Surgery used to correct curvatures of the spine

Scoliosis Surgery

Scoliosis is a disorder that causes an abnormal curve of the spine or backbone. Scoliosis is about two times more common in girls than boys, affecting about 2 percent of females and 0.5 percent of males. It can be seen at any age, but it is most common in those over 10 years of age. Scoliosis is hereditary meaning that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next.

In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than three years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis. More than 80 percent of people with scoliosis have idiopathic scoliosis, and the majority of those are adolescent girls.

Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing and surgery. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. Depending on the severity of the curve, you may return to see me every three to four months to check for any worsening of the curve.

Scoliosis is not typically associated with back pain. However, those who do experience back pain, may find relief with massage and exercises, including yoga. These can help to strengthen the muscles of the back. However, they are not a cure for scoliosis and will not be able to correct the abnormal curve.

There are several different types of braces available for scoliosis. Some need to be worn nearly 24 hours a day and are removed only for showering. Braces are not designed to correct the curve. They are used to help slow or stop the curve from getting worse. People with progressive, severe scoliosis could eventually be at risk for heart or lung problems. The goals of surgery for scoliosis are correcting and stabilizing the curve, reducing pain and restoring a more normal curve and appearance to the spinal column.

Before your surgery date, you may undergo a pre-operative medical evaluation and surgical risk assessment by the hospitalist group where your surgery will take place. You will be instructed to stop taking weight loss supplements, herbals, aspirin, non-steroidal medications and anti-coagulants several days prior to surgery to help reduce blood loss.

The Surgery

There are different techniques and methods used today for scoliosis surgery. The most frequently performed surgery for idiopathic adolescent scoliosis involves spinal instrumentation with fusion of the vertebrae involved. This is done with a combination of screws, hooks and rods that are attached to the bones of the spine to hold them in place. The surgeon places bone graft above and below the bones to be fused to get them to grow together and become solid. This prevents any further curvature in that portion of the spine. In most cases, the screws and rods will remain in your spine and not need to be removed. There are many different ways to perform the fusion surgery. It may be all performed from a single incision on the back of your spine while you lie on your stomach. The surgery may also be done from the back, combined with another incision along your front or side. This decision is based on the location and severity of the curve.

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After Surgery

You may have a Foley catheter (a small tube) in your bladder for urination, which would have been placed when you were under anesthesia in the operating room. It will be painlessly removed the next day following surgery. At the hospital, a physical therapist will instruct you on how to safely get up and out of the bed, go to the bathroom and walk. You may need to use a walker for the first few days until you are stronger. This can be arranged to be taken home if needed.

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What You Can Do to Increase Your Chances of a Successful Outcome:

• No smoking
• Maintain a normal weight
• Proper nutrition with protein for healing
• A positive attitude

Call the office at 317.802.2490 if you develop any of the following:

• Leg swelling or calf pain.
• Fever, chills, redness around or drainage from your incision.
• Increasing back pain or numbness and tingling not relieved by rest and pain medication.

Pain Medication: Usually about four to six hours after surgery, the lidocaine that was used to numb the surgical site wears off, and you may start to feel a new post-op pain. This is normal, and you will be given pain medication for this through your IV. Later on post-op day one, the IV pain medication may be switched to pain pills. You will go home with a prescription for the same pain pills that worked for you in the hospital. Please remember that narcotic pain medications cause the intestines to move more slowly, which allows more time for your body to reabsorb water from your intestines. This can cause your stool to become dry and hard, thus causing constipation. Take an over-the-counter stool softener (Colace, Miralax, Senekot-S, Dulcolax or Milk of Magnesia) while you are taking narcotic pain medication and drink plenty of fluids. Your pain medication may contain an ingredient called acetaminophen or APAP. That is the generic name for Tylenol. Keep track of how many tablets you take a day and do not exceed 4,000 mg of acetaminophen in a 24-hour period. Excessive use of Tylenol can cause liver damage.

Wound Care: Your dressing will be changed on post-op day two in the hospital. There will be sutures at the top and bottom of your incision that will be painlessly removed at your first post-op appointment two weeks following your surgery. At times, I choose to use “skin glue” called Dermabond that does not require external sutures. If you feel the edges of this clear coating, do not peel or pick. It will come off over time. There may also be strips of tape across your wound called Steri-strips. Please leave these in place, even if they begin to curl up at the edges. They will be removed by me or my assistant at your first post-op appointment. Once you no longer notice drainage on the dressing, you don’t need to wear a dressing. However, some patients prefer keeping a dressing on for the first two weeks to avoid friction from the waistband of their pants or bras. Do not apply any ointments, peroxide or betadine to the incision, as these may inhibit new skin cell growth and delay complete healing of your incision.

Bathing: No tub bathing or swimming for six weeks; but you may shower at home after you are discharged from the hospital. It’s okay to shampoo your hair and for shower water to gently flow over the incision, but keep the full force of the stream away from your incision. Pat the incision dry and then let it air dry.

Nutrition: Drink a can of Boost or Ensure nutritional supplement at each meal until you are eating three regular, nutritious meals per day. Proteins are the building blocks of healing.

Initial Activity at Home:

• No bending, twisting, stooping or lifting over five to ten pounds for at least six weeks after surgery
• Sleep on your back or side with pillows under or between the knees
• First week: Walk short amounts in the house every ten to fifteen minutes. Stairs are okay as tolerated. Office work and driving are permitted after one week, but do not drive if you are still taking narcotic pain medication.
• Third week: You should be able to walk up to a half mile per day in divided doses
• Fourth week: You should be able to walk up to one mile per day in divided doses
• Sixth week: Return to moderate duty work
• Third month: Return to heavy duty work and be able to walk up to three miles per day

Students:

• You may request a second set of textbooks from your school to keep at home in order to avoid carrying too much weight in your book bag.
• Please refrain from contact sports that involve the risk of falling or being pushed.
• My office staff can provide the necessary paperwork for your school administrators or teachers.
• Use good body mechanics (always bend with your knees to lift or to pick up something from the floor). Physical therapy may be prescribed for you later in your recovery, depending on your progress. You may return to driving when you are completely off narcotic pain medications and are able to quickly step on the brake without pain.

Follow-up: Your first post-op appointment will be about two weeks after surgery; however, if you have concerns prior to this date, I will see you back sooner as needed. The tiny suture knots at each end of your incision will be painlessly removed and X-rays may be taken. Subsequent follow-up appointment intervals will be based on how you are progressing.