Northern California Spine Institute---Surgical Treatments---Frequently Asked Questions---Posterior Scoliosis Surgery

Surgical Procedures
POSTERIOR SCOLIOSIS SURGERY


1. WHAT IS SCOLIOSIS SURGERY?

Scoliosis surgery is done to a part of the spine that is more curved than normal. Metal rods, screws, and hooks are usually used to help the spine fuse. The rods and hooks are useful to help hold the fusion until it consolidates.
Once the fusion is solid, the rods and hooks really are no longer necessary. However, we do not see a strong reason to take these out, and therefore we usually leave these in place.

2. WHAT IS A FUSION?

Fusion is a process in which the spine is "welded" together. A bone graft taken from the hip is turned into a solid piece of bone by the body. If one could go inside the body and look at a healed fusion, one would see it as solid as any other bone. This means that there is no movement across this part of the spine. If the fusion does not heal, movement will occur and the rods will eventually break. We would have to repair the area that has not healed (pseudarthrosis) with another operation.

3. HOW MUCH CORRECTION OF THE SPINE DO WE AIM FOR?

At the time of surgery we try to obtain some correction of the curve, although this is not the main goal of the surgery. We find that complete correction is not necessary as people can function very well with a slight curvature of the spine. Also, too much correction may cause the spine to be out of balance with the shoulders or pelvis. We never try to completely correct the curve as this is dangerous to the spinal cord. This increased correction is not worth the risk of neurological damage. On average we usually obtain about 50% correction, but this depends on many factors.

4. WHAT ARE THE DETAILS OF THE SURGERY

The surgery takes 4 to 6 hours to perform. The patient lies face down on the operating table and after the surgery it is not uncommon for patient to have a swollen face for a couple of days. A skin incision is made along the length of the curve. We lift the muscles away from the spine, place the rods, hooks, screws, and roughen up the surface of the spine so that the bone graft will adhere to the spine for eventual fusion. After, the patient will be in the recovery room for about 2 hours.

5. WHAT IS THE POSTOP COURSE LIKE?

Usually the patient can be up out of bed within 2 days of the surgery. The hospital stay is 4 to 6 days. The first couple of days are quite uncomfortable, and we do the best we can to keep the patient comfortable with strong pain medications. Usually by the second or third day, the pain eases off considerably. There will be some soreness for 6 weeks, or longer.
On leaving the hospital, the patient is able to get around easily and can usually return to light activity within 2 to 4 weeks after the operation. Adolescents, usually return to school in 6 weeks. A brace may or may not be required after surgery, depending on the instrumentation and whether the fixation holding the spinal correction is strong.
We do not allow the patient to return to normal activities until the fusion is completely healed. This is determined by x-rays and the amount of time from surgery. It usually takes 6 months for the fusion to become solid. At that point, full activities can be gradually worked in. Full activity is reached by 8-12 months from surgery. However, their may be some permanent restrictions such as aggressive contact sports (e.g. football or wrestling).

6. WILL MY SPINE BE VERY STIFF AFTER THE FUSION ?

Patients are concerned about losing mobility of the spine with this type of surgery. There is some loss of twisting motion in the thoracic spine and some bending forward motion in the lumbar spine. However, most of the bending in the low back takes place at the hips, and we find that people do quite well and can even be very, active with completely fused spines.

7. WHAT ARE THE POTENTIAL COMPLICATIONS OF SURGERY ?

Scoliosis surgery is major surgery. The following are some of the potential complications: 1) paralysis - the risk is low, especially with the availability of the spinal cord monitor; 2) infection; 3) nonunion (pseudarthrosis); 4) rod, hook or screws dislodging or pulling out; 5) persistent pain.
Other potential complications relate to any major surgery and not specifically scoliosis surgery. These include 1) blood loss and transfusion risks (such as AIDS and hepatitis) [if we anticipate a moderate risk of transfusion, you will be asked to donate blood in advance]; 2) medical complications, including death; 3) gastrointestinal problems, including ileus; 4) bladder infection; 5) pneumonia.
As with every major surgery there are significant risks of infection, blood clots, stroke, heart attack and even death. We would like to emphasize that these are potential complications, and the actual complication rate is quite low.