What factors should be discussed before surgery is considered? Surgical correction of spinal deformity

This page outlines the factors that should be considered before surgery to correct spinal deformity.
  • How your child feels about the surgery: spinal surgery is a big decision and one that your child should feel confident and optimistic about.
  • Your child’s age: ideally surgery is considered when most of a child’s growing is complete. In some instances however the progression of scoliosis does not allow waiting and surgery in these cases can be done earlier, in the first decade of life.
  • What your child weighs: spinal surgery is very demanding on the body so having a good weight and nutrition will help in your child’s recovery. Some children can lose up to 10% of body weight during surgery and recovery. Being too thin and light puts extra demands on your child’s ability to recover.
  • Your child’s breathing: this will be discussed with you by the anaesthetist. Broad guidelines would suggest that your child’s breathing should be above 30% of normal though there are differences between different conditions. Your child will have a sleep study to measure the breathing efficiency. If needed your child may be referred to a respiratory specialist to assess the breathing and the need of noninvasive breathing support at night around the time of surgery (see MDC factsheet Making breathing easier).
  • Your child’s heart: if your child’s heart is affected as part of his/her condition surgery can still be considered, unless the severity of the cardiac involvement poses significant concern. It is common practice for every child having scoliosis surgery to have their heart function assessed with an echocardiogram (if you are not sure, ask your child’s doctor). The surgery puts heavy demands on your child’s heart and it is important to consider whether your child’s heart is strong enough to cope with this.
  • Your home adaptations: once spinal surgery has been carried out moving and handling your child will need to be carried out using a hoist. This is particularly the case if your child is a constant wheelchair user. Home adaptations are therefore essential for managing your child’s needs after the operation.

What does the surgery involve?

There are now several orthopaedic surgeons in the UK performing spinal surgery on patients with neuromuscular disorders and they all have slightly different procedures and approaches to this, which reflect local expertise and different school of training. The following is a guide only.

There are two possible approaches:

  • a posterior approach where the surgeon does the operation through an incision (cut) down the length of the spine; 
  • a two stage anterior and posterior approach. The first stage is an anterior approach, where the surgeon makes an incision in the chest to release the spine from the front. The second stage takes place about a week later when the surgeon makes an incision down the length of the spine to insert the rods and fuse the vertebrae (spinal bones). Which procedure is used depends on your child’s condition and is a decision made between the surgeon and the anaesthetist. They will consider safety and your child’s specific situation and underlying diagnosis. The rods used to support the spine in an improved straighter position are metal and fixed in place with screws, but can also be fixed with wires and hooks. There are various designs available. Each surgeon will have his/her individual preference. It is therefore very helpful for each family to discuss the nature of the surgery with their surgeon and ask for detailed information regarding the exact nature and duration of surgery and the risks involved. Following spinal surgery it is hoped that your child/young person will no longer be required to wear a spinal brace. Again this can vary and some surgeons prefer some kind of support in the form of a spinal brave for a short period following surgery. Families should ask their surgeons about this at the time of surgery.

What are the risks?

This is major surgery. Prior to this surgery, each child/young person needs to undergo a full assessment by the medical, surgical and anaesthetic team to evaluate the risks involved for them.

The risk of anaesthesia requires skilled anaesthetic advice. Certain drugs should be avoided during anaesthesia in order to minimise reactions (see MDC factsheet Anaesthetics).

The operation itself is technically demanding and should be carried out by an experienced spinal surgeon. The spinal bones (vertebrae) protect the spinal cord. This surgery exposes the spinal cord during the operation. Careful monitoring of the spinal cord takes place throughout the surgery to detect very early if any stress to the spinal cord is occurring. Any major operation will involve the risk of significant blood loss; this is carefully monitored and managed by the surgeon and anaesthetist. The duration of surgery is an important factor and the longer the procedures, the higher the rate of complications and risks.

Other risks include infection which often requires return to hospital to clean and washout the wound; failure of the metalwork which may require repair at a second operation; further curve progression: prolonged paralysation (bowels stop functioning) which in some patients can prolong the stay in the hospital.