IS MONOPOLAR DIATHERMY SAFE IN PAEDIATRIC NEUROMUSCULAR SCOLIOSIS SURGERY WITH AN IMPLANTED VAGAL NERVE STIMULATOR?

Children with drug-resistant epilepsy requiring vagal nerve stimulation (VNS) may have associated neurological and motor impairment predisposing them to progressive neuromuscular scoliosis. Manufacturer guidance classifies surgical electrocautery as a precaution rather than a contraindication, yet monopolar diathermy is often avoided because of concerns regarding device interference or damage. We reviewed the available literature and our institutional experience to evaluate the safety of monopolar diathermy during scoliosis surgery in patients with an implanted VNS.

A structured search of PubMed, EMBASE, Scopus and Web of Science identified evidence relating to scoliosis surgery in patients with VNS, diathermy use during VNS surgery, perioperative guidance and other implanted electronic devices. No primary study reported VNS damage, generator failure or clinically significant device malfunction attributable to monopolar diathermy. We also reviewed six consecutive paediatric patients with an implanted VNS undergoing posterior spinal fusion for neuromuscular scoliosis over three years, compared with seven matched controls. The VNS was deactivated preoperatively, grounding pads were positioned on the posterior thighs distal to the generator, and monopolar diathermy was used throughout.

Postoperative interrogation confirmed normal device function in all six patients, with no generator or lead damage, parameter disruption or clinically apparent deterioration in seizure control attributable to surgery. Operative time was similar between groups (303.3 versus 307.1 minutes, p = 1.000). Blood loss as a proportion of estimated blood volume (73.1% versus 46.9%, p = 0.018) and PICU stay (29.5 versus 1.7 days, p = 0.046) were greater in the VNS cohort. The prolonged PICU requirement reflected greater underlying medical complexity, including requirements for seizure management, respiratory monitoring and nutritional rehabilitation, rather than VNS dysfunction or diathermy-related complications.

We conclude that monopolar diathermy can be used without observed VNS dysfunction during paediatric neuromuscular scoliosis surgery when appropriate perioperative precautions are taken. Together with the available literature, these findings support protocol-guided monopolar diathermy use rather than blanket avoidance based on theoretical risk.