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At least 451 records · Page 25Linked to original sources
PubMed1991

Intrathecal morphine: dosage and efficacy in younger patients for control of postoperative pain following spinal fusion.

Intrathecal morphine in an average dose of 0.01 mg/kg was given to 33 patients between ages 11 and 16 years who had spinal arthrodesis for idiopathic scoliosis. The morphine was administered intrathecally as a 10-cc bolus at the conclusion of the arthrodesis, but before closure. The goal was to study safety in terms of respiratory depression and pain relief. Respirations occurred spontaneously in 30 of the 33 patients within 15 minutes of cessation of anesthesia. Respiratory depression occurred in five patients, four of whom had arterial blood pCO2 levels greater than 60 mm Hg. Thirty-one patients had relief of pain for 8 to greater than 40 hours, averaging 18 hours. Two patients had no noticeable pain relief. There appeared to be no relation between dose and pain relief in this limited dose range. We were unable to duplicate the long duration of pain relief reported elsewhere. We also were unable to decrease the side effects of respiratory depression and nausea to a level reported by others. It may be that the 10 cc bolus injected intrathecally circulates to the brain and ventricles faster than desired, or that factors relating to type of anesthesia or dose need to be considered. Low-dose intrathecal morphine does provide noticeable pain relief in younger patients undergoing spinal fusion. The side effects of nausea and respiratory depression can be managed safely with medication.

Adolescent↗
PubMed1991

Intrathecal morphine in younger patients for postoperative pain following spinal fusion.

Intrathecal morphine in an average dose of 0.01 mg/kg was given to 33 patients between ages 11 and 16 years who had spinal arthrodesis for idiopathic scoliosis. The morphine was administered intrathecally as a 10 cc bolus at the conclusion of the arthrodesis, but before closure. The goal was to study safety in terms of respiratory depression and pain relief. Respirations occurred spontaneously in 30 of the 33 patients within 15 minutes of cessation of anesthesia. Respiratory depression occurred in five patients, four of whom had arterial blood pCO2 levels greater than 60 mm Hg. Thirty-one patients had relief of pain for 8 to greater than 40 hours, averaging 18 hours. Two patients had no noticeable pain relief. There appeared to be no relation between dose and pain relief in this limited dose range. We were unable to duplicate the long duration of pain relief reported elsewhere. We also were unable to decrease the side effects of respiratory depression and nausea to a level reported by others. It may be that the 10 cc bolus injected intrathecally circulates to the brain and ventricles faster than desired, or that factors relating to type of anesthesia or dose need to be considered. Low-dose intrathecal morphine does provide noticeable pain relief in younger patients undergoing spinal fusion. The side effects of nausea and respiratory depression can be managed safely with medication.

Adolescent↗
PubMedDate not supplied

Posterior spinal fusion complicated by posterior column injury. A case report of a false-negative wake-up test.

A case is reported of an isolated posterior column injury secondary to direct mechanical trauma complicating a posterior spinal fusion. This case documents a rare complication of posterior spinal surgery. Intraoperative somatosensory-evoked potential (SEP) monitoring documented the injury whereas two intraoperative wake-up tests did not. This case demonstrates the value of intraoperative spinal cord monitoring in general. It also demonstrates the value of combining means to assess both anterior and posterior cord separately, intraoperatively. It is recommended that the wake-up test be used in conjunction with SEPs intraoperatively.

Adult↗
PubMed1985

Posterior spinal fusion and instrumentation in the treatment of adolescent idiopathic scoliosis.

Three hundred and nineteen patients with adolescent idiopathic scoliosis were treated by posterior spinal fusion over an eight year period. The changes in preoperative correction and surgical techniques are reviewed. The anaesthetic technique using induced hypotension and the postoperative routine are described. The amount of deformity and its correction at operation and postoperatively is discussed by reference to Cobb angles. The early and late complications are reviewed.

Adolescent↗
PubMed1998

[A case report on surgery for chylothorax after anterior spinal fusion: usefulness and effectiveness of intraoperative milk administration and postoperative OK-432 administration].

A 75-year-old man of chylothorax after anterior spinal fusion successfully underwent thoracoabdominal operation in order to ligate chyloleakage. Not only preoperative milk intake but also intraoperative administration of milk through nasogastric tube was useful for identification of the site of leakage. OK-432 was administered through locally placed and chest tube after operation, after which residual chyloleakage was stopped. lntraoperative administration of milk through nasogastric tube was useful and OK-432 injection through topical and chest tube may be effective, these should be recommended for management of chylothorax.

Aged↗
PubMed2005

Allograft bone in spinal fusion for adolescent idiopathic scoliosis.

