Scoliosis

Surgery

Pre-operative X-ray of a scoliosis patient

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If a child's spinal curvature is greater than 40 to 50 degrees, doctors typically recommend surgery to correct and to fuse the vertebrae along the spinal curve. Surgery may also be necessary for curves that occur in certain areas of the spine or for adults with scoliosis who suffer from pain.

Scoliosis surgery is one of the longest and most complicated orthopedic surgical procedures performed on children. The operation takes approximately six hours. Hospitalization can last several (usually around six) days, and activities are restricted for several months.

Surgery is most commonly performed through incisions in the back (referred to as a posterior surgical approach). For less common, very rigid, or severe curves, additional surgery may be required through the front or side of the body. Mayo Clinic's pediatric orthopedic surgeons are extremely experienced and skilled in these procedures.

Posterior Spinal Fusion
Mayo surgeons often use a modification of a two-rod system (or instrumentation) for spinal fusions, following a procedure that was invented in 1984 by two French surgeons named Ives Cotrel and Jean Dubosset. Two metal rods and hooks or screws are attached to the spine to provide as much correction as possible. A portion of the spine fuses (heals together) to hold the correction in place. The patient's ability to bend or move may be altered minimally.

The instrumentation is left in the body, even after the bones have fused, to avoid another surgery. In addition to supporting the fused area, instrumentation also applies force to the spine to help correct the deformity. This surgery may straighten the spinal curve considerably.

Post-operative X-ray of same patient following posterior spinal fusion.

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Growing Rods
Early onset scoliosis can severely impact a child's growth, and in severe cases can affect the heart and lungs. Some cases of scoliosis surgery in very young children can impact a child's growth and result in restricted breathing ability and other problems.

To address this issue, Mayo surgeons are investigating a technique that employs "growing rods." Surgeons anchor two parallel rods to bone at either end of the spinal curve; the middle section of the rods is adjustable. Periodic lengthening of the adjustable section is performed during outpatient procedures.

Prior to surgery
The Mayo Clinic health care team educates each patient prior to scoliosis surgery. They also work with patients to review the details of surgery and educate them about how it will affect their child's lifestyle. Mayo patient education tools include:

• Patient Education Class: "Preparing for Surgery ... A Program for Children and Teenagers." This class is held in the patient health and education center.

• Patient Literature: "Anticipated Recovery Plan" This publication includes a written plan for each day of surgery and recovery. Mayo health care providers distribute this to surgery patients.

These resources help patients learn the reasons for surgery, the risks and complications of surgery, steps to recovery, deep breathing and coughing exercises, movement while in bed, how to get in and out of bed, how to manage pain, and how to use drainage tubes.

Patients should plan for a six-day hospital visit; parents may stay with their children during surgery hospitalization.

After surgery
Following successful surgery, the patient's back is straighter and all or most of the rib prominence is corrected. A red or pink scar typically appears on the back, along the spine, but it will fade. Following surgery, there is usually no need for a brace.

Once a patient returns home, activity should be limited to allow the spinal fusion to heal. During the days and months after the surgery, patients may reinstate activity incrementally:

• For three months after the surgery, the patient should refrain from physical activity such as gym class or running.
• After three months, the patient may return to normal activity, except gym class, diving, contact sports, horseback riding, amusement park rides and lifting more than 25 pounds.
• At six months, with a doctor's permission, the patient may resume all activity except contact sports.
• After one year, with a doctor's permission, patients can resume all activity including contact sports.

Drawbacks and complications
One drawback of spinal fusion is that it stops growth in the area of the spine where surgery occurs. A child's final height is not drastically affected, however, because most growth occurs in the leg bones and in the unaffected part of the spine.

The complication rate of scoliosis surgery can be significant. It is extremely important to engage experienced surgeons who are skilled in this procedure. Complications may include bleeding, infection, pain, nerve damage, arthritis, and disk degeneration. In rare cases, a second surgery may be needed if the first does not correct the problem.