← Neuromuscular Scoliosis: A Guide for Families
The surgeon attaches anchors and rods to the spine to straighten it, and adds bone graft so the spine fuses and the curve stays corrected. These are long, demanding operations, and your child is watched closely throughout.
What is done
A long cut is made along the back. Hardware anchors, metal rods and bone graft are attached to the spine to straighten it, and to fuse the bones together so the curve doesn't come back.
- The anchors (screws, hooks or wires) are fixed directly to the spine and connected to straight rods. The rods run from just below the neck to the pelvis, or less often to the lower spine. Attaching the curved spine to straight rods straightens it
- Individual bones fuse (grow together) when the joints between them are removed. Artificial or donor bone graft acts like glue to support the fusion once the rods are in. Fusion stops the curve from returning, which can happen even with rods in place
- The rods are made of stainless steel, cobalt chrome or titanium, and don't need to be removed
Other operations we sometimes use
- Growing rods: in young children who are still growing a lot, growing rods are attached above and below the curve without a full fusion, so the spine can keep growing. They are lengthened every few months, and a final fusion is done when growth is nearly complete
- Traction and releases: very large, stiff curves may need traction (gentle stretching with weights) before or during surgery, or a release of tight ligaments at the front of the spine as a separate operation
Before surgery
- You and your child have a visit with your surgeon. We may take more X-rays to plan the surgery. We review it, and you give informed consent. This guide does not replace the consent form. Ask us any question you have, so you are as comfortable as you can be with your decision on the day
- Your child has a pre-operative nursing visit. You get instructions about surgery, including how to wash the skin beforehand to lower the risk of infection. Blood tests check that your child isn't anaemic and has enough kidney function for surgery. We may also ask for lung and heart checks, depending on your child's condition
- Tell us about all medicines, including herbal remedies. Some, such as aspirin and ibuprofen-type painkillers, raise the risk of bleeding and need stopping beforehand. We will tell you which, and when
- The anaesthesia team will give you exact times for stopping food, feeds and drinks
On the day of surgery
- You arrive well before the operation. Extra blood is taken so blood is ready if your child needs a transfusion
- Because of the long fusion, the large curves and your child's other medical problems, these operations are demanding. They can take several hours or longer
- You get an update from the operating theatre at least every two hours
- We monitor the spinal cord (for both feeling and movement) during surgery to detect injury
Anaesthesia
- You and your child meet the anaesthesia team beforehand to plan the anaesthetic. A paediatric anaesthetist watches your child throughout, so the risks of a long anaesthetic are kept as low as possible
- All children have a breathing tube during surgery, to protect the airway and keep breathing steady
- Bleeding is closely watched, because large blood loss is common. We use medicines to help clotting, and often your child's own blood is cleaned through a cell saver and given back. Bleeding may also mean your child needs a blood transfusion
- Donated blood is carefully screened, so the risk of passing on infections is very low. Your surgeon and anaesthetist are happy to talk about any worry you have
- We pay special attention to keeping your child warm and to positioning that prevents pressure damage to the skin
- Anaesthetic medicines are chosen to interfere as little as possible with spinal cord monitoring, while keeping your child asleep and comfortable. Pain medicine is given throughout