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Background: The erector spinae plane block (ESPB) was proposed as a part of the postoperative multimodal analgesic regimen to improve pain management after posterior spinal surgery. However, ESPB might cause more surgical incisional wound exudate and poor wound healing, which might be improved after topical lyophilized thrombin application. Materials and methods: We performed a retrospective study on patients who received posterior spinal surgery between January 2018 and December 2021. These patients were assigned into three groups: group A (general anesthesia), group B (general anesthesia with ESPB), and group C (general anesthesia with ESPB and topical 1000-unit thrombin application). Postoperative outcomes, including times of dressing changes, duration of suture removal, and incisional wound healing, were compared among these groups. Results: Our study included 89 patients, with 48, 20, and 21 patients in groups A, B, and C, respectively. Baseline demographics, height, weight, comorbidities, and operation duration were comparable among the three groups. Group B required statistically significantly more dressing changes and had a prolonged duration of suture removal than group A (9.4 ± 4.7 versus 6.5 ± 2.0 times, 16.2 ± 3.7 versus 14.2 ± 1.4 days, respectively), which could be statistically significantly improved after the thrombin application in group C. Group B also had more frequent poor wound healing (25.0 %), which could also be improved after the thrombin application (0.0 %). Conclusions: ESPB could cause more dressing changes and poor surgical wound healing after posterior spinal surgery, which could be improved by topical lyophilized thrombin powder application.

IntroductionDistal junctional kyphosis (DJK) is a serious complication after posterior spinal surgery in managing adolescent idiopathic scoliosis (AIS). Our study aims to investigate the predictors of DJK in AIS patients.MethodsWe searched the English databases of PubMed, Embase, and the Cochrane Library for clinical research studies on AIS. To identify the risk factors for DJK, we collected demographic data, such as age, gender, and body mass index (BMI), and sagittal parameters, including preoperative pelvic tilt (PT), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), distal junctional angle (DJA), lowest instrumented vertebrae (LIV) relative to sagittal stable vertebrae (SSV), and postoperative DJA. Data were analyzed by RevMan (5.3 version) and STATA (12.0 version).ResultsFinally, six included articles (1,240 patients) showed 9% (98 of 1,240 patients) of patients suffering from DJK. Our findings indicated that preoperative TK [p = 0.007, OR = 0.35, 95% CI (0.10, 0.61)], TLK [p

Background: Posterior spinal surgery for adolescent idiopathic scoliosis is aimed at correcting deformity and stopping deformity progression to improve the health related quality of life. The correlation between radiological outcome and health related quality of life is yet unclear. This study aimed to assess the correlation between radiological outcome and health related quality of life. Methods: A descriptive cross-sectional study of 31 cases of adolescent idiopathic scoliosis who underwent posterior spinal surgery at our center from July 2013 to August 2019, was done. Radiological outcomes were measured by the Cobb’s angle before and after surgery in standing whole spine X-ray and compared by paired t-test. Health related quality of life was measured by Scoliosis Research Society-30 questionnaire. Correlation between radiological outcomes and Scoliosis Research Society-30 and its domains were assessed by Pearson’s correlation coefficient, and Spearman’s rank correlation coefficient. Results: There were 18 females (58.06%) and 13 males (41.93%) with a mean age of 14.81 years (range 12-18 years). Average post-operative follow-up was 37 months (range 6-82 months).The mean amount of deformity correction post-operatively was 460 (range 300-740). The mean of total SRS-30 score was 137.64±7.84. The post-operative Cobb angle correlated significantly with the mean total Scoliosis Research Society-30 score (p=0.046). Self-image/appearance and satisfaction with management correlated significantly with residual deformity and amount of deformity correction. Self-image/appearance and pain correlated significantly with satisfaction with management. Self-image/appearance had a significant positive correlation with mental health (p=0.004). Conclusions: Posterior spinal surgery for adolescent idiopathic scoliosis provided better radiological outcomes, and a positive correlation with health related quality of life. There was significant improvement of self-image/appearance and satisfaction after surgery, which in turn, improved mental health.

