title: Postoperative ketorolac does not predispose to pseudoarthrosis following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.
abstract: METHODS
  A retrospective review comparing patients who had postoperative ketorolac and those who did not following posterior spinal fusion and instrumentation (PSFI) for adolescent idiopathic scoliosis (AIS).
  
  
  OBJECTIVE
  To analyze the effect of postoperative ketorolac on the incidence of pseudoarthrosis in postoperative AIS patients.
  
  
  BACKGROUND
  Ketorolac (Toradol, Roche Laboratories, Nutley, NJ) is a nonsteroidal antiinflammatory drug that is an effective adjunct to manage postoperative pain. It has been previously demonstrated to inhibit spinal fusion in adult patients undergoing a L4 to sacral fusion. To our knowledge, there are no large studies analyzing this effect following PSFI for AIS.
  
  
  METHODS
  An IRB-approved retrospective medical record review was performed from 1994 to 2000 of patients undergoing a PSFI for AIS at a single institution. Segmental spinal instrumentation (Texas Scottish Rite Hospital) and iliac crest bone graft were used in both groups. Demographic and operative data were recorded. Patients were divided into those who had postoperative ketorolac (K group) and those who did not (NK group). Patients who had a surgically confirmed pseudoarthrosis were identified and the K group and NK group were statistically compared.
  
  
  RESULTS
  There were 161 patients in the NK group and 158 in the K group. There were no differences with respect to age (14.4 vs. 14.2 years), gender (83.9% vs. 84.8% females), levels fused (9.8 vs. 9.7), or preoperative curve magnitude (57.9 degrees vs. 58.9 degrees ). In the K group, the number of doses of ketorolac administered was 6.7 for an average of 26.7 mg for a duration of 46 hours after surgery. Patients in the K group were more likely to have Motrin (average 5.8 doses) compared with the NK group (average 0.7 doses) (P < 0.01). No patient in the K group had a history of cigarette smoking compared with 2 patients in the NK group, both of whom went on to solid arthrodesis. The overall incidence of pseudoarthrosis was 2.5% for all patients. There was no difference in the incidence of pseudoarthrosis comparing the K (1.9%) and the NK group (3.1%)(P = 0.7). When the single rod posterior implants were excluded, there was no difference between the K (0.7%) and NK groups (1.8%) (P = 0.58).
  
  
  CONCLUSIONS
  Ketorolac does not increase the incidence of developing a pseudoarthrosis when used as an adjunct for postoperative analgesia following a PSFI for AIS using segmental spinal instrumentation and iliac crest bone graft. The differences seen here compared with adults may be due to the greater healing potential in these young patients. We recommend utilization of ketorolac after surgery to supplement pain management when necessary.
authors.affiliation: TX Scottish Rite Hospital, Department of Orthopaedic Surgery, University of Texas at Southwestern Medical Center, 2222 Welborn Street, Dallas, TX 75219, USA. dan.sucato@tsrh.org
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sucato
authors.forename: John F
authors.initials: JF
authors.lastname: Lovejoy
authors.forename: Sundeep
authors.initials: S
authors.lastname: Agrawal
authors.forename: Emily
authors.initials: E
authors.lastname: Elerson
authors.forename: Trudi
authors.initials: T
authors.lastname: Nelson
authors.forename: Anna
authors.initials: A
authors.lastname: McClung
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D016025:Bone Transplantation / Q000009:adverse effects; D002648:Child; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation; D015994:Incidence; D020910:Ketorolac / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care; D011542:Pseudarthrosis / Q000139:chemically induced / Q000209:etiology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac