Medical Health Encyclopedia

It should be noted that procedures will differ depending on whether a child has idiopathic scoliosis or scoliosis due to muscle and nerve disorders (such as muscular dystrophy or cerebral palsy). In the latter cases, children also need a team approach to reduce their risks for serious complications.

Preoperative Care

Before the operation, a complete physical examination is conducted to determine leg lengths, muscle strength, lung function, and any postural abnormalities. The patient is trained in deep breathing and effective coughing to avoid lung congestion after the operation. The patient should also be trained in turning over in bed in a single movement (called log-rolling) before the operation. Psychologic intervention using cognitive-behavioral methods that help young patients cope may be very helpful in reducing anxiety and pain after surgery.

Patients are encouraged to donate their own blood before the operation for use in possible transfusions. The patient should have no sunburn, rashes, or sores on the back before the operation, which will increase the risk for infection.

Fusion

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All scoliosis operations involve fusing the vertebrae. The instruments and devices used to support the fusion vary, however.

The Fusion Procedure. The fusion procedure generally is as follows:

• The surgeon first slices flaps to expose the backs of the vertebrae that lie along the curve.
• The surgeon then removes the processes, the bony outgrowths along the vertebrae that allow the spine to twist and bend.
• The surgeon lays matchstick-sized bone grafts vertically across the exposed surface of each vertebra, being careful that they touch adjoining vertebrae.
• The flaps are then folded back to their original position, covering the bone grafts.
• These grafts will regenerate, grow into the bone, and fuse the vertebrae together.

Depending upon the severity and responsiveness to other treatment surgery may be recommended for the scoliosis. Surgical correction involves correcting the curve (although not all the way) and fusing the bones in the curve together. Bone grafts are laid across the exposed surface of each vertebra. These grafts will regenerate, grow into the bone, and fuse the vertebrae together. The bones are held in place with one or two metal rods held down with hooks and screws, which also helps to support the fusion of the vertebrae.