Patients Undergoing Scoliosis Surgery Research Articles

Visual Loss after Scoliosis Surgery: What Do Surgeons and Patients Need to Know? Three Case Reports.

Visual deficit after spinal surgery is rare but tragic. The main causes include external eye injury, cortical blindness, central retinal artery occlusion, and ischemic optic neuropathy. In scoliosis surgery, this complication potentially arises from prolonged surgical time, high blood loss, prone position, hydroelectrolytic imbalance, and cerebrospinal fluid loss. In 849 scoliosis correction surgeries, 3 patients developed postoperative visual deficits: 2 achieved complete visual acuity recovery, but 1 remained with partial sequelae. There are four causes of postoperative amaurosis: ischemic optic neuropathy, central retinal artery occlusion, external eye injury, and cortical blindness. Since the prevention of this complication cannot be assured, it is essential to explain the risk of visual deficits to patients undergoing scoliosis surgery, who must sign the informed consent form. Visual loss after spinal surgery for scoliosis correction is a rare but severe and, sometimes, irreversible complication. The surgical team must know about this possibility in order to adopt preventive measures and reduce its incidence.

Neuraxial Analgesia for Scoliosis Correction: A Case Series in a Specialised Children's Centre.

Surgical correction of spinal deformities in children presents a challenge to the anaesthetist due to the extensive nature of the surgery, the co-morbidities of the patients and the constraints on aesthetic techniques of intraoperative neurophysiological monitoring of the spinal cord. Patients undergoing scoliosis surgery are considered to suffer severe pain, which may lead to a negative impact on patient psychology and physical well-being. By using effective postoperative pain regimens to enhance recovery after surgery, pain can be significantly reduced, leading to patient satisfaction, facilitating early mobilisation, promoting oral intake, lowering postoperative pain and shortening the length of hospital stay. Thus, the primary objectives of this study were to assess the postoperative pain management andfirst rescue analgesic medications, by using preservative-free morphine 50 mcg/kg and dexmedetomidine 4 mcg along with normal saline 0.5 ml kg caudally, as well as to look for thesecondary objectivesside effects, including respiratory depression, nausea, vomiting and pruritis, timing of postoperative ambulation and length of hospital stay. Methods: In this study, we retrospectively included children under 14 years of age and above three years who underwent scoliosis surgery under a caudal epidural-general anaesthesia using caudal morphine and the dexmedetomidine technique in the period from January to May 2023 at the National Guard Health Affairs Hospital (NGHA), Riyadh. We collected the data of seven cases using the electronic chart system of the Best Care database to extract the specific cases that meet the inclusion criteria for the study, which are idiopathic scoliosis patients, aged 3-14 years, and primary correction procedures. Results: The pain-free duration was between seven hours and 48 hours (about two days). There were four female cases (57.14%), and three cases were male (42.85%). The patients' American Society of Anesthesiologists (ASA) status were II to III. In all the cases, there was no documentation of any episodes of postoperative nausea and vomiting (PONV), respiratory distress or pruritus, except for one case where the patient had an episode of PONV. Conclusion: In this study, our aim was to present our experience with dexmedetomidine as an efficient medication when coadministered with morphine to be used in the operating room. We found a high level of reliability in prolonging analgesia time and delaying the usage of rescue medication. We encourage more studies on caudal dexmedetomidine for patients undergoing scoliosis surgery.

Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block (ESPB) in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-Blinded, Controlled Trial.

This study aimed to compare the effect of the ultrasound-guided bilateral and bilevel erector spinae plane block (ESPB) on pain scores, opioid requirement, intraoperative motor-evoked potentials (MEPs), and stress response to surgery expressed by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) versus standard analgesia methods following idiopathic scoliosis surgery. This was a prospective, double-blinded, randomized controlled trial. Sixty patients aged 10 to 18 years and physical status ASA 1 or 2 were randomized into 2 equal groups, each receiving an ESPB or sham block. The primary outcome was the pain scores (Numerical Rating Scale, NRS) within 48 hours after spinal correction and fusion surgery for idiopathic thoracic scoliosis. The secondary outcomes were total opioid consumption, NLR, and PLR levels at 12 and 24 hours postoperatively and intraoperative MEPs. ESPB patients presented lower NRS scores, signifying less pain, at all time points (30, 60, 90, 120 min; and 6, 12, 24, and 48 h after surgery), all P <0.0001. The total opioid consumption, the incidence of nausea or vomiting, and the need for remifentanil and propofol during surgery were significantly lower in the ESPB group. The surgery-induced stress response expressed by NLR and PLR was considerably lower in the ESPB group. ESPB did not affect the intraoperative MEP's amplitude. ESPB is effective for postoperative analgesia, can reduce opioid consumption in patients undergoing scoliosis surgery, and reduces the stress response to surgery. ESPB does not interfere with neuromonitoring. Level I.

