Stomaching the pain of spinal fusion: Gastrointestinal discomfort is as severe as back pain in 50% of adolescent idiopathic scoliosis patients following posterior spinal fusion

Abstract

Abstract:PurposeThere have been no prospective studies investigating gastrointestinal (GI) symptoms of patients with adolescent idiopathic scoliosis (AIS) following posterior spinal fusion (PSF). The purpose of this study was to evaluate the incidence and severity of self-reported GI symptoms following PSF.MethodsIn all, 40 AIS patients undergoing PSF were prospectively enrolled between March 2015 and October 2016. Patients completed a survey on each postoperative, inpatient day regarding nausea, emesis, constipation, abdominal pain and back pain, rating their pain on a scale of 1 to 10.ResultsAbdominal pain (50%), emesis (63%), nausea (65%) and constipation (68%) were experienced by the majority of patients. Of those reporting back pain, the mean pain level during the postoperative period was 5.1 (0.2 to 9.6). Of those reporting abdominal pain, the mean pain level during the postoperative period was 5.5 (1.4 to 8.6), which was not different than the severity of their back-pain levels (mean = 6.0, p = 0.31).ConclusionsGastrointestinal issues in AIS patients following PSF are common. Abdominal pain was as severe as the back pain for half of the patients.Level of Evidence:II

Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

“…A study of patient reported postoperative GI symptoms found that half of patients selfreported that their abdominal pain and discomfort was equivalent in severity to their back pain following PSF, and that overall incidence of GI issues following PSF was high, occurring in over half (65%) of all participants. 4 The use of methylnaltrexone has the potential to reduce constipation and subsequent GI discomfort and pain, which may lead to overall improvement in postoperative pain experienced by patients undergoing PSF. While pain control regimens are often focused on controlling back pain, the potential to reduce GI related discomfort is critical for overall patient postoperative experiences.…”

“…3 The incidence of postoperative gastrointestinal (GI) issues following PSF is high, with 1 study finding that over half of AIS patients self-reported abdominal symptoms and frequently rated them as severe as their back pain. 4 There are multiple contributing factors leading to GI symptoms, particularly constipation, following spinal surgery. A significant cause is the use of opiates for pain control, which can result in opioid-induced constipation (OIC).…”

“…5 OIC can lead to additional, more invasive, interventions such as enemas and suppositories which negatively impact a child's postoperative experience and prolong hospital length of stay. 4 Methylnaltrexone is a peripheral opioid antagonist with limited central nervous system absorption. It decreases the negative peripheral effects of opiates, such as OIC, while preserving the centrally mediated analgesic effects.…”

“…Following pediatric spine surgery, constipation is common and can result in significant impacts on morbidity, hospital length of stay, and patient experience 3. The incidence of postoperative gastrointestinal (GI) issues following PSF is high, with 1 study finding that over half of AIS patients self-reported abdominal symptoms and frequently rated them as severe as their back pain 4…”

“…Unfortunately, stool softeners, traditional osmotic and stimulating laxatives have been shown to be ineffective in about 50% of patients with OIC 5. OIC can lead to additional, more invasive, interventions such as enemas and suppositories which negatively impact a child’s postoperative experience and prolong hospital length of stay 4…”