Ye Zhang,1,* Bin He,1 Jinqiu Zhao,2,* Muzi Zhang,1 Qinsong Ren,1 Wei Zhang,1 Shuai Xu,1 Zhengxue Quan,1 Yunsheng Ou1 1Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bin He Email binheing@163.comBackground: Serious pain commonly occurs after posterior spinal surgery. This study aims to evaluate the effect of preemptive and multimodal analgesia using celebrex, pregabalin and ropivacaine on pain control after this surgery.Methods: Ninety-three patients undergoing posterior spinal surgery were enrolled in this prospective, randomized, double-blind, placebo-controlled clinical trial. All patients were treated with patient- controlled analgesia (PCA, intravenous tramadol hydrochloride and flurbiprofen) as required. They were randomized to combination analgesia intervention (oral celebrex, pregabalin and subcutaneous infiltration of ropivacaine), ropivacaine intervention (only subcutaneous infiltration of ropivacaine), and control intervention (placebo). We compared postoperative visual analog scale (VAS) scores and PCA dose among the three groups.Results: The VAS scores were significantly lower in the combination analgesia group than in the control group at 0 h, 2 h, 12 h, 24 h, 3 d, 5 d, 7 d and 14 d after posterior spinal surgery, while combination analgesia was also superior to ropivacaine in terms of VAS scores at 24 h and 14 d postoperatively. The combination analgesia group was also associated with significantly reduced PCA consumption compared with the control group, but there was no statistical difference in PCA consumption between the ropivacaine group and control group.Conclusion: Combination analgesia using celebrex, pregabalin and ropivacaine is effective and safe to alleviate pain after posterior spinal surgery.Clinical Trial Registration: Chinese Clinical Trial Registry No. ChiCTR2000031236.Keywords: preemptive analgesia, multimodal analgesia, pain control, posterior spinal surgery, randomized trial

Introduction: There is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE), either on using or timing it in patients undergoing spine surgery. VTE is a current concern because, even though being an uncommon event, it can cause serious complications. The aim of the present study is to propose guidelines for the prevention of thrombotic events in posterior spinal surgery, either as deep vein thrombosis or pulmonary thromboembolism. If the number of patients getting prophylaxis drugs is reduced a subsequent reduction of the incidence of epidural hematoma can be expected., Materials and Methods: A number of 235 patients who had undergone posterior spinal arthrodesis in the previous five years were studied. Mechanical thromboprophylaxis measures consisting of compression stockings were applied in all of them. Anticoagulant drugs were also applied whenever risk factors for thrombosis were observed. Early weight-bearing was resumed immediately after surgery. Demographic, clinical, and surgical variables were collected, as well as complications appearing during the follow-up period, that was scheduled at one, two, four, six and twelve months after the surgery. Thrombotic events, if present, were diagnosed by clinical and imaging tests such as ultrasound and CT angiography., Results: From the total 235 patients of this series, one hundred and fifty-three cases met the study inclusion criteria. A total of four thrombotic events appeared, one in the form of deep vein thrombosis and other three in the form of pulmonary thromboembolism. These last patients suffering an embolism died because of it. None of the variables studied had statistical significance for the occurrence of a thrombotic event. All four patients who suffered thrombotic events were receiving anticoagulant drugs, in addition to mechanical compression stockings, because of the presence of risk factors for thrombosis., Conclusions: By applying the fore mentioned protocol, adequate prevention of thromboembolic events was achieved in this study population of patients undergoing posterior spinal surgery., (Copyright © 2024 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The erector spinae plane block (ESPB) was proposed as a part of the postoperative multimodal analgesic regimen to improve pain management after posterior spinal surgery. However, ESPB might cause more surgical incisional wound exudate and poor wound healing, which might be improved after topical lyophilized thrombin application., Materials and Methods: We performed a retrospective study on patients who received posterior spinal surgery between January 2018 and December 2021. These patients were assigned into three groups: group A (general anesthesia), group B (general anesthesia with ESPB), and group C (general anesthesia with ESPB and topical 1000-unit thrombin application). Postoperative outcomes, including times of dressing changes, duration of suture removal, and incisional wound healing, were compared among these groups., Results: Our study included 89 patients, with 48, 20, and 21 patients in groups A, B, and C, respectively. Baseline demographics, height, weight, comorbidities, and operation duration were comparable among the three groups. Group B required statistically significantly more dressing changes and had a prolonged duration of suture removal than group A (9.4 ± 4.7 versus 6.5 ± 2.0 times, 16.2 ± 3.7 versus 14.2 ± 1.4 days, respectively), which could be statistically significantly improved after the thrombin application in group C. Group B also had more frequent poor wound healing (25.0 %), which could also be improved after the thrombin application (0.0 %)., Conclusions: ESPB could cause more dressing changes and poor surgical wound healing after posterior spinal surgery, which could be improved by topical lyophilized thrombin powder application., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The current surgical treatment for patients diagnosed with progressive and severe adolescent idiopathic scoliosis (AIS) consists of the correction of the spinal curvature, followed by posterior spinal fusion (PSF). However, research has uncovered short- and long-term complications of posterior spinal fusion in patients with AIS. Minimally invasive growing rod techniques have successfully been used to treat patients with early-onset scoliosis and neuromuscular scoliosis. It may be questioned if minimally invasive posterior spinal nonfusion (PSnF) surgery with bipolar instrumentation can be used for the treatment of AIS., Objective: This study will be performed to monitor the efficacy and safety of PSnF surgery by using a commercially available Conformité Européenne-certified spinal implant consisting of bilateral bipolar one-way self-expanding rods (OWSER) for the treatment of patients diagnosed with AIS., Methods: In 14 selected patients with AIS with Lenke 1-6 curves, minimally invasive PSnF surgery with the OWSER system is performed after the failure of conservative treatment (curve progression of >5° within 1 year). The patients are over 7 years of age, with a major Cobb angle of ≥30°, sufficient flexibility, and a Risser stage of ≤2. Patients will be followed over time, according to the standard medical care. Efficacy will be measured using radiological and patient satisfaction assessments and safety will be determined by the amount of perioperative complications., Results: Patient inclusion started on November 17, 2021 and we hope to finalize patient inclusion by the beginning of 2025. The first results will be expected by the beginning of 2024., Conclusions: Minimally invasive PSnF in patients with AIS is presented as a less invasive surgical technique that prevents the progression of the scoliotic curve and that allows minor posture correction of coronal imbalance. This will be the first study to examine whether the PSnF bipolar OWSER instrumentation will be the next generation of surgical instrumentation in AIS., Trial Registration: ClinicalTrials.gov NCT04441411; https://clinicaltrials.gov/study/NCT04441411., International Registered Report Identifier (irrid): DERR1-10.2196/47222., (©Anne Mareille Post, Hanneke I Berends, Barend J van Royen. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 25.12.2023.)

