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Purpose To determine predictors for postoperative urinary retention in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. Postoperative urinary retention affects almost every third adolescent after spinal fusion for idiopathic scoliosis. There are limited data regarding the risk factors of postoperative urinary retention in this patient group. Methods A retrospective study with prospectively collected urinary retention data from paediatric spine register with 159 consecutive patients (114 females, mean age 15.6 years, range 10–21 years) undergoing pedicle screw instrumentation for adolescent idiopathic scoliosis at a university hospital between May 2010 and April 2020. Postoperative urinary retention was defined as an inability to void after catheter removal and documented residual over 300 mL as confirmed using an ultrasound or by catheterization. Results Postoperative urinary retention was diagnosed in 33% (53 of 159) of the patients during hospital stay. Opioid amount on the day of catheter removal (OR 6.74 [95% CI: 2.47, 18.36], p p = 0.048), and increasing weight (OR 1.04 [95% CI: 1.01, 1.07], p = 0.014) were associated with postoperative urinary retention. Mean opioid consumption on the day of catheter removal was 0.81 mg/kg (95% CI: 0.66, 0.96) in the retention group vs 0.57 mg/kg (95% CI: 0.51, 0.64) in the non-retention group, p Conclusions Higher total opioid consumption, opioid amount on the day of catheter removal, higher weight, and male gender increases the risk of postoperative urinary retention in adolescents with idiopathic scoliosis undergoing posterior spinal fusion.

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. Keywords: Adolescent idiopathic scoliosis; health related quality of life; posterior spinal surgery; radiological outcome

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

Rationale: Atlantoaxial transarticular screw fixation has been an effective and appealing method for inducing fusion of the C1-C2 complex. This technique is usually performed with Gallie fusion. In performing Gallie fusion using sublaminar wiring, a major concern is the risk of dural tear associated with passing sublaminar wires through the epidural space. We present the first report on symptomatic symptomatic subdural hygroma (SDH) due to transarticular screw fixation with posterior wiring. Patients concerns: A 50-year-old man had sustained dens fracture 20 years ago and presented with severe neck pain following a recent traffic accident. The images showed atlantoaxial instability due to nonunion of the dens fracture and the patient underwent transarticular screw fixation with posterior sublaminar wiring using Gallie technique. When the U-shaped wire was passed under the arch of C1 from inferior to superior, a dural tear and cerebrospinal fluid (CSF) leak occurred. The site of dural tear was repaired by direct application of sutures. The patient was discharged in good condition. Fifteen day after surgery, the patient was readmitted with a history of a progressive headache associated with vomiting and vertigo. Diagnonsis: Brain CT and MRI showed bilateral posterior fossa and a right-sided supratentorial SDH. Interventions: The patient underwent right occipital burr hole and evacuation of posterior fossa SDH due to deteriorating neurological status. Outcomes: The patient's condition gradually improved after the operation and became asymptomatic at 3-year follow-up. Lessons: Posterior fossa and supratentorial SDH could occur resulting from any intraoperative dural tear and CSF leakage during posterior cervical spinal surgery. Symptomatic SDH after posterior cervical spinal surgery should be cautiously assessed and treated. Level of Evidence: 5

International audience; This grand round raises the risk of a rare complication that can be avoided with the knowledge of the particular anatomy of scoliosis vertebra. Transpedicular screws have been reported to enhance the operative correction in scoliosis surgery. The narrow and inconsistent shape of the thoracic pedicles makes the placement of pedicle screws technically challenging. Furthermore, in thoracic curves, the close proximity of the spinal cord and major soft tissue structures also adds a greater risk to the procedure. The esophagus lies close to the upper thoracic vertebras and, an anterior cortical perforation can cause esophageal injury. We report a case of anterior cortical perforation by a T4 pedicle screw complicated by an esophageal perforation in a 15-year-old girl with convulsive encephalopathy. She was operated for a severe neurological scoliosis (Rett syndrome). Her neurological condition deteriorated 3 years after the posterior spinal surgery, requiring a percutaneous gastrostomy. An intra-esophageal screw was discovered incidentally during an endoscopy. We decided not to remove this screw, because the patient's health status presented a surgical contraindication. The patient showed no apparent discomfort at the 10-year follow-up examination after spinal arthrodesis. Esophageal perforation caused by a posterior pedicle screw is very rare. We highlight the risk of injury to esophagus from pedicle screws in upper thoracic vertebra. The systematic removal of a malpositioned screw must be discussed, on a case-to-case benefit-risk basis, especially if the patient has numerous comorbidities, given the long-term tolerance of a number of these improperly positioned implants.