In spinal fusion for
scoliosis, rods, hooks, wires, or screws are attached
to the curved part of the backbone and the spine is straightened. Small pieces
of bone are then put over the spine. The bone pieces will grow together with
the spinal bone, fusing it into the proper position. Spinal fusion is major
surgery that usually takes several hours to complete.
Although the basic procedure is the same, a variety of specialized
techniques can be used to do spinal fusion. Many different types of spinal
instrumentation are used to treat scoliosis. Also, techniques vary, from
what type of hooks or rods are used to whether the surgery is done from the
front of the body or from the back. The method chosen will depend on a number
of things, including the child's age, spinal maturity, the location and
severity of the curve, the clinical opinion of the surgeon, and the preference of the
child and parents.
The surgical technique most often used to straighten and stabilize
the spine is to do surgery from the back, called the
Another option is to do the surgery from the front of the
body, called the
What To Expect After Surgery
Antibiotics to prevent infection are usually given at the beginning
of surgery and continued for 48 hours after the operation.
Most people spend several days in the hospital after surgery,
gradually increasing their movement over those several days. Depending on which
technique was used, some people may be fitted for a brace, but this is much
less common now than in the past.
By the time a person leaves the hospital after surgery, he or she
will be able to dress, bathe, feed himself or herself, and walk around. A child
may not return to school for 3 to 4 weeks.
Medicine used to reduce pain will be gradually decreased over a
After surgery, it is important to avoid any extreme bending,
twisting, stooping, or lifting of objects weighing more than
10 lb (4.5 kg). One should
expect to spend the first weeks at home with occasional rest periods throughout
Activities that could jar the spine—including competitive sports,
ice skating, roller skating, and skiing (water or snow)—are restricted for 6 to
12 months. Cycling and swimming can usually be resumed in 3 to 4 months, unless
prohibited by a brace or cast.
Why It Is Done
Surgery is indicated for:
- A child who has a severe spinal curve that is likely to progress.
- An adult who has
a severe spinal curve that is likely to
- A person who has a severe spinal curve that continues to
progress even after bracing.
Other factors considered before surgery include:
- Age, skeletal age, and status of
- Location of the curve.
Surgery may be considered in some situations, such as:
- An adult who has trouble breathing or who has
disabling back pain caused by scoliosis.
- A very young child who has
a severe spinal curve(s).
For very young children, the timing of surgery for severe scoliosis
is controversial. Some experts believe that surgery should be delayed until the
child is at least 10 years old and preferably 12 because surgery stops the
growth of the part of the spine that is fused. But in some situations, early
surgery can't be avoided.
How Well It Works
Whether surgery is successful depends on many factors, including
the flexibility of the curve and the technique that was used.
Multiple-hook, multiple-screws (that may also include hooks), and
double-rod systems improve the shape of the spine and back as seen from the
back and side.
The goal of surgery is not a perfectly straight spine but a
balanced one, in which fusion prevents the curve from getting worse.
After surgery, back pain in adults usually gets better or goes
Risks of surgery include neurological complications, infection, and
Surgery in an adult carries a higher rate of complications and
risks than in a child or teen, including blood clots,
pseudoarthrosis, infection, and neurological
Other risks of surgery
Early complications of surgery include the following:
- Ileus (lazy bowel) is a common complication
after spinal fusion. To treat this complication, the person is not allowed to
have any food and drink by mouth until normal bowel function returns, usually
within 36 to 72 hours after surgery.
- Collapse of a small portion of
the lung is a common cause of fever after surgery. Frequent turning of the
person and deep breathing and coughing help prevent this.
wound infections are rare but may require another surgery.
Late complications after surgery include the following:
- The most common late complications of spinal
pseudoarthrosis and back pain.
- A rod or
instrument that breaks usually indicates a pseudoarthrosis. But if there
is no pain and the curve seems stable, a broken rod does not need to be
- Loss of lumbar lordosis (flat-back syndrome) is
characterized by upper back pain, lower neck pain, inability to stand up
straight, increasing upper back fatigue with prolonged upright posture, and
front thigh and knee pain.
- Although neurological complications are
rare, they can occur. To reduce the risk, most centers use intraoperative
electronic monitoring of spinal cord functioning.
What To Think About
Fusing the curved area of the spine will cause that portion of the
spine to stop growing. But this should not greatly affect a child's adult
height, because the rest of the spine will continue to grow normally.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
|Primary Medical Reviewer||John Pope, MD - Pediatrics|
|Specialist Medical Reviewer||Robert B. Keller, MD - Orthopedics|
|Last Revised||July 21, 2011|