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.

PURPOSE: There 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. METHODS: In 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. RESULTS: Abdominal 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). CONCLUSIONS: Gastrointestinal 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.

Complete division of the radial nerve associated with a closed fracture of the humeral shaft in a child.

The management of closed fractures of the humerus with an associated nerve palsy remains controversial. With very little written about this injury in children, we present the case of a three-year-old child with a closed humeral shaft fracture in whom surgical exploration and reconstruction of the radial nerve with a sural nerve graft was performed three months after injury. The child regained full function. To the best of our knowledge, this is the first such case to be reported in the English literature.

Iatrogenic injury to the ilioinguinal and iliohypogastric nerves in the groin: a case report, diagnosis, and management.

A case of right-sided ilioinguinal and iliohypogastric neuralgia following laparoscopic repair in a 52-year-old man is presented. Significant pain persisted despite conservative measures and was successfully treated with resection of the ilioinguinal and iliohypogastric nerves in the retroperitoneal space. The anatomy, mechanisms of injury, and management of postherniorrhaphy neuropathy are reviewed.

Quality of life and functional outcome following brachial plexus injury.

Thirty-two patients (3 women, 29 men) participated in a mailed questionnaire survey to evaluate long-term subjective, employment, and functional outcome following surgical treatment for brachial plexus injury. The mean age was 37 years and mean postinjury time was 7 years. The main outcome measures were overall life satisfaction, employment status, and the impact of the brachial plexus injury on life domains. Quality-of-life questions were adapted from the interviewer form of the U.S. General Social Survey. Considering overall life satisfaction, 25 patients (78%) reported at least moderate satisfaction and no patients reported extreme dissatisfaction. Ten patients reported that their injury did affect to a great deal their overall quality of life and slightly more than half the patients were employed at the time of the study. These outcomes were not affected by such patient factors as coverage by workers' compensation, litigation, pain, marital status, number of children, educational status, and the degree of functional recovery. These patient factors also did not alter the impact of the injury on overall life satisfaction. In spite of the devastating nature of these injuries, this patient population for the most part reported good quality of life with employment status predicted within the first year following injury.