What pre-operative assessments are necessary for patients undergoing neurosurgery for spinal disorders?

Pre-operative assessment for patients undergoing neurosurgery for spinal disorders requires a comprehensive multidisciplinary approach to optimise surgical outcomes and patient safety. Initial clinical evaluation should include a detailed neurological examination assessing motor strength, sensory function, and signs of spinal cord or nerve root compression, as well as a thorough history including previous spinal conditions or surgeries ¹. Imaging investigations are essential, with MRI of the spine being the gold standard to delineate the extent of spinal pathology, spinal cord compression, and to guide surgical planning. MRI sequences should include sagittal T1 and/or STIR, sagittal T2-weighted, and supplementary axial images through abnormalities. If MRI is contraindicated, CT scanning with multiplanar reconstruction is recommended to assess spinal stability and anatomy ¹.

Medical assessment should evaluate comorbidities that may impact surgery, such as cardiovascular, respiratory, and metabolic conditions, as well as optimisation of these prior to surgery (Arora et al., 2023). This includes assessment of airway, breathing, circulation, and neurological status, especially in trauma cases, with spinal immobilisation maintained during assessment ¹,². Pre-operative planning should also consider the patient’s functional status and goals, including rehabilitation potential and discharge planning ¹.

Additional considerations include screening for factors that may complicate surgery such as infection, coagulopathy, and nutritional status, although these are not explicitly detailed in the UK guidelines but are supported by recent literature emphasizing a holistic preoperative evaluation (Arora et al., 2023). In children and young people undergoing neurosurgical interventions for spinal disorders, specialist neurosurgical centre involvement for pre-implantation assessments and ongoing monitoring is advised ³.

In summary, the necessary pre-operative assessments for neurosurgery in spinal disorders integrate detailed neurological and functional evaluation, advanced imaging primarily with MRI, comprehensive medical optimisation, and multidisciplinary planning including rehabilitation considerations ¹,² (Arora et al., 2023).