What is spinal fusion for scoliosis?

Scoliosis is a problem with the curve in the spine. Some curves in the spine are normal. But sometimes a spine makes a large curve from side to side in the shape of the letter "S" or the letter "C." If this curve is severe, it can cause pain and make it hard for your child to breathe. Spinal fusion is surgery that helps straighten the curves. It can relieve pain, make breathing easier, and give the spine a more normal appearance.

The doctor makes one or more cuts in the back. These cuts are called incisions. The doctor then attaches metal fasteners to the curved part of the spine. The doctor straightens the spine and puts small pieces of bone, called grafts, into the spine. These pieces are usually taken from the child's hip. Over time, the grafts grow together, or fuse, with the spinal bone to put the spine into the proper position.

Your child will stay in the hospital for several days after surgery. By the time your child leaves the hospital, your child may be able to dress, feed themself, and walk. Your doctor will tell you if your child has to come back to get stitches out. Your child may not be able to go back to school for a month or more.

Activity

• Have your child rest when your child feels tired. Getting enough sleep will help your child recover.
• Your child may shower 24 to 48 hours after surgery, if your doctor okays it. Pat the incision dry. Do not let your child take a bath for the first 2 weeks, or until your doctor tells you it is okay.
• Have your child try to walk each day. Start by walking a little more than the day before. Bit by bit, increase the amount your child walks. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Your child should not ride a bike, play running games, or take part in gym class for at least a few months or until your doctor says it is okay.
• For at least several months, make sure your child avoids lifting anything that can cause strain. This may include a heavy backpack, heavy grocery bags and milk containers, or bags of cat litter or dog food. Ask your doctor when your child can do activities that could jar the spine, such as competitive sports, skating, and skiing.

Diet

• Your child can eat a normal diet. If your child's stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Have your child drink plenty of fluids to avoid becoming dehydrated.
• You may notice a change in your child's bowel habits right after surgery. This is common. If your child has not had a bowel movement after a couple of days, call your doctor.

Medicines

• Your doctor will tell you if and when your child can restart any medicines. The doctor will also give you instructions about your child taking any new medicines.
• Be safe with medicines. Give pain medicines exactly as directed.
  • If the doctor gave your child a prescription medicine for pain, give it as prescribed.
  • If your child is not taking a prescription pain medicine, ask your doctor if your child can take an over-the-counter medicine.
• If you think the pain medicine is making your child sick to the stomach:
  • Give the medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics for your child, give them as directed. Do not stop using them just because your child feels better. Your child needs to take the full course of antibiotics.

Incision care

• Your child will go home with a bandage and stitches or staples over the incision the doctor made. Your doctor may remove your child's bandage and stitches or staples 10 to 14 days after the surgery. If your child has stitches that dissolve in the body over time, the doctor will not need to take them out. Your doctor will tell you if your child needs to go back to have any stitches removed.
• If your child has strips of tape on the incision the doctor made, leave the tape on for a week or until it falls off. Or follow your doctor's instructions for removing the tape.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Whether surgery is successful depends on many factors, including the flexibility of the curve and the technique that was used.

Multiple-hook, multiple-screws (that may also include hooks), and double-rod systems improve the shape of the spine and back as seen from the back and side.

The goal of surgery is not a perfectly straight spine but a balanced one, in which fusion prevents the curve from getting worse.

After surgery, back pain in adults usually gets better or goes away.

Surgery can be stressful for both your child and you. This information will help you understand what you can expect. And it will help you safely prepare for your child's surgery.

Preparing for surgery

• Your child may need to shower or bathe with a special soap the night before and the morning of surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your child's skin that could cause an infection after surgery.
• Talk to your child about the surgery. Tell your child that spinal fusion will help your child's body work better. Hospitals know how to take care of children. The staff will do all they can to make it easier for your child.
• Ask if a special tour of the surgery area and hospital is available. This may make your child feel less nervous about what happens.
• Plan for your child's recovery time. Your child may need more of your time right after the surgery, both for care and for comfort.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell the doctor ALL the medicines, vitamins, supplements, and herbal remedies your child takes. Some may increase the risk of problems during the surgery. Your doctor will tell you if your child should stop taking any of them before the surgery and how soon to do it.

The day before surgery

• A nurse may call you (or you may need to call the hospital). This is to confirm the time and date of your child's surgery and answer any questions.
• Remember to follow your doctor's instructions about your child taking or stopping medicines before surgery. This includes over-the-counter medicines.

