Spinal fusion for scoliosis
In spinal fusion for scoliosis, rods, hooks, wires, or screws are attached to the curved part of the backbone and the spine is straightened. Small pieces of bone are then put over the spine. The bone pieces will grow together with the spinal bone, fusing it into the proper position. Spinal fusion is major surgery that usually takes several hours to complete.
Although the basic procedure is the same, a variety of specialized techniques can be used to do spinal fusion. Many different types of spinal instrumentation are used to treat scoliosis. In addition, techniques vary, from what type of hooks or rods are used to whether the surgery is done from the front of the body or from the back. The method chosen will depend on a number of factors, including the child's age, spinal maturity, the location and severity of the curve, the expertise of the surgeon, and the preference of the child and parents.
The surgical technique most often used to straighten and stabilize the spine is to do surgery from the back, called the posterior approach.
Another option is to perform the surgery from the front of the body, called the anterior approach.
What To Expect After Surgery
Antibiotics to prevent infection are usually given at the beginning of surgery and continued for 48 hours after the operation.
Most people spend several days in the hospital after surgery, gradually increasing 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, he or she will be able to dress, bathe, feed himself or herself, and walk around. A child may not return to school for 3 to 4 weeks.
Medication used to reduce pain will be gradually decreased over a few weeks.
After surgery, it is important to avoid any extreme bending, twisting, stooping, or lifting of objects weighing more than 10 lb (4.5 kg). One should expect to spend the first weeks at home with occasional rest periods throughout the day.
Activities that could jar the spine—including competitive sports, ice skating, roller skating, and skiing (water or snow)—are restricted for 6 to 12 months. Cycling and swimming can usually be resumed in 3 to 4 months, unless prohibited by a brace or cast.
Why It Is Done
Surgery is indicated for:
- A child who has a severe spinal curve (greater than 40 to 45 degrees) that is likely to progress.
- An adult who has a severe spinal curve (greater than 50 degrees) that is likely to progress.
- A person who has a severe spinal curve that continues to progress even after bracing.
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(s).
For very young children, the timing of surgery for severe scoliosis is controversial. Some experts believe that surgery should be delayed until the child is at least 10 years old and preferably 12 because surgery stops the growth of the part of the spine that is fused. But in some situations, early surgery can't be avoided.
How Well It Works
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 objective 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.
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, pseudoarthrosis, infection, and neurological complications.
Other risks of surgery
Early complications of surgery include the following:
- Ileus (lazy bowel) is a common complication after spinal fusion. To treat this complication, the person is not allowed to have any food and drink by mouth until normal bowel function returns, usually within 36 to 72 hours after surgery.
- Collapse of a small portion of the lung is a common cause of fever 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:
- The most common late complications of spinal fusion are pseudoarthrosis and back pain.
- A rod or instrument that breaks usually indicates a pseudoarthrosis. However, 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) is characterized by upper back pain, lower neck pain, inability to stand up straight, increasing upper back fatigue with prolonged upright posture, and front thigh and knee pain.
- Although neurological complications are rare, they can occur. To reduce the risk, most centers use intraoperative electronic monitoring of spinal cord functioning.
What To Think About
Fusing the curved area of the spine will cause that portion of the spine to stop growing. However, this should not greatly affect a child's adult height because the rest of the spine will continue to grow normally.