Introduction: Distal junctional kyphosis (DJK) is a serious complication after posterior spinal surgery in managing adolescent idiopathic scoliosis (AIS). Our study aims to investigate the predictors of DJK in AIS patients., Methods: We searched the English databases of PubMed, Embase, and the Cochrane Library for clinical research studies on AIS. To identify the risk factors for DJK, we collected demographic data, such as age, gender, and body mass index (BMI), and sagittal parameters, including preoperative pelvic tilt (PT), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), distal junctional angle (DJA), lowest instrumented vertebrae (LIV) relative to sagittal stable vertebrae (SSV), and postoperative DJA. Data were analyzed by RevMan (5.3 version) and STATA (12.0 version)., Results: Finally, six included articles (1,240 patients) showed 9% (98 of 1,240 patients) of patients suffering from DJK. Our findings indicated that preoperative TK [ p  = 0.007, OR = 0.35, 95% CI (0.10, 0.61)], TLK [ p  < 0.0001, OR = 5.99, 95% CI (3.33, 8.65)], and postoperative DJA [ p  = 0.002, OR = 0.56, 95% CI (0.21, 0.91)] in the DJK group were markedly higher than those in the non-DJK group. Moreover, patients with LIV above SSV [ p  < 0.0001, OR = 7.95, 95% CI (4.16, 15.22)] were more likely to develop DJK. No discernible difference was found in age, sex, BMI, preoperative PT, SVA, LL, or DJA between the two groups., Conclusions: Regarding the AIS patients, factors such as higher preoperative TK and TLK, higher postoperative DJA, and LIV above the SSV were related to an increased rate of DJK., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Jia and Long.)