Risks of surgery include neurological complications, infection, and lung problems.

Surgery in an adult carries a higher rate of complications and risks than in a child or teen, including blood clots, infection, and neurological complications.

Other risks of surgery

Early complications of surgery include the following:

• Collapse of a small portion of the lung is a possible problem after surgery. Frequent turning of the person and deep breathing and coughing help prevent this.
• Deep wound infections are rare but may require another surgery.

Late complications after surgery include the following:

• Back pain.
• Failure of the fusion. A rod or instrument that breaks usually indicates that not enough bone has formed to fully fuse the bones together. But if there is no pain and the curve seems stable, a broken rod does not need to be removed.
• Loss of lumbar lordosis (flat-back syndrome). Loss of the normal curve in the low back causes the upper body to tilt forward, so standing up straight is hard to do. It takes more energy to stand this way, and that can lead to fatigue in the upper back. Some people bend their hips and knees a little to help them straighten up, which can lead to pain around those joints. And there can be severe pain in the upper back, lower neck, and areas of the low back that were not fused.
• Although neurological complications are rare, they can occur. To reduce the risk, most centers use intraoperative electronic monitoring of spinal cord functioning.

Antibiotics to prevent infection are usually given at the start of surgery.

Most people spend several days in the hospital after surgery. They slowly increase their movement over those several days. Depending on which technique was used, some people may be fitted for a brace. But this is much less common now than in the past.

By the time a person leaves the hospital after surgery, they may be able to dress, bathe, feed themself, and walk around. A child may not return to school for a month or more.

Medicine used to reduce pain will be gradually decreased over a few weeks.

Activity

After surgery, it's important to avoid any extreme bending, twisting, stooping, or lifting of objects that weigh more than 10 lb (4.5 kg) . You can expect to spend the first weeks at home with rest periods now and then throughout the day.

Activities that could jar the spine—such as competitive sports, ice skating, roller skating, and skiing (water or snow)—are restricted for several months. Cycling and swimming can often be resumed in a few months as long as you don't need a brace or cast.

Your child has had spinal fusion surgery to treat scoliosis. Your doctor did the surgery through a cut, called an incision, in your child's back. Metal fasteners were attached to the curved parts of your child's spine to make it straighter. Then small pieces of bone, called grafts, were placed like bridges between pairs of vertebrae. As your child recovers, the grafts will become part of the spine and help keep it from curving.

It's normal for children to have pain after spinal fusion surgery. But your child is getting medicines to help manage the pain.

In 10 to 14 days, your doctor will remove your child's bandage and stitches or staples. If your child has stitches that dissolve in the body over time, the doctor will not need to take them out. Your doctor will tell you if your child needs to go back to have any stitches removed.

Your child may not be able to go back to school for a month or more. Full recovery may take 6 to 12 months. Your child will need lots of emotional support during this time.

Surgery may be done if:

• Your child has a moderate to severe curve or yours is severe, and the curve is getting worse.
• You have pain or trouble doing your daily activities.
• Bracing can't be used or doesn't work.

Other factors considered before surgery include:

• Age, skeletal age, and status of puberty.
• Location of the curve.

Surgery may be considered in some situations, such as:

• An adult who has trouble breathing or who has disabling back pain caused by scoliosis.
• A very young child who has a severe spinal curve.

Experts have different opinions about the timing of surgery to treat scoliosis in young children. Some experts believe that surgery should be delayed until the child is older. That's because surgery stops the growth of the part of the spine that is fused. But in some situations, early surgery can't be avoided.

• Follow the instructions exactly about when your child should stop eating and drinking. If you don't, the surgery may be canceled. If the doctor told you to have your child take any medicines on the day of surgery, have your child take them with only a sip of water.
• Have your child take a bath or shower before you come in. Do not apply lotion or deodorant.
• Your child may brush their teeth. But tell your child not to swallow any toothpaste or water.
• Do not let your child wear contact lenses. Bring your child's glasses or contact lens case.
• Be sure your child has something that's a reminder of home. A special stuffed animal, toy, or blanket may be comforting. For an older child, it might be a book or music.

At the hospital or surgery center

• A parent or legal guardian must accompany your child.
• Your child will be kept comfortable and safe by the anesthesia provider. Your child will be asleep during the surgery.
• The surgery takes several hours to complete.
• After surgery, your child will be taken to the recovery room. As your child wakes up, the recovery room staff will monitor your child's condition. The doctor will talk to you about the surgery.