Research focus: Scoliosis and spinal surgery in adolescence
We look at three recent studies on a specific topic.
Scoliosis (abnormal curvature of the spine) affects up to 3% of young people.
Adolescent idiopathic scoliosis presents from around the age of 10. The spine develops a side-to-side curvature; an elongated S or C shape with the spine slightly twisting or rotating (90% of the time to the right). Treatment: the Three Os – observation, orthosis (braces) and operative.
This review looks at three recent studies exploring aspects of surgery.
Idiopathic scoliosis: managing pain before and after spinal surgery
A small, 18-month service evaluation project was undertaken in one specialist children’s hospital in the north of England.
Service evaluation is distinct from audit or research as it attempts to clarify and make judgements about current care compared to measuring it against defined standards or generating new knowledge. The aim was to evaluate though the opinions and experiences of young people in pain information, assessment and management.
Structured activity sheets designed with the help of other youngsters were used to capture thoughts and ideas of pre-operative pain information needs and pain experiences before, during and after surgery. Of 42 approached, 9 (6F 3M) participated. Six provided confidential written responses pre and post-surgery while three provided just a preoperative response.
Content analysis was used to describe the findings. Anxiety and apprehension about anticipated pain was highlighted, indicating a need for improved preoperative information. Pain following surgery was a feature despite reports of pain assessments correctly performed. Further studies are needed to investigate surgical preparation and pain communication strategies.
Bray L, Craske J (2015) Nursing Children and Young People. journals.rcni.com/doi/abs/10.7748/ncyp.27.10.22.s26
Use of Tranexamic Acid (TXA) on reducing blood loss during scoliosis surgery in Chinese adolescents
A retrospective female-cohort, Chinese-based study investigated the potential problems resulting from large blood losses during corrective spinal surgery and efficacy of intraoperative anti-fibrinolytic therapy.
A consecutive, blind selection basis was used to collate data comparing a control group (n35) to a therapy group (n55) of girls aged 10-23 years, who received Tranexamic acid medication during a posterior spinal fusion.
Intraoperative blood loss was measured and recorded in addition to demographic, surgical statistics, clotting and coagulation factor data. Statistical analyses included different regression modelling techniques.
Findings indicated that TXA appeared to positively influence amount of blood loss by up to 53% concurring with findings in other studies and reduced overall use of transfused blood. This first but small study of TXA in paediatric adolescent idiopathic scoliosis patients has limitations, but authors concluded it paves the way for further prospective, dose-ranging studies in the future.
Ng BKW, Chau WW, Hung ALH et al (2015) Scoliosis Open Access. Oct 5; 10 (28) 1-6
Opioid consumption and bowel dysfunction in adolescents after spinal surgery
A retrospective, case-note service evaluation was undertaken in a tertiary referral, paediatric spinal unit in London.
In the absence of any national guidance or local bowel care management pathways following paediatric spinal surgery, the authors aimed to evaluate their current practices.
A total of 44 case notes from adolescents (aged 11-17) who had undergone spinal fusion for adolescent idiopathic scoliosis were reviewed. A 16-point data collection tool was developed enabling basic statistical analyses to identify any correlations between length of surgery, stay in hospital, opioid consumption and laxative use.
Wide variations in laxative prescribing practices were found, including a high number (45.5%) of young people given an enema prior to discharge. No relationships between opioid use, effects of laxatives on length of surgery or hospital stay were identified.
Further investigation and better levels of evidence are needed prior to initiating any changes in practice.
James T, Askew N (2016) Nursing Children and Young People. journals.rcni.com/doi/abs/10.7748/ncyp.2016.e730
Study compiled by Kathy Davis, independent specialist nurse consultant, colorectal and pelvic floor disorders, Wimbledon