Spine Surgery, Spinal Cord Injury, Prone Positioning Mechanics, and Scoliosis Correction — WACS Viva & Clinical Scenarios (Orthopaedics & Trauma)

Exam-style spine surgery, spinal cord injury, prone positioning mechanics, and scoliosis correction viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 26-year-old male (ASA 3E) is brought to the theatre following a diving accident resulting in a C4 burst fracture with complete sensory and motor loss below the clavicles. His BP is 75/40 mmHg and HR is 44 bpm. He is scheduled for emergent anterior cervical decompression. Detail your airway management, haemodynamic goals, and pharmacological choices.
• SCENARIO 2: A 14-year-old female (ASA 2) with severe Adolescent Idiopathic Scoliosis (Cobb angle 78°, restrictive lung pattern on spirometry with FVC 55% predicted) presents for posterior spinal fusion from T4 to L3. Intraoperative neurophysiological monitoring is unavailable. Describe your anaesthetic maintenance technique, blood loss mitigation strategy, and conduct of the intraoperative Stagnara wake-up test.
• SCENARIO 3: A 48-year-old male (ASA 3) is scheduled for a 5-hour L2-L5 lumbar decompression and fusion in the prone position. Outline the physiological effects of the prone position on the cardiovascular and respiratory systems, and describe your protocol for preventing Postoperative Visual Loss (POVL) and peripheral nerve injuries.
• SCENARIO 4: A 35-year-old male (ASA 3E) with chronic T4 complete paraplegia sustained 2 years ago presents for emergent open reduction and internal fixation of a fractured femur. During skin incision, his BP spikes to 230/125 mmHg, HR drops to 38 bpm, and he develops profuse sweating and blotching of the face and neck. Diagnose the condition and outline your emergent anaesthetic intervention.