PCA-pump for analgesia following pediatric scoliosis surgery: bolus administration with/without basal infusion.

The aim of this study is to compare the use of two different opioid delivery systems (bolus PCA with/without basal infusion) to control postoperative pain and evaluate the side effect profile in pediatric patients undergoing scoliosis surgery. 38 patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis were included in the study. Patients were randomly divided into 2 groups by the computer. Patients who received only bolus PCA were named Group 1, and patients who received bolus PCA with basal infusion were named Group 2.Morphine consumption, postoperative pain assessmentduring rest, movement and coughing with numeric rating scale (NRS) and the Wong -Baker pain scale, heart rate and average blood pressure, sedation levels withRamsey sedation scale and side effects such as nausea, vomiting, itching, desaturation, and urinary retention were recorded. Total mean morphine consumption (mg) was 32.7 ± 9.7 in Group 1 and 43.4 ± 9.1 in Group 2. The mean morphine consumption (mg) at 12-24hours and 0-48hours in Group 1 was statistically lower than Group 2 (p = 0.001). There was no significant difference between the groups in terms of median NRS scores (p = 0.55). There was no statistically significant difference in the evaluation of the groups in terms of Wong-Baker pain scale. Wong-Baker pain scale is p:0.66 at the 2nd hour, p:0.951 at the 12th hour and p:0.467 at the 24th hour.There was no statistically significant difference in Ramsay Sedation Scale evaluation between groups during each follow-up time (p > 0.05). The Ramsay Sedation Scale was p: 0.94 at the 2nd hour, p:1.0 at the 12th hour, and p:1.0 at the 24th hour. The duration of vomiting between 0-2h, 2-24h and 0-48h was higher in Group 2 (p = 0.001, p = 0.024, p = 0.001). The two administration settings of morphine sulphate by PCA pump have shown to be equally effective in the treatment of postoperative pain following PSF. In addition, PCA with basal infusion administration causes more opioid consumption and more systemic side effects. Therefore, the use of only bolus PCA in pediatric scoliosis surgery should be encouraged. LevelII, Randomized Controlled Trial.

Effectiveness and Safety of Intrathecal Morphine for Pediatric Patients Undergoing Scoliosis Surgery: A Systematic Review and Meta-Analysis.

Adolescent idiopathic scoliosis (AIS) often necessitates spinal fusion surgery in pediatric patients, posing significant challenges in postoperative pain management. Standard care involves the administration of intravenous opioids perioperatively, often requiring high doses to achieve adequate analgesia following an operation. This increases the risk of adverse events, may delay recovery and prolong hospital stay, and increases the likelihood of future abuse and dependence. In this systematic review and meta-analysis, we assess the safety and effectiveness of intrathecal morphine (ITM) in pediatric patients undergoing posterior spinal fusion. Ovid Embase and MEDLINE were searched in October 2023 for articles that directly compared ITM use with standard pain management approaches for pediatric patients undergoing posterior spinal fusion. Our primary outcome was postoperative pain scores. Secondary outcomes included opioid usage details, adverse events, and blood loss. Of the 384 unique studies identified, nine studies (one randomized control trial, one prospective review, and seven retrospective reviews) met the inclusion criteria. The total number of patients within the ITM and control groups were 1384 and 676, respectively. Meta-analysis revealed significantly lower pain scores in the ITM group (standardized mean difference (SMD):-1.30 (-2.29, -0.31); p = 0.01). Similarly, ITM patients had significantly lower opioid usage, both intraoperatively (mean difference (MD): -0.71 mg/kg (-0.99, -0.44); p < 0.00001) as well as postoperatively (SMD: -2.10 (-3.48, -0.73); p = 0.003), and significantly lower blood loss (MD: -0.88 L (-1.34, -0.43); p = 0.0001). The occurrence of adverse events was similar across both groups. Our analysis of the available data demonstrates that a low to moderate dose of ITM is a safe and effective adjunct to improve standard postoperative care without increasing the risk of respiratory depression. When compared to control, ITM patients had superior analgesia while using fewer opioidshad significantly reduced intraoperative blood loss when ITM was administered before spinal fusion, and had a similar complication profile. While further studies are warranted to establish optimal dosing, these findings underscore the potential of ITM as a valuable addition to multimodal pain management.