OBJECTIVE: The purpose of this long-term study was to determine the efficacy of allograft bone for spinal fusion for adolescent idiopathic scoliosis. Prior studies comparing allograft and autograft have been short term. METHODS: This multicenter retrospective study was carried out on 111 patients with 132 total curves fused for adolescent idiopathic scoliosis. Minimum follow-up was 5 years (average 72 months). A variety of segmental instrumentation was used, with most being dual-rod, multiple-hook constructs. RESULTS: Average preoperative curve was 59 degrees with immediate correction to 29 degrees (51%) and final follow-up of 32.24 degrees (45.4%). Average loss of correction was 3.5 degrees (5.9%). There were three pseudarthroses, one infection, and no rod breakage. CONCLUSION: Pseudarthrosis rate of 2.7% and loss of correction of 5.9% are comparable with or better than those in previous reports using autogenous bone graft and either segmental or nonsegmental instrumentation.

Adolescent↗
PubMed2002

Low-dose ketorolac improves analgesia and reduces morphine requirements following posterior spinal fusion in adolescents.

PURPOSE: To determine if low-dose ketorolac would improve analgesia while minimizing unwanted side effects in adolescents following posterior spinal fusion (PSF). METHODS: A prospective randomized double-blind placebo-controlled trial assessed the analgesic effects of low-dose ketorolac following PSF. Thirty-five adolescents aged 11-17 yr were randomly assigned to receive placebo or 0.5 mg x kg(-1) ketorolac (maximum of 15 mg) six hourly postoperatively for 36 hr in conjunction with standard morphine patient controlled analgesia (PCA). Pain and sedation were assessed twice daily for the first three postoperative days (POD). The incidence of side effects related to both non-steroidal anti-inflammatory agents and opioids were recorded. RESULTS: Adolescents in the ketorolac group received an average dose of 0.2 mg x kg(-1) (average exposure 1.2 mg x kg(-1)), had lower pain scores on POD one and two (P < 0.05) and consumed less morphine in the postanesthesia care unit and on POD two. There was no difference in the incidence of pruritus, nausea, vomiting or constipation, but patients in the ketorolac group tolerated activity better on POD one (P < 0.05). There were no differences between groups with regard to postoperative blood loss or transfusion requirements. Fourteen patients were followed for two years and the incidence of curve progression, hardware failure or back pain at final follow-up was not different. CONCLUSION: Low-dose ketorolac in conjunction with morphine PCA improved the quality of analgesia and reduced morphine requirements following PSF compared to placebo without increasing the incidence of non-steroidal anti-inflammatory side effects.

Adolescent↗
PubMedDate not supplied

Repeat lumbar surgery. A review of patients with failure from previous lumbar surgery treated by spinal canal exploration and lumbar spinal fusion.

Thirty-six patients with chronic back and/or leg pain following previous lumbar surgery who underwent both spinal canal exploration and spinal fusion were subjected to retrospective review. The purpose was to determine the probability of success for this surgical approach. Twenty (56%) of the 36 patients had a satisfactory result. In 15 patients with multiple objective findings of an ongoing radiculopathy, 11 (73%) improved. Only nine (43%) of 21 patients improved if these preoperative criteria were absent. Analysis according to the type of surgery performed in the spinal canal demonstrated improvement in (a) 17 (74%) of 23 patients who had wide bony decompression, (b) eight (61%) of 12 patients who had discectomy, and (c) seven (47%) of 15 patients who had an extensive neurolysis. In 17 patients whose time interval between the previous operation and present reconstruction was greater than 18 months, 13 (76%) improved. Only seven (36%) of 19 patients with a shorter time interval improved. The presence of pseudarthrosis was a poor indication for repeat lumbar surgery. The number of previous lumbar surgeries may not necessarily preclude a satisfactory outcome. Solid fusion correlated highly with a satisfactory outcome. Best results are obtained when objective preoperative findings indicate the presence of a surgically correctable abnormality.

Back Pain↗
PubMed1986

Stimulation of bone formation by electrical current on spinal fusion.

An experimental double-blind study to evaluate the effectiveness of a constant current stimulator was performed on 30 young pigs that underwent a spinal fusion at the level of L5-L6. The group of animals with an active bone-growth stimulator showed a statistically significant increase of osteoblastic activity with bone formation.

Animals↗
PubMed2005

A prospective comparison of thoracoscopic vs open anterior instrumentation and spinal fusion for idiopathic thoracic scoliosis in children.

