Spinal Fusion for Scoliosis

Surgery Overview

Scoliosis is a problem with the curve in the spine. Some curves in the spine are normal. But sometimes a spine makes a large curve from side to side in the shape of the letter "S" or the letter "C." If this curve is severe, it can cause pain and make it hard to breathe. Spinal fusion is surgery that helps straighten the curves. It can relieve pain, make breathing easier, and give the spine a more normal appearance.

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, called grafts, are then put over the spine. Bone for grafts is often taken from other parts of the body, like the hipbone. The grafts will grow together with the spinal bone, fusing it into the proper position. Spinal fusion is major surgery. It usually takes several hours to complete.

Different techniques can be used to do spinal fusion. But the basic procedure is the same.

The surgical technique most often used to straighten and stabilize the spine is to do surgery from the back. This is called the posterior approach.

What To Expect

Antibiotics to prevent infection are usually given at the start of surgery.

Most people spend several days in the hospital after surgery. They slowly increase 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, they may be able to dress, bathe, feed themself, and walk around. A child may not return to school for a month or more.

Medicine used to reduce pain will be gradually decreased over a few weeks.

Activity

After surgery, it's important to avoid any extreme bending, twisting, stooping, or lifting of objects that weigh more than 10 lb (4.5 kg). You can expect to spend the first weeks at home with rest periods now and then throughout the day.

Activities that could jar the spine—such as competitive sports, ice skating, roller skating, and skiing (water or snow)—are restricted for several months. Cycling and swimming can often be resumed in a few months as long as you don't need a brace or cast.

Why It Is Done

Surgery may be done if:

• Your child has a moderate to severe curve or yours is severe, and the curve is getting worse.
• You have pain or trouble doing your daily activities.
• Bracing can't be used or doesn't work.

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.

Experts have different opinions about the timing of surgery to treat scoliosis in young children. Some experts believe that surgery should be delayed until the child is older. That's 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 goal 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

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, infection, and neurological complications.

Other risks of surgery

Early complications of surgery include the following:

• Collapse of a small portion of the lung is a possible problem 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:

• Back pain.
• Failure of the fusion. A rod or instrument that breaks usually indicates that not enough bone has formed to fully fuse the bones together. But 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). Loss of the normal curve in the low back causes the upper body to tilt forward, so standing up straight is hard to do. It takes more energy to stand this way, and that can lead to fatigue in the upper back. Some people bend their hips and knees a little to help them straighten up, which can lead to pain around those joints. And there can be severe pain in the upper back, lower neck, and areas of the low back that were not fused.
• Although neurological complications are rare, they can occur. To reduce the risk, most centers use intraoperative electronic monitoring of spinal cord functioning.