The perioperative analgesic effect of opioid free anesthesia using combination of dexmedetomidine, ketamine and lidocaine in adolescent patients undergoing Scoliosis Surgery; A randomized Controlled Trial

ABSTRACT Background Posterior spinal fusion treatment is one of the most painful options accessible to teenagers with idiopathic scoliosis. Objectives This study evaluated the opioid-sparing anesthesia analgesic effect using a combination of dexmedetomidine, ketamine and lidocaine versus opioid-based anesthesia (OBA) with fentanyl in adolescent patients undergoing scoliosis surgery. Methods This prospective, double-blinded, randomized study was conducted on 50 patients, American Society of Anesthesiologists (ASA) physical state I–II, scheduled for surgical correction of adolescent idiopathic scoliosis under general anesthesia. Patients were equally categorized into two groups: group I – opioid-free anesthesia (OFA) and group II – OBA. Intraoperative magnesium, total postoperative morphine consumption, time to first postoperative rescue analgesia and adverse effects were recorded. Results Total postoperative morphine consumption at 24 h was insignificantly different between groups. The proportion of patients requiring intraoperative magnesium was significantly higher in OBA (P < 0.001). Visual analog scale was only significant at 1 and 2 h which was significantly higher in group OBA than group OFA (P = 0.012 and < 0.001, respectively). Time to first postoperative rescue analgesia was significantly earlier in OBA than in OFA. Hemodynamic stability was insignificantly different between both groups. Bradycardia, postoperative nausea and vomiting and respiratory depression were insignificantly different between groups. Conclusions In adolescent patients ASA I-II undergoing scoliosis correction surgery, OFA with a combination of dexmedetomidine, ketamine and lidocaine could provide adequate intra- and postoperative pain management, which can obviate the use of intraoperative opioids minimizing the total postoperative opioid requirements compared to OBA using fentanyl.

Updating the Evidence: Systematic Literature Review of Risk Factors and Strategies for Prevention, Diagnosis, and Treatment of Surgical Site Infection After Pediatric Scoliosis Surgery.

Surgical site infection (SSI) is a major potential complication following pediatric spinal deformity surgery that is associated with significant morbidity and increased costs. Despite this, SSI rates remain high and variable across institutions, in part due to a lack of up-to-date, comprehensive prevention, and treatment protocols. Furthermore, few attempts have been made to review the optimal diagnostic modalities and treatment strategies for SSI following scoliosis surgery. The aim of this study was to systematically review current literature on risk factors for SSI in pediatric patients undergoing scoliosis surgery, as well as strategies for prevention, diagnosis, and treatment. On January 19, 2022, a systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting risk factors for acute, deep SSI (<90d) or strategies for prevention, diagnosis, or treatment of SSI following pediatric scoliosis surgery were included. Each included article was assigned a level of evidence rating based on study design and quality. Extracted findings were organized into risk factors, preventive strategies, diagnostic modalities, and treatment options and each piece of evidence was graded based on quality, quantity, and consistency of underlying data. A total of 77 studies met the inclusion criteria and were included in this systematic review, of which 2 were categorized as Level I, 3 as Level II, 64 as Level III, and 8 as Level IV. From these studies, a total of 29 pieces of evidence (grade C or higher) regarding SSI risk factors, prevention, diagnosis, or treatment were synthesized. We present an updated review of published evidence for defining high-risk patients and preventing, diagnosing, and treating SSI after pediatric scoliosis surgery. The collated evidence presented herein may help limit variability in practice and decrease the incidence of SSI in pediatric spine surgery. Level III-systematic review.

