Scoliosis and Stimulators: A Case Series of Spinal Fusions in Pediatric Patients with Neuromuscular Scoliosis and VNS Devices
Presenter Status
Medical Student
Abstract Type
Case Report
Primary Mentor or Principal Investigator
Michael Benvenuti
Presentation Type
Poster
Start Date
21-5-2026 12:00 PM
End Date
21-5-2026 1:00 PM
Abstract Text
Background: Children with neuromuscular scoliosis frequently have comorbid drug resistant epilepsy, for which vagal nerve stimulation (VNS) is an established therapy. As VNS use increases, pediatric spine surgeons are more commonly encountering these devices during complex posterior spinal fusion (PSF). Limited evidence exists to guide perioperative management of VNS during spinal deformity surgery, particularly regarding the safety of monopolar electrocautery and the reliability of intraoperative neuromonitoring.
Objectives/Goal: To describe perioperative management strategies, neuromonitoring performance, and clinical outcomes of pediatric patients with neuromuscular scoliosis and pre-existing VNS devices undergoing posterior spinal fusion.
Methods/Design: We conducted a retrospective single-center case series of pediatric patients with implanted VNS who underwent PSF for neuromuscular scoliosis at a tertiary children’s hospital between 2014 and 2025. Demographic, clinical, radiographic, operative, and postoperative data were collected. Outcomes were analyzed descriptively, given the small cohort size.
Results: Eleven patients (7 female, 4 male) with significant neurologic comorbidities underwent PSF, most commonly from T2 to the pelvis (n = 7). Mean major Cobb angle was 79° ± 24, and mean kyphosis was 60° ± 20. Monopolar cautery was used in all cases, with grounding pads placed on the lower extremities. All VNS devices were turned off preoperatively and restarted afterwards. Neuromonitoring was not affected by VNS. No VNS-related complications were documented. Postoperative complications occurred at similar rates in patients without VNS. Two patients experienced increased postoperative seizure frequency, with one developing super-refractory status epilepticus despite intact VNS function.
Conclusions: Posterior spinal fusion in pediatric patients with neuromuscular scoliosis and VNS devices appears safe when appropriate perioperative precautions are followed. Monopolar cautery and standard neuromonitoring did not result in VNS malfunction in this series. However, postoperative seizure exacerbation can occur despite proper VNS management, highlighting the importance of close postoperative neurologic surveillance and multidisciplinary coordination.
Scoliosis and Stimulators: A Case Series of Spinal Fusions in Pediatric Patients with Neuromuscular Scoliosis and VNS Devices
Background: Children with neuromuscular scoliosis frequently have comorbid drug resistant epilepsy, for which vagal nerve stimulation (VNS) is an established therapy. As VNS use increases, pediatric spine surgeons are more commonly encountering these devices during complex posterior spinal fusion (PSF). Limited evidence exists to guide perioperative management of VNS during spinal deformity surgery, particularly regarding the safety of monopolar electrocautery and the reliability of intraoperative neuromonitoring.
Objectives/Goal: To describe perioperative management strategies, neuromonitoring performance, and clinical outcomes of pediatric patients with neuromuscular scoliosis and pre-existing VNS devices undergoing posterior spinal fusion.
Methods/Design: We conducted a retrospective single-center case series of pediatric patients with implanted VNS who underwent PSF for neuromuscular scoliosis at a tertiary children’s hospital between 2014 and 2025. Demographic, clinical, radiographic, operative, and postoperative data were collected. Outcomes were analyzed descriptively, given the small cohort size.
Results: Eleven patients (7 female, 4 male) with significant neurologic comorbidities underwent PSF, most commonly from T2 to the pelvis (n = 7). Mean major Cobb angle was 79° ± 24, and mean kyphosis was 60° ± 20. Monopolar cautery was used in all cases, with grounding pads placed on the lower extremities. All VNS devices were turned off preoperatively and restarted afterwards. Neuromonitoring was not affected by VNS. No VNS-related complications were documented. Postoperative complications occurred at similar rates in patients without VNS. Two patients experienced increased postoperative seizure frequency, with one developing super-refractory status epilepticus despite intact VNS function.
Conclusions: Posterior spinal fusion in pediatric patients with neuromuscular scoliosis and VNS devices appears safe when appropriate perioperative precautions are followed. Monopolar cautery and standard neuromonitoring did not result in VNS malfunction in this series. However, postoperative seizure exacerbation can occur despite proper VNS management, highlighting the importance of close postoperative neurologic surveillance and multidisciplinary coordination.
Comments
Restricted to Title/Author List/Abstract only as requested by primary author
Poster Board Number: 8