Scoliosis Surgery. OrthoInfo Scoliosis Surgery Page 1 of 6

Size: px

Start display at page:

Download "Scoliosis Surgery. OrthoInfo Scoliosis Surgery Page 1 of 6"

Clarence Charles
5 years ago
Views:

Scoliosis Surgery INTRODUCTION You have been diagnosed with scoliosis, which is a sideways curvature of the spine. Your doctor feels your curvature is big and at risk for getting bigger.

1 Scoliosis Surgery INTRODUCTION You have been diagnosed with scoliosis, which is a sideways curvature of the spine. Your doctor feels your curvature is big and at risk for getting bigger. If the curvature gets very big it makes your trunk look twisted, puts you at risk for premature arthritis, and can lead to chest changes which interfere with you heart and lung function. For these reasons, scoliosis surgery has been recommended for you. BACKGROUND Scoliosis is a sideways (lateral) curvature of the spine, usually developing in early adolescence. Eighty percent of scoliosis is idiopathic, meaning the cause of the scoliosis is not known. About people out of every 1000 people will have scoliosis. Mild cases may only require observation. Scoliosis tends to run in families and although boys and girls are at equal risk at the onset, girls are more likely to continue to worsen and require treatment. About 2-3 people out of every 1000 people will need treatment for a progressive condition. Spinal curvature is best treated when the curvature is small and the body is still growing. Progression can usually be stopped or slowed with bracing. About 1 person out of every 1000 people may require surgery. WHAT DOES SURGERY INVOLVE? The primary goal of surgery is to partially straighten the sideways curvature and get each of the bones to fuse together in this position. It is essentially a partial correction and fusion of the spinal curvature. Everything about the surgery, your stay in the hospital, and your subsequent recuperation will be explained to you by your doctor and nurses. It seems like a huge deal, but most kids handle the whole thing very well. Prior to surgery, a number of studies are done to make sure you are as healthy as possible. This usually involves a physical exam by your pediatrician or family doctor, usually with blood and urine tests. If you are able, we like for you to donate a unit of your blood to be available if you need it after surgery. We will have you take a vitamin pill with iron to help your body be as strong and ready as possible for the surgery. You should avoid contact with other people who have colds or the flu. Get plenty of sleep, exercise, and eat right so that you are in good shape. Sunburn and insect bites can also be troublesome, so be careful when you are outdoors. Do not get a tattoo, body piercing, or have dental work done in the 2 weeks prior to surgery. OrthoInfo Scoliosis Surgery Page 1 of 6

You should take your regular medications as directed, but you should stop taking aspirin and related medications like Motrin for 10 days prior to surgery.

2 You should take your regular medications as directed, but you should stop taking aspirin and related medications like Motrin for 10 days prior to surgery. Tylenol can be taken if you have a headache or cramps. We will make arrangements for you to visit the hospital to see the operating area, the waiting area for your family, and an example of the hospital room where you will be after your surgery. The school should be informed of your operation so they can plan for homebound schooling, if needed. Most people miss about 4 weeks of school while recovering. When you come to the hospital, you should wear loose fitting comfortable clothes, including a shirt that buttons up the front, slippers, and a bathrobe. The hospital will have soap and toothpaste so don t worry about these things. It is a good idea to bring a tape or CD player and your favorite music. On the day of surgery, your doctor will meet you in the preoperative area and answer any last questions. You will meet the anesthesiologist who will keep you asleep and comfortable during the surgery. You will also meet several nurses and other staff who will help in the operating room. WHAT HAPPENS IN SURGERY? There are two main types of scoliosis surgery, which are anterior (front side) spinal fusion and posterior (back side) spinal fusions. In some circumstances, both anterior and posterior procedures are needed. Posterior spinal fusion is through an incision down the middle of your back. The back side of the vertebral bones of the spine are exposed. Tissue from the joints spaces between the vertebra are removed to provide a good bed for bone to heal and fuse all the bones together. Bone chips are also taken from the back of your pelvis, usually through a separate incision, to help fill in the gaps. Spinal instrumentation, which is a combination of hooks, wires, screws, bolts, and rods are then secured to the vertebra to hold the partially corrected position. Anterior spinal fusion is usually accomplished from the right side, usually through one of the rib spaces. Just like the posterior procedure, the spine is exposed and the tissue between the bones is removed to create good surfaces for the bones to heal together. Bone is usually harvested from one of your ribs and from your pelvis through a separate incision to pack into the gaps. Spinal instrumentation with screws, bolts, and rods are then attached to the vertebral bones of the spine to hold the corrected position. OrthoInfo Scoliosis Surgery Page 2 of 6

The instrumentation is made of stainless steel or titanium. It is not magnetic and does not rust or set off airport metal detectors.