Factors Affecting Intraoperative Blood Loss in Scoliosis Surgery: An Observational Cross-sectional Study

Introduction: Significant intraoperative blood loss may be associated with scoliosis surgery. To know about the quantity of blood loss and risk factors associated is imperative in limiting the blood loss as well as to plan transfusion strategies like blood conservation techniques. Aim: To evaluate the quantity of intraoperative blood loss in scoliosis surgery and to study the various factors contributing to blood loss. Materials and Methods: This was a cross-sectional prospective observational study conducted at Government Medical College, Thiruvananthapuram, India, from January 2019 to January 2020. Thirty-five (ASA I and II) consecutive patients were scheduled to undergo surgery for correction of scoliosis, and consecutive sampling was done. Age, gender, weight, height and body mass index were noted. During surgery, intraoperative blood loss was measured by gravimetric method from the suction drain and by numerically assessing the quality of the surgical field by the operating surgeon using fromme’s ordinal scale. All these data were entered into structured proforma and analysed by using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of subjects was 13.69±1.43 years. The mean intraoperative blood loss was 645.60±143.26 mL {20.11±11.7 % of Estimated blood volume (EBV)}. Mean duration of surgery (r=0.890, p&lt;0.001),Cobb’s angle (r=0.829, p&lt;0.001), number of fused vertebra (r=0.694, p&lt;0.001) correlated with intraoperative blood loss, expressed as a percentage of EBV. The quality of the surgical field, using Fromme’s ordinal scale by visual assessment, correlated with the mean intraoperative blood loss (p=0.001). Conclusion: Duration of surgery, number of fused vertebrae, and preoperative cobb’s angle are the most important factors predicting intraoperative blood loss in patients undergoing scoliosis surgery.

Pulse-train versus single-pulse t-EMG stimulation for intraoperative neurophysiologic monitoring of thoracic pedicle screws in adolescent idiopathic scoliosis

ObjectiveTo assess the PTS method in neuromonitoring of thoracic pedicle screws in a young cohort of AIS patients. The accuracy of both PTS (Pulse-train stimulation) and SPS (Single-pulse stimulation) techniques in the detection of misplaced thoracic screws was compared with special reference to the screws placed at the concavity and the convexity of the curve. Patients and methodsA single-center prospective clinical cohort study. Level of evidence II. Twelve AIS patients who underwent elective surgery were included in this study. Screw stimulation using repetitive constant-current stimulus train of variable intensities was first performed after screw insertion. SPS was performed immediately after PTS. Postoperatively, CT scan was used to check the final position of the screws. A total of 246 thoracic pedicle screws were placed. Thresholds of screws placed in the convexity and the concavity were compared. ResultsInvasion of the spinal canal was postoperatively confirmed in 29 of the pedicle screws. The SPS technique detected three (10.3%) of these screws using a threshold limit of 12 mA. The PTS technique detected 25 (86.2%) of the 29 misplaced screws using threshold of 30 mA (negative predictive value, 93.1%). When using a PTS threshold of < 20 mA, the positive predictive value was 70%. SPS did not detect any of the misplaced screws at the apex level of the scoliotic curves, and PTS detected 10 out of 17 of these screws. Overall, area under the ROC curve was 0.82 for PTS and 0.61 for SPS. ConclusionsPTS is a reliable method for detecting medially misplaced screws among young AIS patients undergoing scoliosis surgery. PTS provides more accurate predictions than SPS and improves the identification of screws invading the spinal canal at the apex or near the apex levels.

Goal Directed Fluid Therapy based on Stroke Volume Variation and Oxygen Delivery Index using Electrical Cardiometry in patients undergoing Scoliosis Surgery

