Scoliosis surgery - child
Alternative Names: Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child
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.
Description of Procedure
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, screws, or other metal devices to straighten your child's spine and support the bones of the spine. Then the surgeon will often 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 one surgical cut 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 usually 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 usually 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 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 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, screws, hooks, or wires will also be placed to help hold the spine together until the bone grafts 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 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 always as successful as autografts.
- Scientists are developing a man-made (synthetic) 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.
- In the Cotrel-Dubousset instrumentation (CDI), instruments are placed in each part of the spine that needs straightening. Your child may go home in about 5 days and may return to school in about 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 of Scoliosis surgery - child
There may be complications with any of the procedures for scoliosis repair.
Risks for any anesthesia are:
Risks for any surgery are:
- Bleeding
- Blood clots in the legs that may travel to the lungs
- Heart attack or stroke during surgery
- Infection, including in the lungs (pneumonia), bladder, or kidney
Possible complications from any scoliosis repair surgery are:
- Blood loss that requires a transfusion.
- Gallstones or pancreatitis (inflammation of the pancreas) may occur.
- Infection.
- Intestinal obstruction (blockage) may occur.
- Nerve injury. This occurs in fewer than 1% (1 out of 100) of patients and may cause muscle weakness. Paralysis is very rare.
- 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.
Problems that may develop in the future include:
- The fusion does not heal. This can lead to a painful condition in which a false joint grows at the site. It 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).
- 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 problems may develop, especially in children who have surgery before their spine has stopped growing.
Learn more about Scoliosis surgery - child
Reviewed By: Thomas N. Joseph, MD, Private Practice specializing in Pediatric and Adult Orthopaedics, subspecialty Foot and Ankle, Camden Bone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Copyright 2011 A.D.A.M., Inc.