BACKGROUND/PURPOSE: The management of scoliosis in children has been evolving. Anterior release, diskectomy, and anterior instrumentation and spinal fusion (AISF) may be of benefit compared with a combined anterior and posterior or a posterior-only approach. Because thoracoscopic AISF (TAISF) has the potential benefit of muscle sparing, superior cosmesis, and less pain, the authors decided to prospectively compare this newer technique with open AISF (OAISF) to evaluate whether the 2 approaches were equivalent. METHODS: All children with idiopathic thoracic scoliosis undergoing AISF at a single center were prospectively examined. One hundred fifty-five children who had a minimum of 1-year follow-up were included in the study. Descriptive statistics are reported as means and SDs. Groups were compared using the independent-samples t test with Levene's test for equality of variances; a 2-tailed P value of .05 or less was considered significant. RESULTS: Open AISF was performed in 114 patients and TAISF was performed in 41; there were 126 girls and 29 boys. Mean age at surgery was similar (14 +/- 3 vs 14.3 +/- 1.5 years; P = .5), as was weight (54.2 +/- 19 vs 54.6 +/- 23 kg; P = .9). There were no differences in preoperative thoracic curves (48.5 degrees +/- 14 degrees vs 49.8 degrees +/- 7 degrees; P = .6) or in the number of vertebral levels instrumented (7.7 +/- 1.3 vs 7.6 +/- 0.7; P = .7). Operative time was shorter with OAISF (383 +/- 65 vs 508 +/- 98 minutes; P < .01), and there was less estimated blood loss (924 +/- 724 vs 1218 +/- 747 mL; P = .03). The OAISF group took longer to extubate (1.4 +/- 1.2 vs 1 +/- 0.3 days; P = .03) and had slightly greater chest tube drainage (1710 +/- 730 vs 1639 +/- 515 mL; P = .5). At the 1-year follow-up, the thoracic curves were similar (17.5 degrees +/- 8 degrees vs 15.2 degrees +/- 7.5 degrees; P = .1) and percentage correction of thoracic curves was also similar (64% vs 69%). CONCLUSIONS: Thoracoscopic AISF is safe and effective in correcting idiopathic childhood scoliosis. Correction of deformity with TAISF is equivalent to OAISF, although it takes longer and has more blood loss. However, it spares cutting muscle, uses smaller skin incisions, and appears to have superior cosmesis.

Adolescent↗
PubMed2005

Evaluation of spinal fusion using autologous anterior strut grafts and posterior instrumentation for thoracic/thoracolumbar kyphosis.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To evaluate anterior strut grafts in spinal fusion for thoracic/thoracolumbar kyphosis. SUMMARY AND BACKGROUND DATA: Autologous strut grafts harvested from the fibula, iliac crest, and rib are frequently used for treating severe kyphosis and kyphoscoliosis. However, a majority of the studies have presented mixed patient populations kyphosis and/or scoliosis, treated either with anterior or anteroposterior fusion. Very few reports have presented an evaluation of autologous strut grafts for anterior fusion with posterior instrumentation for the treatment of kyphotic deformities. METHODS: A total of 23 patients comprised the study. Diagnosis was granulomatous infection (9 patients), congenital (6), posttraumatic (4), neurofibromatosis (1), ankylosing spondylitis (1), Scheuermann disease (1), and plasmacytoma of the vertebral body with pathologic fracture (1). Average age at surgery was 41 years (range 6-77). Indication for surgery was pain with or without progression in 15 patients and additional progressive neurologic deficit in the other 8. Anterior strut grafts consisted of the autologous fibula (9 patients), iliac (10), fibula and ribs (2), fibula and iliac (1), and fibula, iliac, and ribs (1). The fusion areas were thoracic (11 patients), thoracolumbar (11), and cervicothoracic (1). Anterior decompression was performed in 8 patients because of the presence of neurologic symptoms caused by cord compression. Dorsal fusion was performed in all patients with third-generation systems. RESULTS: Average 4.2 vertebrae were fused anteriorly. Mean follow-up bracing time was 9.7 months. Average kyphosis measured 50.9 degrees before surgery and 32.5 at a mean follow-up of 4.5 years (P < 0.0001). No graft breakages were noted at final follow-up. Solid fusion was achieved in all patients. No donor site complications were observed. Of the 8 patients presenting with neurologic deficits, 4 had full recovery, 3 had partial recoveries, and 1 had no improvement. Loss of postoperative correction > 5 degrees was observed in 3 patients. At final follow-up, 3 patients complained of occasional pain, and 1 complained of pain when lying on the back, particularly on hard surfaces. CONCLUSION: Adequate correction was maintained throughout an average follow-up of 4.5 years, and solid fusion was obtained in all patients. Anterior strut grafts, supplemented with posterior fusion with instrumentation provide a good treatment alternative for the treatment of kyphosis deformity of the spine as a result of various etiologies.

Adolescent↗
PubMed1994

Assessment of painful late effects of lumbar spinal fusion with SPECT.

