Perioperative Management and Surgical Challenges in Patients with Spinal Cord Dysfunction

People with spinal cord dysfunction due to spinal cord injury/disorder (SCI/D) represent a frail population with specific challenges, which are usually not reported in commonly adopted guidelines. If a surgeon does not take account of these needs, the risk for surgical complications is significantly high. The peculiarities of people with SCI/D should always be addressed when performing surgery in this population. Autonomic dysreflexia is a potentially life-threatening complication consisting of headache, tachycardia, severe hypertension, tachypnea, convulsions, myocardial infarction, and hemorrhagic stroke. This condition could be triggered by pain, bladder/bowel distension, acute abdominal pathology, urinary tract infections (UTIs), and pressure ulcers. It is mandatory to adopt measures to reduce the risk for these stimuli. Due to musculoskeletal problems (e.g., scoliosis, spasticity, sarcopenia, and pathological fractures), which are common in this population, people with SCI/D may present problems to take the position required for surgery. Surgeons should assess this ability pre-operatively. Other common complications in people with SCI/D undergoing surgery include surgical-site infections, UTIs, pneumoniae, pressure ulcers, and thromboembolic events. The acknowledgment of these surgical complications is mandatory to prevent them by adopting the appropriate strategies to reduce their risks. At last, surgery in people with SCI/D should be performed by top-level surgeons in multi-specialty hospitals with specific know-how about the needs of this population.