The goal of spinal surgery for scoliosis is to fuse the vertebrae so the spine cannot bend and to correct deformity. The doctor will try to correct the curve by 50 percent or more.
An assistant from the Spine Center will contact you to schedule the operation. A clinic appointment will be scheduled within a month of the operation date. During the appointment:
An incision is made in the middle of the back. The muscles are moved to the side to expose the spine. The joints between the vertebrae are removed to loosen them up. The vertebrae are roughened up so that the body responds by producing new bone. The new bone eventually bridges the gaps between the vertebrae and makes them fuse together. Metal implants -- rods, screws, hooks or wires -- are put in to hold the spine still while the vertebrae fuse.
The fusion is augmented with bone graft. This may be obtained from the patient -- known as "autogenous" bone graft and harvested typically from the pelvis, or it can be from a bone bank from a donor -- known as "allogenous." Advantages of autogenous bone graft include more rapid incorporation with the rest of the vertebrae and safety. Disadvantages of autogenous grafts include surgery, which can cause pain and carries its own set of operative risks. The principal risk of allogenous bone graft is risk of infection, in particular hepatitis at the rate of 1 in 1 million and AIDS at the rate of 1 in 10 million. The patient or the patient's parents decide on whether to go ahead with the surgery after a careful discussion of the benefits and risks with the orthopedic surgeon.
Spinal fusion surgery usually takes four to six hours but the time varies according to the individual patient. The surgeons will take as long as they need to do the job well.
The potential complications of surgery include:
Each patient's hospital stay may vary, depending on the individual condition. A typical stay is four days but may vary between three to seven days. Generally, the orthopedic team includes a surgeon, senior resident surgeon, registered nurse and physician assistant.
An epidural catheter is inserted in the back to control pain and usually is removed by the third day after surgery. A catheter also is placed in the bladder so that the patient does not have to walk to the bathroom during the first few days after surgery. This is removed on the third day, shortly after the epidural is removed.
A physical therapist assists the patient to walk after surgery. On the first day, the goal is to get out of bed to a chair. On the second day, the goal is to walk out of the room. By the third day, the patient may walk as tolerated. On the fourth day, the patient begins climbing stairs.
Before being discharged, spinal X-rays are taken to make sure that there are no early problems with the implants or spinal alignment. A nurse assists with discharge planning to ensure all the needs of the patient are met before going home.
The dressing covering the incision shouldn't be disturbed until a follow-up clinic visit, unless there is a concern about a wound, as determined by your surgeon during the operation or during the early recovery period in the hospital.
Generally, during the first two weeks after the operation, the patient shouldn't go to school or work, or participate in organized activity. This is a time to heal, both physically and mentally. During this time, the dressing on the wound should not be disturbed. This means sponge bathing only until the follow-up clinic appointment in two weeks.
At the follow-up appointment, the surgeon will inspect of the wound and change the dressing or bandage.
Over the course of a year, the patient's activities will return to normal:
At 12 months, the patient will visit the surgeon for a third post-surgery appointment. X-rays will be taken. If all is well, the patient will be allowed to return to unrestricted activities.
Reviewed by health care specialists at UCSF Medical Center.
400 Parnassus Ave., Third Floor
San Francisco, CA 94143-0332
Phone: (866) 81-SPINE or
Neuro-spine Fax: (415) 353-2339
Ortho-spine Fax: (415) 353-4047