Teens undergoing posterior spinal fusion surgery for adolescent idiopathic scoliosis decreased post-operative opioid use by 40% when steroids were added to their pain management treatment, according to findings published today in the Journal of Bone and Joint Surgery led by Children’s Healthcare of Atlanta Orthopedic Surgeon Nicholas Fletcher, MD, Medical Director of Spine Quality and Outcomes. Additionally, patients were twice as likely to walk at their initial inpatient physical therapy session and the average hospital stay decreased to under two days.
“We’ve greatly reduced the postoperative challenges faced by kids and their families,” said Dr. Fletcher, associate professor of orthopedic surgery at Emory University School of Medicine. “Patients are getting back to school quicker and their pain is diminished after surgery allowing for them to return to their normal activities sooner.”
Scoliosis is a curve in the spine which appears like a “C” or “S” from the back and is the most common spinal abnormality in children, affecting about three percent of teens ages 10 to 18 in the U.S. The Orthopaedics and Sports Medicine Center at Children’s performs around 500 spinal fusion surgeries each year in severe cases, more than any other children’s hospital in the country according to the Pediatric Health Information System (PHIS). The condition is often detected during school screenings by the presence of uneven shoulders, a rib hump or a lower back hump. Scoliosis usually develops during the teenage growth spurt and is not the result of bad posture, a heavy backpack, poor diet or playing sports. While the cause is unknown, it may run in families.
In the study, Dr. Fletcher and his team studied two groups of patients from 2015 to 2018. One group of 48 patients received postoperative anti-inflammatory steroids in addition to the standard pain management treatment, and a control group of 65 patients received the standard pain management treatment. After surgery, patients self-administered opioid pain medicine through a patient-controlled anesthesia pump or “pain pump.” Results showed the group receiving an additional anti-inflammatory steroid utilized the pain pump 40% less often.
“The goal of any pain management protocol is to minimize the number of opioids or narcotics used given our ever-expanding knowledge of their associated risks,” said Dr. Fletcher. “This 40% decrease in pain medicine requirements means that patients are drastically more comfortable after surgery and that their risk of significant opioid use is dramatically diminished.”
This group was also almost two times more likely to walk upon initial physical therapy evaluation. Dr. Fletcher indicated that over the past 10 years, orthopedic experts have been urging kids to get up and walk sooner to help them ambulate better, which alleviates pain by reducing stiffness. He points out that for teens with scoliosis needing surgery, adding a steroid accelerates this process.
Other benefits included a decline in hospital stay from what is often as long as one week to two days, a decrease in postoperative gastro-intestinal complications, and overall improvement in cognition. Adding steroids did not increase wound-healing problems. A reduction in pain medicine gave patients the ability to become functionally independent faster and return to activities like homework more quickly, also allowing parents to resume work more quickly.
“The focus of our research is optimizing post-operative care,” said Dr. Fletcher. “Families sometimes think their kids are going to be in bed for 6 months, and that’s just not the case anymore. Most of our patients are back at school within a few weeks and can return to sports in a few months.”
Dr. Fletcher’s research team included fellow Orthopedic Surgeons Robert W. Bruce, MD and Joshua S. Murphy, MD, Anesthesiologist Thomas M. Austin, MD, Emory Medical Student Ndeye Guisse and Orthopedic Nurse Practitioner Tracy Ruska.