This is something your body needs to do over the next 6 12 months. The spinal instrumentation holds the bones together while your body heals.

We do a number of things in the operating room to minimize blood loss including hydration with IV fluids, keeping blood pressure low, and collecting blood lost so that it can be filtered and

3 The instrumentation is made of stainless steel or titanium. It is not magnetic and does not rust or set off airport metal detectors. These materials are very compatible with your body and can stay in your back for the rest of your life. The purpose of the instrumentation is to hold your back while the bones heal solidly together. This is something your body needs to do over the next 6 12 months. The spinal instrumentation holds the bones together while your body heals. Blood loss in the operating room is variable and can be from 1 to 4 units of blood. Most adolescents will tolerate losing 2-3 units of blood without difficulty. We do a number of things in the operating room to minimize blood loss including hydration with IV fluids, keeping blood pressure low, and collecting blood lost so that it can be filtered and reinfused into the blood stream. Even with these efforts, it is best to have one or two units of your blood predonated to be available if needed. It is uncommon for them to need more than this in the operating room. Sometimes, the blood count will drift down after surgery and a transfusion may be needed in the first few days after surgery. Most kids do not need blood from the blood bank. It is possible for family members to donate blood to be available if needed. During surgery, special equipment is used to monitor the spinal cord function. As the spinal curvature is corrected, it can sometimes stretch the spinal cord enough to change its function. This does not happen often, but when it does the amount of correction can be decreased to reduce the stretch on the spinal cord. This monitoring is very sensitive and usually picks up more problems that actually exist. However, it is better to be safe than sorry with respect to spinal cord function. It is very uncommon to have a permanent problem with the spinal cord and your doctor will do everything possible to minimize that risk. The incisions are closed with buried dissolvable stitches. Usually a drain will be placed to prevent residual bleeding from pooling under the skin. The incisions are covered with steristrip tapes and a bulky gauze dressing. The bulky dressing and drains are usually removed on the third day after surgery. Immediately after surgery, you are taken to the recovery unit or intensive care unit for monitoring until you are fully awake and stable. Your parents can be at your bedside as soon as you are awake. OrthoInfo Scoliosis Surgery Page 3 of 6

WHAT HAPPENS AFTER SURGERY After surgery, you will probably feel very tired and groggy from the anesthesia and pain medicine. It takes 1 or 2 days for things to clear up.

4 WHAT HAPPENS AFTER SURGERY After surgery, you will probably feel very tired and groggy from the anesthesia and pain medicine. It takes 1 or 2 days for things to clear up. Many patients after surgery do not remember the day of surgery and part of the next day. You will have a number of tubes to help you and monitor your vital signs. You will have oxygen tubes to your nose and a sensor on one of your fingers to monitor your breathing. You will have EKG leads on your chest to follow your heart rate. You may have a tube in your wrist and a blood pressure cuff on your arm to watch your blood pressure. You will have IV tubes in your arms to give you fluids and pain medicine. You will have a drain from your incision to keep blood from pooling under the skin. You will have a tube in your bladder, so you don t have to get on and off a bed pan. Sometimes this tube makes you feel like your peeing. We get you disconnected from these tubes as soon as possible. Most are removed on the first or second day after surgery as you start moving. On the day of surgery, you stay in bed and mostly sleep because of the medicine you got in the operating room. The nurses watch very carefully for problems and try to give you as much pain medicine as you need to keep the pain tolerable. Some people will have nausea. Most of the time your stomach will not be ready to eat or drink anything. On the day after surgery, the nurses or the physical therapists help you sit up in bed. If this goes well, you stand and maybe sit up in a chair for short time. Most of the time your stomach is still not ready to eat much, but some juice or jello may be taken if desired. You will get plenty of fluid through your IV s so that you do not need to eat or drink if your stomach is not yet ready. On the second day after surgery, we get you disconnected from some of the tubes and wires. The nurse or therapist will help you get up several times during the day and take a few steps in the room and then to sit in a chair for minutes. Your stomach will be waking up and should be able to take juice and jello. You can also eat more than this if you wish. As you start eating and drinking, we have you start taking pills for the pain, in addition to medicine through the IVs. Over the next few days after surgery, we change the dressing to your back and get you disconnected from all of the tubes and wires. You gradually get more of an appetite and do more and more walking with the nurses or therapists in the hallway. On the fifth day, the nurses will help you wash up in the bathroom. After this your parents will help you. Long showers are allowed after 7 days and baths after 2 weeks if the incision is fully dry. It is common for girls to start their menstrual periods while in the hospital (even if they have just finished one) due to stress on the body. WHAT HAPPENS AFTER GOING HOME? Patients who have undergone scoliosis surgery have generally been discharged from our hospital within five too seven days. Parents are encouraged to assist their child during this time with issues such as pain management and observation of the surgical site. The surgical site should be OrthoInfo Scoliosis Surgery Page 4 of 6

