Scoliosis

Restrictive lung disease - Severe curves reduce lung volumes and reserve; assess pulmonary function and expect impaired ventilation and possible pulmonary hypertension in advanced disease.

The underlying cause matters - Neuromuscular scoliosis (muscular dystrophy, cerebral palsy) carries relaxant sensitivity and, in some, malignant-hyperthermia and succinylcholine concerns; identify the etiology.

Major spine surgery - Correction is long and prone with large blood loss; plan big IV access, an arterial line, blood availability, cell salvage, and careful prone positioning (eyes, pressure points).

Neuromonitoring - Motor and somatosensory evoked potentials protect the cord and constrain the anesthetic (limit volatile agents and neuromuscular blockade, often a TIVA technique) — coordinate with the neuromonitoring team.

Postoperative respiratory care - Restrictive physiology plus a big operation means a real risk of postoperative respiratory failure; plan support and analgesia for breathing.

Scoliosis is a lateral curvature and rotation of the spine. Beyond the deformity, severe thoracic scoliosis distorts the chest wall and produces a restrictive ventilatory defect with reduced lung volumes and, when advanced, pulmonary hypertension and cor pulmonale.

Some scoliosis is secondary to neuromuscular disease, with its own anesthetic implications including malignant-hyperthermia and relaxant concerns. Corrective spinal surgery is long, prone, and associated with major blood loss and spinal-cord-injury risk requiring neuromonitoring.