ABSTRACT Background: The primary outcome was to evaluate whether goal-directed fluid therapy (GDFT) protocol, established on stroke volume variation (SVV) and oxygen delivery index (DO2I) using electrical cardiometry (EC) monitor, would be effective in reducing perioperative packed red blood cells (RBCs) transfusion, whereas the secondary outcome was to compare the effects of GDFT with liberal fluid therapy (LFT) as regards total amount of fluids transfused, perioperative complications, and postoperative length of ICU and total hospital stay. Settings and Design: This study was a prospective randomized controlled clinical trial. Methods: The study was carried out on 48 patients scheduled for scoliosis surgery. Twenty-four patients, whose intraoperative fluid administration was managed with the GDFT protocol, were compared with 24 patients who received a liberal intraoperative fluid therapy. The proposal and raw data were registered on PACTR as PACTR202007901764021. Results: Patients in group II received less units of packed RBCs (P < 0.001) and a lower volume of intraoperative crystalloids (P < 0.001). They had significantly lower serum lactate levels 2 h after induction (P = 0.033), at the end of surgery (P = 0.001) and 2 h postoperatively (P < 0.001) with shorter ICU stay (P < 0.001), total hospital length of stay (P < 0.001), and faster return of bowel function (P = 0.005). Conclusion:: Application of a GDFT protocol, established o SVV and DO2I using EC monitor in patients undergoing scoliosis surgery, can lead to reduced packed RBCs transfusions, reduced total crystalloid volume infusions, less postoperative pulmonary complications, shorter ICU, and total hospital stay with faster return of gastrointestinal function. Abbreviations: GDFT: goal-directed fluid therapy; SVV: stroke volume variation; DO2I: oxygen delivery index; EC: electrical cardiometry; LFT: liberal fluid therapy; CI: cardiac index; RBCs: red blood cells; CO: cardiac output; IVC: inferior vena cava; CVP: central venous pressure; MAP: mean arterial pressure; CaO2: arterial oxygen content; UOP: urine output; ASA: American Society of Anesthesiologist; BMI: body mass index; ROC: receiver operating characteristic; AUC: area under the curve; FFP: fresh frozen plasma

Scoliosis in Children: Impact of Goal-Directed Therapies on Intraoperative and Postoperative Outcomes

Background: Scoliosis is among interventions with high postoperative complication rates due to the characteristics of the surgery, where blood loss, transfusion and fluid requirements can be increased. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary analysis to describe outcomes in these patients was realized and presented here. Objective: To describe intraoperative and postoperative outcomes in patients under 18 years old in scoliosis surgery included in the initial study and to propose improvement and implementation measures. Methods: A secondary analysis of patients undergoing scoliosis surgery from 1 January 2014 to 17 May 2017 was undertaken in our institution—Necker Enfants Malades university hospital. The study was approved by the Ethics Committee. Results: There were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight patients (24.1%) presented intraoperative and/or postoperative complications. The most common intraoperative complication was hemorrhagic shock in 3 patients (2.6%). The most common postoperative organ failure was neurologic in seven patients (6%), respiratory in 3 patients (2.6%), cardio-circulatory in 2 patients (1.7%) and renal failure in 1 patient (0.9%). The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in 3 patients (2.6%), and abdominal sepsis and septicemia in 2 patients (1.7%). 12 patients (10.3%) had reoperations. Fifty-six patients (48.3%) had intraoperative transfusion. There was no in-hospital mortality. Conclusion: The portion of patients with intraoperative and or postoperative complications was 24.1%, integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.

46. Surgical outcomes in Rett syndrome patients are comparable to cerebral palsy patients

BACKGROUND CONTEXT Rett syndrome (RS) patients often present with scoliosis, which requires surgical correction. However, literature is limited and reports major surgical complications including respiratory failure, prolonged intubation, infections, significant blood loss, and prolonged hospital stay. Cerebral palsy (CP) patients undergoing scoliosis surgery may be comparable to RS patients. They are often nonverbal, nonambulatory with frequent respiratory and surgical complications. Most surgeons have comparatively more experience treating CP patients than RS. PURPOSE The objective of this study is to compare perioperative outcomes of RS and CP patients. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A total of 27 RS and 78 CP patients undergoing PSF from 2005-2018. OUTCOME MEASURES Cobb, kyphosis, pelvic obliquity, coronal decompensation, extubation rate, complication rate, EBL, surgical time, anesthesia time, levels fused, fixation points, METHODS Patient demographics, perioperative parameters, and X-ray measurements were collected at pre, post, and follow-up. Furthermore, a subanalysis was performed comparing the nonambulatory patients. Wilcoxon rank sums test and chi-square tests were utilized. RESULTS No significant difference for preop Cobb angle (p=0.16), kyphosis (p=0.20), and pelvic obliquity (p=0.09). No significant difference for fixation points (p=0.42), levels fused (p=0.79), time to extubation (p=0.53), complication rate (p=0.66), length of ICU (p=0.07) or hospital stay (p=0.71). EBL was significantly higher in CP patients (p=0.006) as was duration of anesthesia (p=0.04), and transfusion volume (p=0.01). However, surgical time (p=0.07) was similar. Postop Cobb (p=0.008) was significantly higher for CP, but kyphosis (p=0.18) and pelvic obliquity (p=0.09) were similar. Significant difference was found between both preop (p=0.02) and postop (p=0.03) coronal decompensation. Subanalysis of nonambulatory Rett and CP patients showed no significant difference in outcomes. CONCLUSIONS RS patients are comparable to CP patients in terms of surgical, periop, and radiographic outcomes. CP patients had significantly more EBL, intraop transfusions, and longer anesthesia time. The subjects did not differ in their ICU or hospital stays, nor their complication rate. Outcomes and periop expectations of RS patients are similar to CP. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Clinical and radiological factors associated with postoperative shoulder imbalance and correlation with patient-reported outcomes following scoliosis surgery