Objective: This study was performed to investigate the risk factors related to surgical site infection (SSI) secondary to spinal internal fixation via the posterior approach., Methods: Patients who had undergone spinal internal fixation via the posterior approach were selected for inclusion in this cross-sectional study. Factors related to SSI were analysed using univariate and multivariate analyses., Results: Among 4,350 patients, 66 had SSI (infection prevalence of 1.5%). Multivariate logistic regression analysis demonstrated that age of >60 years, surgical duration of >3 hours, haemoglobin concentration of <80 g/L, serum albumin concentration of <30 g/L, diabetes history, and blood loss of >1,000 mL were significantly correlated with SSI secondary to spinal internal fixation via the posterior approach., Conclusions: This study provides information on SSI secondary to spinal internal fixation via the posterior approach. We found that age of >60 years, surgical duration of >3 hours, haemoglobin concentration of <80 g/L, serum albumin concentration of <30 g/L, diabetes history, and blood loss of >1,000 mL are directly correlated with SSI secondary to spinal internal fixation via the posterior approach.

Background and Objective: Opioid medications used to be the key method for the pain management after spine surgery; most of the opioids may cause many adverse reactions. The purpose of this research was to observe the role of dexmedetomidine combined with butorphanol in the pain management of patients after posterior spinal surgery. Methods: This research was conducted at the First Hospital Affiliated to Jinzhou Medical University, China from May 2018 to January 2019. Sixty patients who underwent posterior spinal surgery were equally divided into two groups randomly: Group B who received butorphanol 0.125 mg/kg and Group DB who received dexmedetomidine (DEX) 0.1 µg/kg/hour plus butorphanol (B) 0.125 mg/kg. The patient-controlled analgesia was conducted to deliver a bolus dose of 0.5 ml. followed by an infusion of 2 ml/hour and a lockout time of 15 minutes nutes. Heart rate, mean arterial pressure, respiration rate, pulse oxygen saturation, visual analog scale score (VAS), and Ramsay sedation score were recorded as follows: 1 hour (T1), 2 hours (T2), 6 hours (T3), 12 hours (T4), and 24 hours (T5) post-surgery. The total number of buttons pressing of patient controlled intravenous analgesia (PCIA) and supplementary analgesic agents was observed and adverse drug reactions and total rate of patient satisfaction were evaluated statistically. Results: VAS scores at different intervals in DB group were significantly lower compared with the B group after surgery; while the score of Ramsay sedation was remarkably higher in DB group. The total number of buttons pressing of PCIA was less than that of the B group and the frequency of nausea was notably lower in DB group (p < 0.05). The total rate of satisfaction with analgesia in DB group was higher after surgery. Conclusion: DEX could enhance the analgesic effect of butorphanol after posterior spinal surgery with lesser adverse reactions. [ABSTRACT FROM AUTHOR]

Objective: Postoperative intensive care unit (ICU) admission might be required in adolescent patients following posterior fusion and instrumentation surgery for the treatment of scoliosis. We aimed to evaluate the predictive factors for mechanical ventilation and the characteristics of the patients who required an ICU stay following spinal surgery., Methods: We retrospectively reviewed the records of 85 children undergoing primary scoliosis surgery at a university-affiliated general hospital from January 2010 and June 2020 by the same spinal surgeon. The demographic data, pre- and peritoperative variables were collected and recorded. All patients underwent surgery with a combined anesthesia protocol of fentanyl and remifentanil., Results: There were 31 males (36.5%) and 54 females (63.5%). In the postoperative period, 13 patients (15.3%) were admitted to the ICU, and six of them required mechanical ventilation. Among these, three patients (50%) were extubated within the postoperative 0-12 hours, two (33.3%) within postoperative 12-24 hours, and one (16.7) after postoperative 24 hours. The major complications included acidosis (4.7%), hemodynamic instability (1.2%), hypercapnia (1.2%), hypoxemia (1.2%), and delayed extubation (1.2%)., Conclusions: A smaller bodyweight percentile, neuromuscular etiology, abnormal findings in preoperative chest X-ray, additional comorbidities, and preoperative estimated risk for postoperative mechanical ventilation were among the risk factors for postoperative ICU stay. The age, height, weight, degree of the curvature, and the number of operated segments did not have an association with the postoperative outcomes., Competing Interests: None., (AJTR Copyright © 2021.)