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.

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.

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.

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.