BackgroundShoulder balance (SB) is an important cosmetic concern and is a determinant to assess outcomes following scoliosis surgery. Shoulder imbalance (SI) has been studied predominantly in idiopathic scoliosis with limited literature on other etiologies. PurposeTo assess SB following scoliosis surgery and correlate SRS-30 self-image scores with radiological shoulder imbalance SI. MethodsA retrospective analysis was performed for 43 patients undergoing scoliosis surgery with a minimum 2-year follow-up. Radiological SI was assessed by the coracoid height difference on whole spine standing radiographs at preoperative, 12-weeks postoperative and 2-year follow-up. The preoperative Cobb angle, postoperative Cobb angle and mean correction were recorded. The upper and lower end vertebrae (UEV/LEV), and instrumented vertebrae (UIV/LIV) were documented. The aetiology of scoliosis and functional outcomes based on the SRS-30 questionnaire were noted. ResultsThere were 19 males and 24 females with a mean age of 14.5 ± 4.7 years. The 12-week postoperative radiographs showed SI in 15 patients and residual SI in 7 patients at 2-year follow-up. SI was seen in four congenital scoliosis with segmentation or mixed anomalies in the proximal thoracic spine. Two idiopathic scoliosis (Lenke type 1 and type 3) showed SI where the UIV was T3 and T2 respectively. The mean preoperative SRS-30 score for patients with SB (N = 9) was 2.5 ± 0.72 and for SI (N = 34) was 3 ± 0.42 without significant difference (p > 0.5). The final mean SRS-30 self-image score for patients with SB was 3.7 ± 0.54 and for patients with SI was 3.7 ± 0.53 without significant difference (p > 0.05). ConclusionRadiological SI assessed by coracoid height difference was not associated with a significant difference in SRS 30 scores preoperatively and at 2 year follow up. SI was seen with congenital scoliosis associated with segmentation and mixed anomalies of the proximal thoracic spine.

The Tampa Scale of Kinesiophobia: Structural Validation among Adolescents with Idiopathic Scoliosis Undergoing Spinal Fusion Surgery

Aims Spinal fusion surgery is one of the most invasive orthopedic surgeries. Pain while moving or a fear of experiencing pain after surgery may delay return to function and cause prolonged disability. The purpose of the study was to examine the psychometric properties of the Tampa Scale of Kinesiophobia (TSK) in pediatric patients undergoing scoliosis surgery. Methods Fifty-five adolescents (10–18 years old) scheduled for spinal fusion surgery were enrolled. Participants completed the TSK questionnaire before surgery and six weeks after surgery. Reliability, exploratory and confirmatory factor analyses were performed on the two-factors TSK including activity avoidance (TSK-AA) and somatic focus (TSK-SF). Results Before and after surgery, all TSK-AA items conformed into the same factor component and revealed good internal reliability with Cronbach’s alpha of .76 and .70 respectively. TSK-SF items were separated into different factor components and revealed poor reliability (.11 and .56). The TSK-AA also produced an adequate fit to the data, as reflected with several fit indices at both timepoints, respectively: χ 2/df = 1.19 and 1.22; CFI=.96 and .94; and RMSEA=.06 and .06. Conclusions The TSK-AA demonstrated good psychometric properties in patients undergoing scoliosis surgery, which provides empirical evidence for pediatrics. Its validation in distinct populations and settings is recommended prior to its use.

