Armed with this knowledge, surgeons can plan accordingly by taking a few additional preventive steps to make what is an already safe surgery even safer.”

Dr. Sponseller told OTW, “I was led to this work because not everyone considers this possibility when discussing and planning for spine surgery. It was surprising to learn that a diagnosis (especially neuromuscular scoliosis) is able to help predict risk. Orthopedic surgeons should be aware that small patients have lower blood volume to serve as a reservoir during surgery.”