Adolescent idiopathic scoliosis - information about surgery

Who is the leaflet for? What is its aim?

This information leaflet has been prepared to help you understand as fully as possible about surgery for scoliosis. Please read this information carefully and if you have any further questions do not hesitate to ask.

Adolescent idiopathic scoliosis (AIS) is by far the most common type of scoliosis, affecting children and young people between the ages of 10 to 18; it is found in as many as 4 in 100 adolescents. In general, AIS curves progress during your rapid growth period. While most curves slow their progression significantly at the time of skeletal maturity, some, especially curves greater than 60 degrees, continue to progress during adulthood. Many theories exist regarding the causes of AIS including hormonal imbalance, asymmetric growth and muscle imbalance. Although the cause of AIS remains elusive, we have methods of estimating the risk for curve progression of scoliosis and good methods of treatment.

Surgery is considered in cases where there is risk of the curve progressing or it has progressed beyond 40 degrees. Approximately 1 in 4 patients with scoliosis will require surgery. The aim of surgery is to correct and stabilise your spine to prevent further deterioration.

The surgery which is required to correct this deformity of your spine is major. It is important to be aware of the risks of possible complications and that although the end result should be an improved appearance, your spine will still be far from normal and there may be further problems in the future.

The operation involves positioning you to correct the curve. An incision is made down the middle of your back, screws are inserted on both sides of the spine and then two metal rods are inserted, which hold the correction in place. Bone graft is then added which causes the fusing (joining) of the vertebrae in that part of the spine so that they eventually join together. The operation itself normally takes four to five hours. You may, however, be in the operating theatre for most of the day, which includes the time it takes to set you up for surgery.

Risks of surgery and blood transfusion

Blood loss is normal during surgery and a proportion of patients may require a blood transfusion either during surgery or shortly afterwards.

The main risk is the possibility of damage to your spinal cord. If this happens it can result in paralysis of the legs and loss of control of the bowels and bladder. Fortunately this complication is rare. Worldwide it occurs in about 0.5 per cent of cases. Special precautions are taken to protect your spinal cord. In particular spinal cord monitoring is used so that if anything damages your spinal cord during the operation it can be detected immediately and hopefully the situation can be remedied.

The other risks are those which exist with any large operation. These include damage to the important blood vessels. Damage to one of the main blood vessels near the spine could result in life-threatening bleeding, although this is exceedingly rare.

Wound infections can occur although these sometimes do not become apparent until several months or even years later. If this occurs then it may be necessary to remove the metalwork from your spine.

Occasionally, the implants (screws and rods) can loosen or fail. You will have regular xrays after the operation to check the metalwork.

There will always be a large scar on your back, although it fades over the six months following surgery. Sometimes the skin around the scar can feel numb or tender.

Treatment after the operation

After the operation, you will be looked after on the intensive care, high dependency unit or closely monitored on the ward. You will have a variety of wound drainage tubes and a tube, called a catheter, in your bladder.

It should be possible for you to get out of bed on day one and then gradually become more mobile on the ward. Patients are normally ready to leave hospital from four days after their surgery.

After discharge from hospital you should be able to gradually increase activity levels at home and should be able to return to school or college in four to six weeks. It takes several months for the bone fusion to happen and you should consider your spine somewhat weaker than normal until it is fused.

It is most important that you fully understand the nature of the operation which you are about to have. If you have any further questions after reading this leaflet the team will be happy to discuss them with you.

Scoliosis team

• Consultant orthopaedic spinal surgeons – Mr J Crawford and Mr D Hay
• Paediatrician Consultant anaesthetist
• Specialist physiotherapists
• Specialist Nurse Practitioner
• Scoliosis co-ordinator – 01223 254694
• Secretary to Mr J Crawford – 01223 257299
• Secretary to Mr D Hay – 01223 274152

Decision making process

• Counselling about scoliosis surgery
• MRI
• Lung function testing
• Medical risk assessment

If the decision is made to proceed with surgery at this point, your case will be put forward for discussion at a multi-disciplinary meeting. If the team agree that no further investigations are necessary prior to surgery your name will be placed on the waiting list for surgery.

While on the waiting list – which can take several months – you will not be routinely reviewed in clinic.

If it has been over six months since the last x-ray or you are experiencing an increase or change in your symptoms then an appointment can be arranged with the specialist physiotherapist for review and an x-ray can be taken if appropriate.

Before the operation

When we have a potential date for your surgery you will be asked to attend the outpatient clinic for a few hours for a ‘pre-operative assessment’. During this visit the following tests are likely to be done to help plan the operation and make sure that you are fit for surgery:

Prior to your admission you are welcome to visit the ward to familiarise yourself with the set up.

Admission

You will be advised about the plans for your admission by letter. You will be admitted to a ward at Addenbrooke’s or to Nuffield Health, Cambridge Hospital.

A parent, carer or guardian can stay with you on the ward.

At Addenbrooke’s, relatives can also stay on site at: Acorn House (opens in a new tab) 01223 586806

Unfortunately if there are unforeseen emergencies, there is a chance that your operation may be cancelled or postponed if no appropriate bed for your post-operative care is available.

Day of the operation

You will be in the operating theatre most of the day and then you will be transferred to the ward.

After the operation

Foot and ankle exercises

You will be attached to drips and drains, including a catheter. These will gradually be removed as you recover.

Static muscle exercises

You will be attached to a special pain controlling system called PCAS (patient controlled analgesia system) which allows you to control the amount of painkillers that you receive.

Leg and trunk exercises

• Breathing exercises
• Foot and ankle exercises
• Static muscle exercises
• Leg and trunk control exercises

You will be assisted to roll in bed until you can turn yourself comfortably.

You will be helped out of bed to stand on day one.

You will be able to start sitting for short periods for functional activities such as toileting and eating.

The physiotherapist will assist and monitor you as you mobilise (walk) around the ward. You will then be able to walk regularly and gradually increase time sitting.

Once safety and comfort allow, you will be discharged home. This would be from day four onwards.

First six weeks:

• Gradually increase the frequency and length of time spent sitting, standing and walking. Decrease the amount of time spent lying and resting.
• You will probably benefit from lying down for a rest if your back becomes uncomfortable.

Four to six weeks:

• Return to school or college part time, for example half days or every other day, gradually increase time and frequency of attendance as able.
• Increase time and distance walking, increase pace as able.

Six weeks onwards:

• Consultant review and x-ray in clinic.
• Commence physiotherapy and hydrotherapy – the team will be in contact about these appointments and they will be take place over the next couple of months.

After three months:

• You can go swimming, cycling or running

Six months:

• Review and x-ray in clinic.
• Aim to increase fitness.
• Acceleration/deceleration and turning.
• No contact sport.

12 months:

• Competitive contact sport.

Useful organisations

• Scoliosis Association UK (opens in a new tab) (SAUK) – leaflet from clinic 6
• Scoliosis Research Society (opens in a new tab)
• The British Scoliosis Society (opens in a new tab)

If you would like to be put in touch with a patient who has had scoliosis surgery, please contact the scoliosis co-ordinator on 01223 254694.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.