In children with spinal cord injury (SCI), scoliosis due to trunk muscle paralysis frequently requires surgical treatment. Transcutaneous spinal stimulation enables trunk stability in adults with SCI and may pose a non-invasive preventative therapeutic alternative. This non-randomized, non-blinded pilot clinical trial (NCT03975634) determined the safety and efficacy of transcutaneous spinal stimulation to enable upright sitting posture in 8 children with trunk control impairment due to acquired SCI using within-subject repeated measures study design. Primary safety and efficacy outcomes (pain, hemodynamics stability, skin irritation, trunk kinematics) and secondary outcomes (center of pressure displacement, compliance rate) were assessed within the pre-specified endpoints. One participant did not complete the study due to pain with stimulation on the first day. One episode of autonomic dysreflexia during stimulation was recorded. Following hemodynamic normalization, the participant completed the study. Overall, spinal stimulation was well-tolerated and enabled upright sitting posture in 7 out of the 8 participants.

Thirty-eight patients undergoing elective hip or knee surgery were randomly allocated to two groups. Neuromuscular blockade in group A was antagonized with neostigmine 2.5 mg and atropine 1.2 mg, while group B received no drugs to facilitate antagonism of blockade. The incidence and severity of postoperative nausea and vomiting were assessed 24 h after operation. Nausea and vomiting were significantly reduced in group B. The incidence of nausea in group A was 68%, compared with 32% in group B (P less than 0.01). The incidence of vomiting was 47% in group A, compared with 11% in group B (P less than 0.02). A significant relationship was shown between postoperative emetic symptoms and the antagonism of neuromuscular blockade by neostigmine and atropine.

We studied the effects of supplementing anaesthesia with halothane (up to 1.5%, inspired) on the somatosensory evoked potential recorded in the extradural space of six patients before corrective surgery for idiopathic adolescent scoliosis. A further six patients in whom anaesthesia was supplemented with thiopentone acted as a control group. Halothane 1.5% resulted in a significant decrease in overall amplitude (P less than 0.05) from the left leg only. Halothane had no significant effect on overall amplitude, first peak amplitude, second peak amplitude and first peak latency. We conclude that halothane is unlikely to alter the interpretation of somatosensory evoked potentials recorded extradurally during scoliosis surgery. A possible unilateral effect of halothane on the concave side in idiopathic adolescent scoliosis needs further investigation.

Background: A recent study in pediatric spinal cord injury (SCI) demonstrated activity-based locomotor training (ABLT) improved trunk control, measured by the Segmental Assessment of Trunk Control (SATCo). It is not known whether improved trunk control is maintained and, if so, for how long. Objectives: The purpose was to determine the durability of improvements in trunk control after ABLT is stopped. We hypothesized that SATCo scores at follow-up would not significantly regress (a) beyond the score measured at discharge and (b) to the initial SATCo pre-ABLT level. Methods: Patients were assessed pre ABLT, after completing an episode of care, and upon returning to the clinic 1 or more months without ABLT. Durability is a score change less than 3, which is the measurement error of the SATCo. Results: Twenty-eight children (10 females; 4 ± 2.5 years old) completed at least 40 sessions of ABLT and returned for the follow-up 8 ± 7 months (range, 1–38) after the episode of care. Trunk control improved 6 ± 3/20 points with ABLT (p < .0001). At the follow-up, average SATCo score decreased 2 ± 2/20 points, and the follow-up SATCo score was 4 ± 3 points higher than pre ABLT (p < .0001). There was no correlation between the change in SATCo scores and changes in age, weight, height or elapsed time between discharge and follow-up. Conclusion: Improvements in trunk control due to ABLT were maintained, indicating ABLT is neurotherapeutic. Although not achieving complete recovery of trunk control, the immediate effects and sustained improvements provide support for a clinical shift to neurotherapeutic approaches and for continued research to achieve enhanced recovery.