Anaesthetic Management of Paediatric Patients Undergoing Scoliosis Surgery in Camp

BACKGROUND: Scoliosis is most commonly idiopathic in origin, but it may be congenital or secondary to neuromuscular disease, trauma, infection or neoplasm. Aim: Aims of surgery is to correct the curvature, improve posture and reduce progression of respiratory dysfunction.Objectives: Perioperative challenges for anaesthetist in scoliotic surgery are to avoid hypothermia, hemodynamic stability, spinal cord monitoring, positioning, induced hypotension, major blood loss, postoperative pain management and intensive care management of patient. Material and method: After taking parenteral consent, 15 paediatric patient’s data were collected who underwent scoliotic correction surgery over 12 days from 1st to 12th January of 2019. Result:Children underwent posterior fusion scoliosis surgery aged (11.2 ± 2.3) years. surgical duration and blood loss were (7.5 ±1.5) hours, (856 ±235) ml respectively. patients were shifted to ICU because of prolonged procedure and major fluid shift. Conclusion: Cardio-respiratory dysfunction may exist as a result of progressive scoliosis or related to coexisting disease, therefore careful preoperative assessment is required. Intraoperative considerations include the prone position, avoiding hypothermia, minimizing blood loss and monitoring spinal cord function. Good postoperative pain control is essential and requires a multimodal approach.

Radiation Exposure to the Surgeons and Patients in Fluoroscopic-Guided Segmental Pedicle Screw Placement for Pediatric Scoliosis.

Prospective case series. To analyze the radiation exposure to the surgeons and patients in fluoroscopic-guided segmental pedicle screw placement for pediatric scoliosis. Fluoroscopic-guided pedicle screw placement is a safer technique for pedicle screw placement in spinal deformity. However, radiation exposure is a concern, particularly for spine surgeons due to the requirement of multiple pedicle screws in spinal deformity surgery. We measured radiation dose to the surgeons and pediatric patients undergoing scoliosis surgery by a team of two surgeons (S1 and S2) from March 2016 to December 2017. Surgery was performed using fluoroscopic-guided segmental pedicle screw placement. The dosimeters were placed at the forehead, inside and outside thyroid shield, both hands, back, and suprapubic under lead apron for each surgeon; and at the thyroid and gonads for patients. Thirty patients were included in the study. The mean numbers of pedicle screws per case were 23.2 ± 3.4. The mean dose (mrem) per case for the two surgeons S1 and S2 was 0.07 and 0.47 at forehead, 0.07 and 0.37 at outside thyroid shield, 0.00 and 0.30 at inside thyroid shield, 16.87 and 13.73 at right hand, 6.07 and 11.37 at left hand, 0.50 and 0.00 at back, and 0.00 and 0.00 at suprapubic under lead apron, respectively. The mean dose (mrem) per case for the male and female patient was 3.67 and 14.71 for thyroid and 3.83 and 3.17 for gonads, respectively. The results of this study demonstrated that radiation exposure to the spine surgeons and patients is low using fluoroscopic-guided segmental pedicle screw technique for pediatric scoliosis surgery. Both hands of the surgeons received much higher doses compared to other body areas and, and thus radiation-reducing gloves and careful attention to surgeon's hands need to be considered for this procedure. 2.

Reduction of Deep Infections and Length of Stay in Paediatric Spinal Deformity Surgery After the Introduction of A Standardised Care Pathway

AIM: The purpose of the study was to investigate the impact of a new care pathway in reducing deep infections and length of stay following paediatric spinal deformity surgery in our institution. METHOD: Restropective longitudinal cohort study of patients pre and post-institution of a new care protocol for paediatric patients undergoing scoliosis surgery were analysed. The new protocol introduced in 2010 involved all aspects of care pre, intra- and post operatively including patient, nurse and surgeon education with strict adherence to rules regarding wound care. RESULTS: In total, 246 patients undergoing 275 procedures were studied. Between 2008-2009, 80 index procedures were performed, and between 2011-2012, 144 cases following the implementation of the pathway. There were no important demographic differences between the 2 cohorts. A significant reduction was seen in rates of infection from 37% to 2.9% for neuromuscular cases and 9.5% to 2.3% for idiopathic cases. An increased number of operations performed was also associated with a reduced mean hospital stay. CONCLUSION: Deep infection rates following paediatric spinal deformity surgery carry major implications for morbidity. Complications including length of stay may be reduced with a team based approach to wound care.

Quantitative analysis of a spinal surgeon's learning curve for scoliosis surgery.

