Yrjälä Tommi, Helenius Ilkka, Rissanen Tiia, Ahonen Matti, Taittonen Markku, Helenius Linda
Department of Anesthesia and Intensive Care, University of Turku and Turku University Hospital, 20521 Turku, Finland.
Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
Children (Basel). 2022 Nov 10;9(11):1729. doi: 10.3390/children9111729.
Persistent pain after posterior spinal fusion affects 12 to 42% of patients with adolescent idiopathic scoliosis. The incidence of persistent pain among surgically treated children with Scheuermann kyphosis and spondylolisthesis is not known. The aim of our study was to determine the predictors and incidence of acute and chronic postoperative pain in adolescents undergoing posterior spinal fusion surgery. The study was a retrospective analysis of a prospectively collected pediatric spine register data. The study included 213 consecutive patients (158 AIS, 19 Scheuermann kyphosis, and 36 spondylolisthesis), aged 10-21 years undergoing posterior spinal fusion at a university hospital between March 2010 and March 2020. The mean (SD) daily postoperative opioid consumption per kilogram was significantly lower in the spondylolisthesis patients 0.36 mg/kg/day (0.17) compared to adolescent idiopathic scoliosis 0.51 mg/kg/day (0.25), and Scheuermann kyphosis 0.52 mg/kg/day (0.25) patients after surgery ( = 0.0004). Number of levels fused correlated with the daily opioid consumption (r = 0.20, = 0.0082). The SRS-24 pain domain scores showed a statistically significant improvement from preoperative levels to two-year follow-up in all three groups ( ≤ 0.03 for all comparisons). The spondylolisthesis patients had the lowest SRS pain domain scores (mean 4.04, SD 0.94), reporting more pain two years after surgery, in comparison to AIS (mean 4.31, SD 0.60) ( = 0.043) and SK (mean 4.43, SD 0.48) patients ( = 0.049). Persistent postoperative pain in adolescents undergoing posterior spinal fusion is related to disease pathology while higher acute postoperative pain is associated with a more extensive surgery. Spondylolisthesis patients report more chronic pain after surgery compared to AIS and SK patients.
后路脊柱融合术后的持续性疼痛影响12%至42%的青少年特发性脊柱侧凸患者。接受手术治疗的休门氏后凸畸形和腰椎滑脱患儿中持续性疼痛的发生率尚不清楚。我们研究的目的是确定接受后路脊柱融合手术的青少年急性和慢性术后疼痛的预测因素及发生率。该研究是对前瞻性收集的儿科脊柱登记数据进行的回顾性分析。研究纳入了2010年3月至2020年3月期间在一家大学医院接受后路脊柱融合手术的213例连续患者（158例青少年特发性脊柱侧凸、19例休门氏后凸畸形和36例腰椎滑脱），年龄在10至21岁之间。腰椎滑脱患者术后每千克每日平均（标准差）阿片类药物消耗量为0.36毫克/千克/天（0.17），显著低于青少年特发性脊柱侧凸患者的0.51毫克/千克/天（0.25）和休门氏后凸畸形患者的0.52毫克/千克/天（0.25）（P = 0.0004）。融合节段数与每日阿片类药物消耗量相关（r = 0.20，P = 0.0082）。SRS - 24疼痛领域评分显示，所有三组从术前水平到两年随访均有统计学显著改善（所有比较P≤0.03）。与青少年特发性脊柱侧凸患者（平均4.31，标准差0.60）（P = 0.043）和休门氏后凸畸形患者（平均4.43，标准差0.48）（P = 0.049）相比，腰椎滑脱患者的SRS疼痛领域评分最低（平均4.04，标准差0.94），术后两年报告的疼痛更多。接受后路脊柱融合手术的青少年术后持续性疼痛与疾病病理相关，而术后急性疼痛程度较高与手术范围更广有关。与青少年特发性脊柱侧凸和休门氏后凸畸形患者相比，腰椎滑脱患者术后报告的慢性疼痛更多。
