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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.

Objective: To explore the clinical effect of posterior decompression screw and spinal canal decompression fixation on patients with thoracic spinal cord injury. Methods: A total of 54 patients with thoracic pulp injury were selected and divided into control group (27 cases) and study group (27 cases) by random number table method. The control group was treated with posterior decompression laminae screw, and the study group was treated with spinal canal decompression fixation. Relevant surgical indexes of the two groups were analyzed. Serum inflammatory factors were detected. Visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the degree of pain and dysfunction in the two groups. Frankel scale was used to evaluate the spinal cord injury of the patients, and the postoperative effects of the two groups were compared. Results: Compared with the control group, the operation time, intraoperative blood loss, surgical incision and hospital stay in the study group were reduced, with statistical differences (all P<0.05). 1 and 3 months after surgery, compared with the control group, the decrease degree of interleukin1B (IL-1β), tumor necrosis factor-a (TNF-α), VAS and ODI scores in the study group was more significant, and the increase degree of Frankel grade was more significant, with statistical difference (all P<0.05). Compared with the control group, the clinical effect of the study group was more significant, with statistical difference (P<0.05). Conclusion: The treatment effect of spinal canal decompression and fixation for patients with thoracic spinal cord injury is good. After treatment, the inflammatory level of patients is reduced, pain is relieved, and motor function and nerve function are restored. The overall effect is significant, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to identify the incidence, clinical features, and risk factors for postoperative acute pancreatitis (PAP) after lumbar surgery. Methods: We retrospectively analyzed patients who developed PAP after posterior lumbar fusion surgery. For each PAP patient, data were collected for four controls who underwent procedures in the same period and did not develop PAP. Statistical methods included univariate and multivariate analyses. Results: Totally, 21 out of 20,929 patients were diagnosed with PAP (0.10%) after posterior lumbar fusion surgery. Patients with degenerative lumbar scoliosis were at higher risk of developing PAP (P < 0.05). With atypical clinical features, PAP occurred within 3 days (0–5) after surgery. PAP patients had significantly higher incidence of osteoporosis (47.6 vs. 22.6%, P = 0.030) and fusion of L1/2(42.9 vs. 4.3%, P = 0.010), lower albumin (42.2 ± 4.1 vs. 44.3 ± 3.2 g/L, P = 0.010), more fusion segments (median 4 vs. 3, P = 0.022), larger surgical invasiveness index (median 9 vs. 8, P = 0.007), longer operation duration (232 ± 109 vs. 185 ± 90 min, P = 0.041), greater estimated blood loss (median 600 vs. 400 mL, P = 0.025), lower intraoperative mean arterial pressure (87.2 ± 9.9 vs. 92.1 ± 8.8 mmHg, P = 0.024). Multivariate logistic regression analysis found three independent risk factors: fusion of L1/2, surgical invasiveness index > 8, and intraoperative mean arterial pressure < 90 mmHg. All patients were treated with conservative therapy and fully recovered after 8.1 (4–22) days. Conclusion: The incidence of PAP following posterior surgery for degenerative lumbar disease was 0.10%, and its clinical features were not typical. The fusion of L1/2, high surgical invasiveness index, and low intraoperative mean arterial pressure were independent risk factors for PAP after surgery for lumbar degenerative disease. [ABSTRACT FROM AUTHOR]