5 observed for redness, warmth, and drainage. The area immediately around the incision may feel numb to the patient. This is common. The surgical site will be covered with short pieces of white tape called steri-strips. These strips fall off on their own and require no maintenance. They should be left in place. The patients temperature can be checked if there is concern for fever and you should call the pediatric orthopedist's office if it is F or higher or if there is significant redness or prolonged drainage from the incision. Five days after surgery, you may shower with minor assistance from your caregiver. Assistance is needed to help you get into the shower and you may need help washing your hair. If there is a dressing on the incision, remove this before showering and leave it off. It is acceptable for the incision to get wet as long as the incision is closed. This is a good time to check the surgical site for the signs and symptoms of infection that are noted above. You should be encouraged to walk around the home and participate in family activities such as meal time. You may feel stiff in the morning or after sitting for a while. You may feel tired or get fatigued easily, especially after busy days. The best thing for the stiffness is walking and moving. Walk around the house or around the block and you will loosen up quickly. When you are tired take a rest or a short nap. As time goes you will gradually have less and less stiffness and you will regain the energy you had before surgery. Most people feel pretty good by 4-6 weeks. The length of time that this takes varies with each patient and with the extent of the surgery, but may take up to six months. Restrictions are imposed immediately after surgery and are gradually lifted as you progress through the post-op process. Initially a weight lifting restriction of 10 to 15 pounds is common. Gym class may need to be substituted with another class for the first 6 months post-op. Also, contact sports are not allowed for 12 months. Over the initial 6 months, restrictions will be gradually lifted allowing the child to become more involved in various activities. Generally, light duty running, biking, and amusement park rides are permissible at 3 months post-operatively, and full speed running, jumping, and skiing are allowed 6 months after surgery. The final decision about when to return to school is up to you and your parents. You may return part-time or full-time when your energy level returns. Contact your school for their advice. Home schooling will be advised for four to six weeks following surgery. Forms can be obtained from your child's school. Students will be unable to carry heavy book bags during the first 3 months. A second set of books for the home or extra locker breaks may be necessary. As you heal up and regain your energy, your strength and flexibility will also improve. The segment of the spine that is usually fused does not contribute significant to your spinal motion. This means OrthoInfo Scoliosis Surgery Page 5 of 6

6 that we fully expect that you will bend, twist, sit, stand, walk, run, and jump normally. The picture shows a girl 12 months after surgery with good flexibility. You will require follow-up visits to the doctor. Usually, we like to see you at 6 weeks after surgery, then at 3 months, 6 months, and then at one year to make sure fusion is solid. Further visits may be needed if you are still growing. Do not get a tattoo or body piercing to minimize risk for seeding an infection. If you need to have dental work or another type of procedure done in the 12 months after surgery, you should be given protective antibiotics to avoid potential for an infection to get into the spinal fusion. The dentist or doctor doing the procedure or work can make arrangements for this. NOTES FOR PARENTS This text has been written primarily for your adolescent. However, the information is also for you. While adolescents want and need a certain degree of independence, they also rely on you to help and guide them with the important things. It is important for you to be involved in the assessment and treatment of your adolescent s scoliosis. Get the information you need, so you can review and reinforce it with your adolescent. Avoid terms and statements which can be upsetting, especially as they relate to being abnormal, having a deformity, or being at risk for long terms problems with pain or paralysis. Almost all adolescents will be treated without problems or complications. At the end of treatment almost all will have a good to excellent cosmetic appearance and little if any limitations on their activities and future. Emphasize that we can treat their scoliosis and in the long run they should look good, play sports, finish their schooling, enjoy family and friends, and live long and productive lives. Make sure your questions are answered so that you can be your adolescent s coach and biggest fan. If you have problems doing this, let your doctor know and we will find resources to help you and your family deal with stress of scoliosis. Scoliosis can be and almost always is treated very successfully! MORE INFORMATION More information is available from the National Scoliosis Foundation at Further information can be obtained on the internet. Two good sites for expert and peer reviewed information are and FEEDBACK If you have questions or comments, please contact the office or submit them to the web site at OrthoInfo Scoliosis Surgery Page 6 of 6

Ileal Conduit Diversion Surgery

Ileal Conduit Diversion Surgery Here are some words and pictures to help you understand this surgery: Bladder: the bladder stores urine that is made by the kidneys Bowels: the bowels are the parts of the body that digest food and fluids.