Idiopathic Scoliosis Surgery

Scoliosis is a condition that involves an abnormal lateral curvature of the spine in
the mid or low back. Basically, the spine has an “S” shape when viewed from the front or back instead of a straight line. Additionally, scoliosis involves rotation of the vertebrae, which cause the ribs attached to the vertebrae to protrude.

The most common type of scoliosis (80-85%) is idiopathic which means “no known cause.” There is often a family history of scoliosis and the spinal deformity usually appears during adolescence, although it can appear in childhood also. Scoliosis typically develops without any pain and detection of the deformity may be difficult.

There are currently no medications to treat or prevent scoliosis. Most minor curves (20 - 40 degrees) can be braced successfully in approximately 80% of cases. Surgery is necessary once the curve is severe, in order to stop the progression and/or correct the spinal deformity. Additional goals of surgery include creating a solid fusion while preserving as many motion segments as possible to maintain flexibility.

The Procedure
The procedure involves a midline incision in the back through which two titanium rods are placed on either side of the spine. Using hooks and/or screws, the rods are anchored to the spine. A spinal fusion denotes the creation of one solid bone and the procedure is utilized to stabilize the spine as one solid mass. Once the instrumentation is completed, the curvature of the spine is then corrected as much as possible. The incision is then closed with sutures.

Pre-operative testing and preparations
You will be advised, if possible, to donate at least 2 units of your own blood approximately 1 month prior to your surgery date. We will provide you with the information to schedule this appointment with the American Red Cross. Usually, only one unit is donated at a time, so it may take you two to three visits to the blood bank to acquire the necessary amount of blood. In some cases, family members with the same blood type may donate instead, which is called directed donor blood. If for some reason you or your family cannot donate blood, screened donor blood from the blood bank may be used.

Prior to your surgery date, you will be required to undergo routine laboratory tests. If you have any history of cardiac or pulmonary problems, you will also be required to have a clearance by a cardiologist or pulmonologist, respectively. You will also be given information on what medications, both prescription and over the counter, that need to be discontinued pre-operatively as many can interfere with wound healing and bleeding time.

What to expect in the hospital post-operatively
You will wake up in the recovery room after the operation is over. During this time you may be disoriented and tired, which is the normal effects of the anesthesia wearing off. Once stable, you will be taken to your room where you may be greeted by family and friends. At this time your pain will be controlled by IV medications and you will have a catheter placed into your bladder to drain urine. Your incision will be covered by a sterile dressing which will stay in place for 2 to 3 days.

It is important to begin moving as soon as possible to prevent blood clots and speed your recovery. The day after surgery you will be visited by a physical therapist that will assist you. It is important to use your brace while out of bed. Over the course of your hospital stay, you will gradually increase your activity as tolerated.

Getting out of bed is also a very important step in helping your lung function return to normal. Areas of your lungs collapse during surgery and a couple of days post-operatively, which is known as "atelectasis". Additionally, deep inspirations and the use of your "incentive spirometer" are essential.

You may shower after 3 days in the hospital, but it is important to keep the incision dry for 5 days. The nurse will cover your wound with Aquaguard to keep it dry or you may take a sponge bath.

Patients typically stay in the hospital for 4 to 5 days. Before your discharge, you will be provided with a list of "do’s and don’ts" and arrangements will be made for home health if necessary.

Once you arrive home
Continue to walk with the use of aids (i.e. front wheel walker) and your brace. Slowly increase your activity level.
You may shower, but do not soak in the bath or hot tub for 4 to 6 weeks.
Once the dressing is removed and you are informed to keep it open to the air, make sure that you protect it from sun exposure. Once the incision is healed, sunscreen should be on the incision for 6 months to one year. This will help decrease its appearance.
Maintain a healthy diet, especially one that is high in dietary fiber to decrease constipation. Additionally, a diet rich in protein is ideal for the healing process. Drink plenty of fluids.
Monitor your incision. It is common to have a small amount of blood and fluid leakage, however, if there is persistent drainage contact the office. Additionally, watch for opening of the incision, redness or warmth around the incision, or fever greater than 101ºF.
Do not take anti-inflammatory medications (i.e. Ibuprofen, Voltaren, Aleve, Feldene, Lodine, Daypro, Naproxen, Naprosyn, Relafen, and Motrin) for 3 months after the surgery as this may inhibit bone fusion.

Restrictions/Precautions
You may return to school 6 - 8 weeks after surgery. A home tutor is a great way during this time for children to stay current with school.
No lifting greater than 5 pounds for 4 to 6 weeks.
Please, do not carry your backpack to school for 4 months.
No bending at the waist or twisting the back.
No physical education class for 6 months. You will be given a note that you may provide to the school.
No driving for 4 to 6 weeks or until advised (if applicable).
No jumping, running, or high-impact sports for 6 months.
After full healing, most patients do not have restrictions on their activities, generally 9 months to 1 year after surgery.


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