The aim of this study was a quantitative analysis of a surgeon's learning curve for scoliosis surgery and the relationship between the surgeon's experience and post-operative outcomes, which has not been previously well described. We have investigated the operating time as a function of the number of patients to determine a specific pattern; we analysed factors affecting the operating time and compared intra- and post-operative outcomes. We analysed 47 consecutive patients undergoing scoliosis surgery performed by a single, non-trained scoliosis surgeon. Operating time was recorded for each of the four parts of the procedures: dissection, placement of pedicle screws, reduction of the deformity and wound closure. The median operating time was 310 minutes (interquartile range 277.5 to 432.5). The pattern showed a continuous decreasing trend in operating time until the patient number reached 23 to 25, after which it stabilised with fewer patient-dependent changes. The operating time was more affected by the patient number (r =- 0.75) than the number of levels fused (r=0.59). Blood loss (p = 0.016) and length of stay in hospital (p = 0.012) were significantly less after the operating time stabilised. Post-operative functional outcome scores and the rate of complications showed no significant differences. We describe a detailed learning curve for scoliosis surgery based on a single surgeon's practise, providing useful information for novice scoliosis surgeons and for those responsible for training in spinal surgery. Cite this article: Bone Joint J 2016;98-B:679-85.

Benefits of the use of blood conservation in scoliosis surgery.

AIMTo investigate whether autologous blood transfusion (ABT) drains and intra-operative cell salvage reduced donor blood transfusion requirements during scoliosis surgery.METHODSRetrospective data collection on transfusion requirements of patients undergoing scoliosis surgery is between January 2006 and March 2010. There were three distinct phases of transfusion practice over this time: Group A received “traditional treatment” with allogeneic red cell transfusion (ARCT) in response to an intra- or post-operative anaemia (Hb < 8 g/dL or a symptomatic anaemia); Group B received intra-operative cell salvage in addition to “traditional treatment”. In group C, ABT wound drains were used together with both intra-operative cell salvage and “traditional treatment”.RESULTSData from 97 procedures on 77 patients, there was no difference in mean preoperative haemoglobin levels between the groups (A: 13.1 g/dL; B: 13.49 g/dL; C: 13.66 g/dL). Allogeneic red cell transfusion was required for 22 of the 37 procedures (59%) in group A, 17 of 30 (57%) in group B and 16 of 30 (53%) in group C. There was an overall 6% reduction in the proportion of patients requiring an ARCT between groups A and C but this was not statistically significant (χ2 = 0.398). Patients in group C received fewer units (mean 2.19) than group B (mean 2.94) (P = 0.984) and significantly fewer than those in group A (mean 3.82) (P = 0.0322). Mean length of inpatient stay was lower in group C (8.65 d) than in groups B (12.83) or A (12.62).CONCLUSIONWhen used alongside measures to minimise blood loss during surgery, ABT drains and intra-operative cell salvage leads to a reduced need for donor blood transfusion in patients undergoing scoliosis surgery.

A New Approach to Reduce Pressure Ulcers and Improve Health of Scoliosis Surgery Patients

Background: Spinal fusion is the common form of corrective surgery for scoliosis, and it is often accompanied with the occurrence of pressure ulcer development. New research and approaches are needed to address the incidence of peptic ulcer in surgical patients. Objectives: The study was designed to reduce/prevent the incidence of pressure sores and to improve the health of patients undergoing scoliosis surgery. Methods: 130 patients with scoliosis surgery were randomly assigned into two groups: 65 patients in the training group and control group, respectively. The patients in the training group received a pre-surgery visit with adaptive training on prone position prior to their surgery, while the control group received no such training. Surgery preparation time and total time in the surgical room were recorded for all patients. The incidence and size of red skin and pressure sores due to scoliosis surgery were also measured and recorded upon surgeries. Results: A comparative analysis showed that a pre-surgical visit to the surgical room has significantly reduced the preparation time prior to surgery by up to 15 minutes for patients in test group, which led to an ostensible reduction of the total time for the day-of-surgery. The implementation of a pre-set optimal prone position helped test patients to reduce the incidence of pressure sores significantly from over 33.8% (control group) to less than 14% (test group, p<0.05). In particular, the optimal setting of the prone position with soft gel pats and cushion has effectively protected patients from serious facial damage as a result of a lengthy surgical process. Conclusion: A simple arrangement of a pre-surgical visit with adaptive training for optimal prone position to scoliosis patients could have important impacts on reducing the incidence of pressure sore and improving patients’ health condition.