Definition of Scoliosis surgery - 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:

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.

Why the Procedure Is Performed:

There are several reasons to treat scoliosis:

• Appearance is usually a major concern for anyone with scoliosis.
• Scoliosis often causes back pain.
• If the curve is severe enough, scoliosis may affect your child's breathing.

Braces are often tried first to slow the curve from getting worse.

The choice of when to have surgery will vary.

• After the bones of the skeleton stop growing, the curve should not get much worse. Because of this, the surgeon may want to wait until your child's bones stop growing.
• However, your child may need surgery before this if the curve in the spine is severe or is getting worse quickly.

Surgery is usually recommended for the following children and adolescents with scoliosis of unknown cause (idiopathic scoliosis):

• All young people whose skeletons have matured, and who have a curve greater than 45 degrees.
• Growing children whose curve has gone beyond 40 degrees. (There is still some debate, however, about whether all children with curves of 40 degrees should have surgery.)