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Study Design:A total of 110 patients with scoliosis were enrolled in this analytical cross-sectional study. Purpose: We aimed to compare the urodynamic study (UDS) results of patients with idiopathic scoliosis (ISC) and congenital scoliosis (CSC) and to evaluate the clinical significance of abnormal UDS findings in predicting underlying tethered cord syndrome (TCS). Overview of Literature: An abnormal UDS finding is commonly found in patients with CSC. However, there is no consensus regarding its prevalence in patients with ISC. Methods: Using the STROBE checklist for cross-sectional studies, 110 patients with scoliosis were selected based on our inclusion and exclusion criteria. Among the patients, 76 presented with ISC and 34 with CSC. Demographic data and other details, such as the results of spine radiography, UDS, and magnetic resonance imaging of the spine in both supine and prone positions, were recorded and analyzed. Results: Approximately 50% of patients with CSC had normal UDS findings; 8.8%, mild impairment; and 41.2%, significant abnormalities. Moreover, 67.1% of patients with ISC had normal UDS findings; 9.2%, mild impairment; and 23.7%, significant abnormalities (p=0.166). TCS was identified in 38.2% and 26.3% of patients with CSC and ISC, respectively (p=0.571). In patients with ISC, a significantly abnormal UDS finding indicated that the risk of TCS increased from 26.3% to 50% (odds ratio [OR], 4.2; p=0.009). Meanwhile, in patients with CSC, the risk was almost similar (OR, 0.8; p=0.8). Conclusions:Even with the absence of subjective urinary symptoms, subclinical urologic impairments can be observed in a significant number of patients with ISC. An abnormal UDS finding can be a sign of underlying spinal cord tethering in a patient with ISC who is a candidate for corrective spine surgery even though it is an independent variant and is not exclusive to candidates for surgery. This finding has high clinical utility for neuro-and ortho-spine surgeons who aim to correct scoliosis (OR, 4.2; p=0.009).

Ketamine and magnesium in brain act as an N-methyl-D-aspartate receptor antagonist that has been shown to be useful in the reduction of acute postoperative pain and analgesic consumption in a variety of surgical interventions. We hypothesized that combination of low dose ketamine and magnesium would reduce early postoperative opiate consumption and analgesic requirement after 6 weeks. This was a randomized, prospective, controlled-placebo trial involving elective and eligible patients undergoing lumbar spine surgery. Seventy patients in the treatment group were administered 0.5 mg/kg intravenous ketamine and 1 gram of magnesium as an intravenous bolus slowly during 3 minute before incision and 0.25 mg/kg/hr ketamine and 0,5 g/hr magnesium intravenous infusion during surgery. Seventy patients in the placebo group received saline of equivalent volume. Patients were observed for48 h postoperatively and followed up at 6 weeks. The primary outcome was 48h morphine consumption. The severity of pain was lower in the intervention group than in the placebo group during 48 hr post-operatively, morphine consumption in this group also decreased significantly during this period. Intraoperative ketamine-magnesium reduces opiate consumption in the 48-h postoperative period. This combination may also reduce pain intensity throughout the postoperative period in this patient population.

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