Scoliosis surgery - child

Definition

Scoliosis surgery repairs abnormal curving of the spine (scoliosis). The goal is to safely straighten the spine, align your child's shoulders and hips, and give you long-term correction for 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. This will make your child unconscious and unable to feel pain during the operation.

During surgery, your child's surgeon will use steel rods, hooks, or other metal devices to straighten your child's spine and support the bones of the spine. Then the surgeon will use bone grafts to hold the spine in the correct position and keep it from curving again.

Your child's surgeon will make at least 1 incision (cut) to get to your child's spine. This incision may be in your child's back, chest, or both places. The surgeon may also do the procedure using a special video camera.

• An incision in the back is called the posterior approach. Your child will lie on their stomach. This surgery usually takes several hours.
• An incision through the chest wall is called a thoracotomy. Your child will lie on their side. The surgeon makes a cut in your child's chest, deflates a lung, and usually removes a rib. Recovery after this surgery is usually faster than after posterior-approach surgery.
• Some surgeons do both of these approaches together. This is a much longer and more difficult operation.
• Video-assisted thoracoscopic surgery (VATS) is a newer 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 3 months after this procedure.

The surgeon will move muscles aside after making the incision. The joints between the different vertebrae (the bones of the spine) will be taken out. Bone grafts will be put in to replace them. Metal instruments, such as rods, screws, hooks, or wires, will also be placed to help hold the spine together until the bone grafts fuse (attach) and heal completely.

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 may be taken from your child's hip or pelvis, the spine itself, or a rib. Bone taken from a person's own body is probably 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 usually as successful as autografts.
• Scientists are developing a synthetic (man-made) bone substitute, but it is not commonly used yet.

Different surgeries use different types of metal instruments. These are usually left in the body after the bone fuses together. Three of the more common procedures are:

• In the Harrington procedure, a steel rod that runs from the bottom of the curve to the top is put in place. Your child must wear a full body cast and lie in bed for 3 to 6 months after this procedure.
• The Cotrel-Dubousset instrumentation (CDI) is the "classic" surgery to correct deformities of the spine. Instruments are placed in each part of the spine that needs straightening. With this procedure, your child may go home in 5 days and may return to school in 3 weeks.
• The Texas Scottish-Rite Hospital (TSRH) operation is similar to the Cotrel-Dubousset procedure.

During surgery, the nerves that come from the spine will be watched using special equipment to make sure no damage is done to any of the nerve roots.

Scoliosis surgery usually takes 4 to 6 hours. It may be longer or shorter for some children.

Risks

There may be complications with any of the procedures for scoliosis repair.

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Infection, including in the lungs (pneumonia), bladder, or kidney
• Bleeding
• Heart attack or stroke during surgery

Possible complications from any scoliosis repair surgery are:

• Blood loss that requires a transfusion.
• Infection.
• Nerve injury. This occurs in fewer than 1% (1 out of 100) of patients and may cause muscle weakness. Paralysis is very rare.
• The fusion fails to heal. This can lead to a painful condition in which a false joint grows at the site. It is called pseudoarthrosis. Smokers are at higher risk for this problem.
• The parts of the spine that are fused can no longer move. This places stress on other parts of the back. This extra stress can cause back pain and disk degeneration (breaking down).
• One of the metal hooks placed in the spine may move a little. One of the metal rods may rub on a sensitive spot. Both of these things can cause some pain.
• New spinal deformities may develop, especially in children who have surgery before their spine has stopped growing.
• Some people may have lung problems up to 1 week after surgery. Breathing may not be completely normal until 1 to 2 months after surgery.
• Gallstones or pancreatitis (inflammation of the pancreas) may occur.
• Intestinal obstruction (blockage) may occur.