Scoliosis surgery in children
Definition
Scoliosis surgery repairs abnormal curving of the spine (scoliosis). The goal is to safely straighten your child's spine and align your child's shoulders and hips to correct your child's back problem.
Alternative Names
Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child
Description
Before surgery, your child will receive general anesthesia. These are medicines that put your child into a deep sleep and make them unable to feel pain during the operation.
During surgery, your child's surgeon will use implants, such as steel rods, hooks, screws, or other metal devices to straighten your child's spine and support the bones of the spine. Bone grafts are placed to hold the spine in the correct position and keep it from curving again.
The surgeon will make at least one surgical cut (incision) to get to your child's spine. This cut may be in your child's back, chest, or both places. The surgeon may also do the procedure using a special video camera.
- A surgical cut in the back is called the posterior approach. This surgery often takes several hours.
- A cut through the chest wall is called a thoracotomy. The surgeon makes a cut in your child's chest, deflates a lung, and often removes a rib. Recovery after this surgery is often faster.
- Some surgeons do both of these approaches together. This is a much longer and more difficult operation.
- Video-assisted thoracoscopic surgery (VATS) is another technique. It is used for certain kinds of spinal curves. It takes a lot of skill, and not all surgeons are trained to do it. The child must wear a brace for around 3 months after this procedure.
During the surgery:
- The surgeon will move muscles aside after making the cut.
- The joints between the different vertebrae (the bones of the spine) will be taken out.
- Bone grafts will often be put in to replace them.
- Metal instruments, such as rods, cages, screws, hooks, or wires will also be placed to help hold the spine together until the bone grafts attach and heal.
The surgeon may get bone for the grafts in these ways:
- The surgeon may take bone from another part of your child's body. This is called an autograft. Bone taken from a person's own body is often the best.
- Bone can also be taken from a bone bank, much like a blood bank. This is called an allograft. These grafts are not always as successful as autografts.
- Manmade (synthetic) bone substitute may also be used.
Different surgeries use different types of metal instruments. These are usually left in the body after the bone fuses together.
Newer types of surgery for scoliosis do not require fusion. Instead, the surgeries use implants to control the growth of the spine.
During scoliosis surgery, the surgeon will sometimes use special equipment to monitor the nerves that come from the spine to make sure they are not damaged.
Scoliosis surgery often takes 4 to 6 hours. It can also be much longer if the involved area is larger.
Why the Procedure Is Performed
Braces are often tried first to keep the curve from getting worse. But, when they no longer work, the child's health care provider will recommend surgery.
There are several reasons to treat scoliosis:
- Appearance is a major concern.
- Scoliosis often causes back pain.
- If the curve is severe enough, scoliosis affects your child's breathing.
The choice of when to have surgery will vary.
- After the bones of the skeleton stop growing, the curve should not get much worse. Because of this, the surgeon may wait until your child's bones stop growing.
- Your child may need surgery before this if the curve in the spine is severe or is getting worse quickly.
Surgery is often recommended for the following children and adolescents with scoliosis of unknown cause (idiopathic scoliosis):
- All young people whose skeletons have matured, and who have a curve greater than 45 degrees.
- Growing children whose curve has gone beyond 40 degrees or is rapidly progressing. (Not all doctors agree on whether all children with curves of 40 degrees should have surgery.)
Risks
There may be complications with any of the procedures for scoliosis repair.
Risks of anesthesia and surgery in general are:
- Reactions to medicines or breathing problems
- Bleeding, blood clots, or infection
Risks of scoliosis surgery are:
- Blood loss that requires a transfusion.
- Gallstones or pancreatitis (inflammation of the pancreas)
- Intestinal obstruction (blockage).
- Nerve injury causing muscle weakness or paralysis (very rare)
- Lung problems up to 1 week after surgery. Breathing may not return to normal until 1 to 2 months after surgery.
Problems that may develop in the future include:
- Bone fusion does not heal. This can lead to a painful condition in which a false joint grows at the site. This is called pseudarthrosis.
- The parts of the spine that are fused can no longer move. This puts stress on other parts of the back. The extra stress can cause back pain and make the disks break down (disk degeneration).
- A metal hook placed in the spine may move a little. Or, a metal rod may rub on a sensitive spot. Both of these can cause some pain.
- New spine problems may develop, largely in children who have surgery before their spine has stopped growing.
Before the Procedure
Tell your child's provider what medicines your child is taking. This includes medicines, supplements, or herbs you bought without a prescription.
Before the operation:
- Your child will have a complete physical exam by the surgeon.
- Your child will learn about the surgery and what to expect.
- Your child will learn how to do special breathing exercises to help the lungs recover after surgery.
- Your child will be taught special ways to do everyday things after surgery to protect the spine. This includes learning how to move properly, changing from one position to another, and sitting, standing, and walking. Your child will be told to use a "log-rolling" technique when getting out of bed. This means moving the entire body at once to avoid twisting the spine.
- Your child's provider will talk with you about having your child store some of their blood about a month before the surgery. This is so that your child's own blood can be used if a transfusion is needed during surgery.
During the 2 weeks before the surgery:
- If your child smokes, they need to stop. People who have spine fusion and keep smoking do not heal as well. Ask the surgeon for help.
- Two weeks before surgery, the surgeon may ask you to stop giving your child medicines that make it harder for the blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn).
- Ask your child's surgeon which medicines you should still give your child on the day of the surgery.
- Let the surgeon know right away when your child has any cold, flu, fever, herpes breakout, or other illness before the surgery.
On the day of the surgery:
- You will likely be asked not to give your child anything to eat or drink 6 to 12 hours before the procedure.
- Give your child any medicines the surgeon told you to give with a small sip of water.
- Be sure to arrive at the hospital on time.
After the Procedure
Your child will need to stay in the hospital for about 3 to 4 days after surgery. The repaired spine should be kept in its proper position to keep it aligned. If the surgery involved a surgical cut in the chest, your child may have a tube in the chest to drain fluid buildup. This tube is often removed after 24 to 72 hours.
A catheter (tube) may be placed in the bladder the first few days to help your child urinate.
Your child's stomach and bowels may not work for a few days after surgery. Your child may need to receive fluids and nutrition through an intravenous (IV) line.
Your child will receive pain medicine in the hospital. At first, the medicine may be delivered through a special catheter inserted into your child's back. After that, a pump may be used to control how much pain medicine your child gets. Your child may also get shots or take pain pills.
Your child may have a body cast or a body brace.
Follow any instructions you are given on how to care for your child at home.
Outlook (Prognosis)
Your child's spine should look much straighter after surgery. There will still be some curve. It takes at least 3 months for the spinal bones to fuse together well. It will take 1 to 2 years for them to fuse completely.
Fusion stops growth in the spine. This is not often a concern because most growth occurs in the long bones of the body, such as the leg bones. Children who have this surgery will probably gain height from both growth in the legs and from having a straighter spine.
References
Negrini S, Felice FD, Donzelli S, Zaina F. Scoliosis and kyphosis. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 153.
Warner WC, Sawyer JR. Scoliosis and kyphosis. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 44.
Yang S, Andras LM, Redding GJ, Skaggs DL. Early-onset scoliosis: a review of history, current treatment, and future directions. Pediatrics. 2016;137(1):e20150709. PMID: 26644484 pubmed.ncbi.nlm.nih.gov/26644484/.
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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