This review is a literature review based on articles gathered over the previous 10 years from scientific search engines. To divide pain management following total joint arthroplasty into segments. The pain is frequently connected with incision pain induced by surgical damage to a major peripheral nerve and differs in quality and location from pain experienced before surgery. Acetaminophen, nonsteroidal anti-inflammatory drugs, and opioid analgesia are the three categories of medicines used to manage postsurgical pain. These medications can be used as pre-emptive analgesia or as part of a multimodal analgesia regimen. Multimodal analgesia is the most common therapy for postoperative pain following joint replacement. This medication is meant to lessen the risk of negative effects that may arise after taking opioids.

BACKGROUND: In the global pandemic of the 2019 coronavirus disease (COVID-19), many countries have reported a decrease in visits to hospitals, and health-care systems around the world are reshaping health protocols. Health service and education in orthopedics are also affected although not at the frontline in dealing COVID-19. METHODS: The data from this study collected from several official databases, including the Indonesian Ministry of Health, Central Java provincial government, general hospital, and orthopedic surgery cases. RESULTS: Pandemic COVID-19 started in March 2020 in Indonesia. Surakarta has become one of the epicenters. Health services in the orthopedic department also experienced a decrease cases on all divisions (outpatient clinics, emergency rooms, and inpatients). Mann–Whitney non-parametric comparative test showed significance result in p value operation of orthopedic cases and inpatients (p = 0.016 and p = 0.016; p < 0.05), meanwhile, outpatient visits did not show significance result with p = 0.0509 (p > 0.05). The decrease in the number of cases being treated in the orthopedic service also has an impact on education and training programs. The digital era is one of the choices in the field of education. However, digital resources cannot substitute for direct patient exposure. CONCLUSION: The average number of orthopedic patients during the pandemic period from January to December 2020 decreased compared to visits in the same period in 2019 so that orthopedic services at tertiary and academic referral hospitals experienced a significant decrease in cases. The education and services department must adapt to the policy on educational activities for residents and medical students. The education department and hospital institutions restructured and reorganized resident doctors to continue providing services. The digital era is an option that supports the education process during a pandemic.

Lumbar spinal stenosis dengan instabilitas, salah satu pilihan pengobatannya dengan laminektomi dekompresi, stabilisasi posterior dan PLIF (Posterior Lumbar Interbody Fusion). Derajat fusi dapat ditentukan dengan pemeriksaan CT-scan post operatif. Sedangkan untuk menilai disabilitas dan skor fungsional pada pasien LSS menggunakan skor Oswestry Disability Index (ODI). Penelitian ini merupakan penelitian analisis observasional pada 18 pasien LSS yang telah dilakukan operasi instrumentasi PLIF. Pasien diminta mengisi kuesioner ODI dan dilakukan evaluasi CT Scan, kemudian dilakukan uji korelasi data yang didapat. Penelitian ini menunjukkan adanya korelasi yang signifikan antara derajat fusi dengan ODI. Koefisien korelasi antara derajat fusi dengan ODI didapatkan 0,904 dengan nilai signifikansi 0,00 (p<0,05). Derajat fusi post operasi dari gambaran CT Scan memiliki korelasi yang signifikan terhadap derajat disabilitas menggunakan skor ODI.Kata Kunci: Lumbar spinal stenosis, Fusion rate, PLIF, ODI Lumbar spinal stenosis with instability one of the treatment options is decompression laminectomy, posterior stabilization and PLIF (Posterior Lumbar Interbody Fusion). The degree of fusion can be determined by CT scan post -operatively. To assess disability and functional scores in LSS patients can use the Oswestry Disability Index (ODI). This study was an observational analysis study in 18 LSS patients who had PLIF instrumentation surgery. Patients were asked to fill in the ODI questionnaire and were evaluated for CT Scan, then the correlation data were obtained. This study shows a significant correlation between the degree of fusion and ODI. The correlation coefficient between the degree of fusion and ODI is 0.904 with a significance value of 0.00 (p <0.05). The degree of postoperative fusion of CT scans has a significant correlation to the degree of disability using the ODI score.Keywords: Lumbar spinal stenosis, Fusion rate, PLIF, ODI

Schwannoma is a benign, encapsulated, benign tumor that grows slowly from neural fairy cells in the nerve sheath. Extracranial schwannoma is a rare case. These tumors can cause neurological deficits because of their intradural location and suppress the spinal cord so it needs to be decompressed to prevent permanent nerve damage. We reported one case of cervical schwannoma with a neurologic deficit in the form of a numbness in four of limbs since 6 month before admission, we finally performed a laminectomy – posterior durotomy and tumor excision with posterior approach without intraoperative monitoring. The result is a return of neurological function in the patient no complain about pain and patient satisfy with the result.