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

Objective To investigate the safety and efficacy of acute hypervolemic hemodilution (AHH) combined with controlled low central venous pressure (CLCVP) in posterior spinal surgery. Methods From February 2021 to January 2022, a total of 60 patients who underwent elective posterior spinal surgery in this hospital were selected, and the American Association of Anesthesiologists classified them as Grade Ⅰ-Ⅱ. They were randomly divided into group C (AHH combined with CLCVP) and group F (routine infusion), with 30 cases in each group using the randomized numerical table method. After entering the room, the patients in both groups were monitored by radial artery puncture and central venous puncture (CVP) under local anesthesia. Routine anesthesia was induced, and perioperative infusions and medications were managed using CLCVP anesthesia techniques. The infusion volume, bleeding volume, urine volume, blood transfusion volume, operation time and nitroglycerin dosage of the two groups were recorded. And the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2), hemoglobin (Hb), hematocrit (Hct), CVP, blood glucose, blood lactate, Hemagglutination indexes [including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg) and platelet count (Plt)], blood gas analysis [including pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), arterial oxygen saturation (SaO2) and alkali residue (BE)] at each time point before anesthesia induction (T0), at the beginning of skin incision (T1), at the beginning of operation (T2), at the end of operation (T3), at the end of operation (T4) and at the first day after operation (T5) were recorded. Perioperative adverse reactions, complications and steward score during recovery also were recorded. Results The operation time in group C was shorter than that in group F and the dosage of nitroglycerin was higher than that in group F, but the differences were not statistically significant (P＞0. 05). The infusion volume and urine volume in group C were significantly higher than those in group F, and the bleeding volume, plasma and suspended red blood cells were significantly lower than those in group F, with statistical significances (P＜0. 05). Compared with T0, the average arterial pressure and heart rate in the two groups were significantly decreased from T1 to T3, the Hb and Hct in group C were significantly decreased from T1 to T4, the CVP and platelet count were significantly decreased, and the PT and APTT were significantly prolonged from T1 to T3. The Hb in group F was significantly decreased from T2 to T5, and the Hct was significantly decreased from T3 to T4, with statistical significances (P＜0. 05). Compared with group F, the Hb in group C decreased significantly at T1, increased significantly at T5, the Hct at T1, CVP decreased significantly from T1 to T3, the PT and APTT prolonged significantly from T1 to T3, with statistical significances (P＜0. 05). There were no significant differences in perioperative adverse reactions, complications and steward score between the two groups (P＞0. 05). Conclusion AHH combined with CLCVP can be safely used in posterior spinal surgery which has a good blood protection effect. It can significantly reduce the amount of intraoperative bleeding and allogeneic blood transfusion, maintain the stability of hemodynamics and internal environment during operation, and keep stable recovery period, without increasing perioperative adverse reactions and complications. At the same time, CLCVP is conducive to providing a clear surgical field and shorten the operation time. [ABSTRACT FROM AUTHOR]

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

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 < 0.001), male gender (OR 2.26 [95% CI: 1.01, 5.05], 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 < 0.001. 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

• Postoperative MP occurs with a higher incidence after spinal surgery than after craniotomy. • Thoracic and lumbar laminectomies are associated with a higher incidence of MP than the other. • The preoperative TK is significantly greater in patients with than in those without MP. Obesity and a prolonged surgical duration are reported risk factors for meralgia paresthetica (MP) after prone position surgery; however, this fails to explain why MP seldom occurs after prone position craniotomy. We reviewed the incidence of MP after spinal surgery and craniotomy in the prone position and investigated whether unidentified factors are involved in the mechanism of postoperative MP. Between January 2014 and March 2020, we performed 556 prone position surgeries. We excluded patients aged ≤16 years and those who were comatose or who required redo-surgery, and reviewed 446 eligible patients (124 who underwent craniotomies and 322 who underwent posterior spinal surgeries). Postoperative MP occurred in 46 (10.3%) patients with a higher incidence after spinal surgery than after craniotomy (13.7% vs. 1.6%, p < 0.001). Among the 322 patients who received posterior spinal surgery, thoracic and lumbar laminectomies were associated with a higher incidence of MP than cervical laminectomy. Analyses limited to those patients who received thoracic and lumbar laminectomies revealed that the preoperative thoracic kyphosis (TK) angle was significantly greater in patients with MP than in those without MP (average TK angle, 38.9° vs. 23.1°; p < 0.001), and that the preoperative lumbar lordosis angle did not significantly differ between the two groups. Apart from the known predisposing factors, we found that thoracolumbar-sacral laminectomy in patients with a greater TK angle is also a risk factor for MP after prone position surgery. [ABSTRACT FROM AUTHOR]

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]

Abstract: Pneumocephalus is a rare, but serious complication of spinal surgery and its management and physiology is not widely recognized. Symptomatic tension pneumocephalus secondary to iatrogenic cerebrospinal fluid (CSF) leak after surgical intervention, and drainage with a vacuum suction device, has not been previously reported. We report a patient who underwent intervertebral disc surgery who developed pneumoencephalus after drainage with a vacuum suction device. Imaging showed significant pneumocephalus in the subarachnoid space of the frontal region and in the cisterns. The condition was resolved by discontinuation of the suction drainage, bed rest and hyperhydration. Thus, spinal drainage may predispose to entry of air intracranially and pneumocephalus. It is important to be aware of this serious post-operative complication in patients with a CSF fistula. [Copyright &y& Elsevier]

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.)