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Orthopedic specialists often recommend posterior spinal fusion surgery as a treatment option for patients with severe adolescent idiopathic scoliosis. Doctors have found that gabapentin, part of multi-modal pain management after surgery, is successful in adults and adolescents who undergo posterior spinal fusion surgery. The associated benefits include:
In addition to pain management, doctors include mobilization with physical therapy as an important part of postoperative recovery. However, researchers have not yet studied increased functionality in pediatric patients related to the use of gabapentin.
At Children's Hospital Colorado, patients who undergo posterior spinal fusion surgery must meet four standard physical therapy goals before they are discharged home:
In July 2014, Children's Colorado providers began using gabapentin as part of a multi-modal pain management approach for patients undergoing posterior spinal fusion surgery.
Researchers in our Orthopedics Institute were the first to examine physical therapy outcomes and length of hospital stay in children and adolescents with idiopathic scoliosis who underwent posterior spinal fusion surgery and received perioperative gabapentin as part of multi-modal pain management.
The study evaluated medical records from all Children's Colorado patients aged 10 to 18 years. These patients had adolescent idiopathic scoliosis and underwent posterior spinal fusion surgery between December 2013 and May 2015.
Subjects were condensed down to 108 participants and stratified into two groups that were matched for age, sex and weight. The two groups consisted of:
Perioperative gabapentin administration protocol for patients with idiopathic scoliosis undergoing posterior spinal fusion surgery:
Capsules were used if the patient could swallow pills; otherwise elixir was used.
A physical therapist saw patients once in the morning and once in the afternoon. Progress towards physical therapy goals was recorded daily until the patient met all the goals, at which point the patient was no longer seen by a physical therapist.
Of the 108 patients in the study:
Goals of physical therapy vs. days to completion of goal:
In the gabapentin group, there was a statistically significant decrease in the time needed to meet all four physical therapy goals and a trend toward a decrease in length of stay:
This study is the first to suggest that the use of perioperative gabapentin in children and adolescents undergoing posterior spinal surgery will decrease the time needed to meet physical therapy goals and discharge readiness.
Researchers recommend a randomized control trial to further evaluate the use of gabapentin to attain physical therapy goals, improve quality of life, and decrease length of stay in this patient population.