UNLABELLED: The authors reviewed planar, SPECT and other contemporaneous radiologic images of the spine and the medical records of 33 patients with back pain after lumbar fusion surgery in order to determine the value of SPECT in the assessment of painful late effects of spinal fusion surgery. METHODS: Twenty-one patients had lateral fusion, nine patients had posterior fusion only and three patients had anterior and posterior fusions. There were 24 patients who had surgery more than 4 yr ago (late group, mean 11.8 yr) and 9 patients who had surgery less than 4 yr ago (early group, mean 17.8 mo). RESULTS: The most common SPECT abnormality in patients in the late group were lesions in the vertebral bodies and apophyseal joints in the free motion segments adjacent to the fused segments (62.5% of patients). Such lesions occurred in 46% of patients after lateral fusion, in 87.5% of patients after posterior fusion and in 67% of patients after posterior and anterior fusions. No SPECT abnormalities were detected in the fused segments in patients in the late group with solid lateral fusion but were detected in three patients with solid posterior fusion. These results correlate with biomechanical studies that have shown posterior fusion to produce the largest amount and lateral fusion to produce the least amount of stress in the free segments adjacent to the fusion. Lateral fusion was found to have a more stabilizing effect than posterior fusion. CONCLUSION: In addition to the already established value of SPECT in detecting painful pseudoarthrosis, our results indicate that SPECT is of value in the assessment of painful late effects of fusion.

Adult↗
PubMed1985

Transcutaneous electrical nerve stimulation for pain control after spinal fusion with Harrington rods. A clinical report.

During the past two years, we have been using transcutaneous electrical nerve stimulation (TENS) for pain control after spinal fusion with Harrington rods. This report describes our postoperative pain management program and our evaluation of its effectiveness. We examined postoperative pain medication usage and found that patients using TENS received fewer doses of several commonly prescribed pain drugs than did patients not using TENS devices. Difficulties we encountered in evaluating our program are described along with recommendations for other researchers interested in assessing TENS in the management of postoperative pain.

Adolescent↗
PubMed1998

The influence of desmopressin on blood loss during spinal fusion surgery in neuromuscular patients.

STUDY DESIGN: A double-blind study comparing the effects of desmopressin and a placebo (normal saline) on blood loss during spinal instrumentation for neuromuscular scoliosis. OBJECTIVE: To determine the effectiveness of desmopressin acetate (DDAVP) in reducing operative blood loss in hemostatically normal patients undergoing spinal fusion surgery for neuromuscular scoliosis. SUMMARY OF BACKGROUND DATA: Desmopressin acetate has been shown to improve bleeding times and to provide surgical hemostasis in patients with platelet disorders. Its effect in reducing bleeding times in normal patients has been the subject of debate in several surgical specialties. Recent observations that DDAVP seems to reduce bleeding times and blood loss in patients undergoing spinal surgery for neuromuscular scoliosis warranted a more focused analysis on its role in this surgical procedure. METHODS: Patients undergoing surgery for neuromuscular scoliosis were randomly assigned to receive DDAVP or placebo. Bleeding times and plasma clotting factors were measured before the administration of the DDAVP or placebo and 60 minutes after. Operative blood loss was carefully measured. RESULTS: Although the administration of DDAVP decreased overall blood loss by an average of 19% compared with blood loss in the placebo group and blood loss per vertebra fused by an average of 15%, these results were not statistically significant. CONCLUSIONS: Bleeding time and blood loss seem to respond better to DDAVP in some patients, in whom significant decreases were observed, than they do in others. The problem is in identifying those patients in whom a decrease in bleeding time will be elicited after administration of DDAVP. Preoperative administration of DDAVP to such patients should significantly decrease operative blood loss.

Adolescent↗
PubMed2004

Spinal fusion using bone morphogenetic proteins.

Dr. Harvinder Sandhu, one of the lead investigators in clinical trials that resulted in the approval of bone morphogenetic protein-2 (BMP) for spinal fusion, updates Orthopedics on the current status of BMPs.

Bone Morphogenetic Proteins↗
PubMed1989

Synthetic biomaterials for spinal fusion.

Calcium hydroxylapatite (HAP), tricalcium phosphate (TCP), and Bioglass (BG) were implanted in the spines of dogs to determine their potential in augmenting and enhancing spinal fusion. HAP and TCP showed continuous bone to biomaterial interfaces of varying degrees. Trabecular bone surrounded and incorporated the particulate hydroxylapatite. Tricalcium phosphate ceramic showed little evidence of resorption. The glass particulate, BG, showed a thin, fibrous encapsulation with some adjacent bony trabeculae. Decortication and autogenous bone enhanced incorporation. This multivariant initial study showed that trends found for the biomaterials implanted independently were similar to those used in combination. No adverse tissue reactions were noted for the combination of materials.

Animals↗