Scoliosis is a sideways curvature of the spine when viewed from the back or front. It is accompanied by a twisting of the body resulting in prominence of the ribs.
Typical signs include:
- A visibly curved spine
- One shoulder is higher than the other
- One shoulder or hip being more prominent than the other
- Clothes not hanging properly
- A prominent ribcage
- A difference in leg lengths
There are two main approaches used in scoliosis surgery:
Anterior, where the surgical cut is on the side of your chest
Posterior, where the surgical incision is on your back.
Your surgeon will choose which approach is best for you based on the type and location of your curve.
Surgery involves inserting metal screws and rods into the vertebrae of the spine to reduce the amount of your curvature. Bone is then added to encourage your spine to fuse. This is often your bone which has been recycled and mixed with proteins that stimulate bone growth. The bone continues to fuse after surgery is completed. The fusion process usually takes about 3 to 6 months and continue for up to 12 months.
Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together. The rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally rods do need removing, however, if they are irritating any soft tissues around the spine. The bones (not the rods) hold the spine in place once it has fused.
Important post-operative advice
After the operation, you will feel some pain and discomfort, which will be helped by medication. You may have the following:
- Small drainage tubes coming from your wound • A drip to replace lost fluids
- Patient Controlled Analgesia (PCA) Device
- An oxygen mask
- A catheter to drain your urine
These will be removed as soon as possible following the surgery.
Following your operation
You are likely to stay in the hospital for five days after your surgery.
A member of the team will inform you when and how much you can sit up in bed. You will be encouraged to sit up as much as you can tolerate for short periods, using the controls of the bed to help you. This allows your body to adapt to its new position, it helps to maintain your blood pressure, and it helps to restore and improve your respiratory and digestive functions. It is essential that you are positioned high enough up the bed so that when you do sit up; your bottom is in the crease of the bed. If you are too low in the bed, you are likely to be uncomfortable and not in the best position for your spine.
You will be encouraged to move around in bed as much as pain allows you, providing you adhere to your precautions. It is safe for you to shuffle up the bed and lift your bottom as long as you are not twisting or bringing your knees up higher than your hips.
You may need to wear a brace after your surgery. This will be confirmed by your surgical team after your operation. You may be given a soft corset initially, for comfort, to allow you to get up, sit in the bedside chair and to walk. Your therapists will guide you as to when you need to wear the corset or brace, and for how long.
When you are able to stand you will be booked for the casting of your brace. This is done early in the morning in plaster theatre. Your nurse will prepare you by dressing you in a stockinette. You will be permitted to stand for 5 to 10 minutes while the orthotist moulds a plaster cast type substance to your body. This shell is then used to create a TLSO (thoracolumbosacral orthosis) brace. The brace will be ready the following day. It often requires alterations to ensure the best fit. The brace is supplied to you to prevent you from excessive bending and twisting and to encourage an upright posture.
Benefits of surgery
There are two primary benefits of successful scoliosis surgery:
- Reduce rib prominence and diminish spinal deformity
- Stop a curve from progressing
All operations involve risk and potential complications. Although rare, it is essential that you understand them. There are risks to you in general and risks of the procedure itself.
Risks of the procedure itself include:
- Sickness, nausea, heart problems, breathing problems and nervous system problems relating to the anaesthetic. The anaesthetic risks will be discussed with you by the anaesthetist on your admission.
- Infection – all possible precautions are taken to avoid infection during your operation. Superficial skin infection is treated with antibiotics. However, if the metalwork becomes infected it may need to be removed and replaced.
- Nerve injury around the surgical site. Nerve injury can cause numbness, weakness, paralysis and bladder/bowel problems. If this happens, we will investigate it carefully and may ask other experts in the hospital for their advice and help in restoring function.
- Blood vessel injury around the surgical site. If this happens, we will investigate it carefully and may ask other experts in the hospital for their advice and help in restoring blood vessels.
- Bowel injury
- CSF leak
- Blindness (very rare)
- Leg length discrepancy Increased back pain
- Failure of fusion
- Failure to improve current symptoms
- Metalwork misplacement
- Metalwork failure
- Adjacent segment disease
- Deep Vein Thrombosis (DVT) – a DVT is a blood clot in the deep veins of the calf or thigh. To reduce the risk of developing DVT and to help circulation, you will be given stockings and will be asked to wear special inflatable sleeves around your legs while in bed. These inflate automatically and provide pressure at regular intervals, increasing blood circulation in your legs. You may require blood-thinning medication which will be decided by the consultant depending on risk factors. The physiotherapist and nursing staff will show you how to exercise your legs and ensure that you start to move about quickly after your operation. If a clot develops and part of it breaks away, it can travel to the lungs where it is called a Pulmonary Embolus (PE). APE is potentially life-threatening and so everything is done to prevent a DVT from developing. We ask you to help by wearing your stockings at all times while you are in the hospital, except when you are bathing.
Fortunately, most of these risks are rare. However, it is crucial that you consider these carefully before making a decision. Please discuss the procedure thoroughly with your surgeon when you see them in the clinic.