Everyone’s spine has curves. These curves produce the normal rounding of the shoulders and the sway of the lower back. Scoliosis is a condition that causes the spine to bend sideways and twist.

Scoliosis can occur in:

• he upper back (thoracic)
• lower back (lumbar)
• or in the neck area (cervical)

You may also have curvature in more than one area. Scoliosis is more commonly seen in girls than in boys. Uneven shoulders or a shoulder blade that protrudes when a child bends over are often the first indicators of the condition. The most common form of scoliosis is idiopathic scoliosis, which means the cause is unknown. Your doctor may recommend surgery if the spinal curve continues to progress despite treatments, such as bracing.

The goal of spinal fusion surgery is to stop the progression of the curve. During the surgery, the doctor attaches screws and rods to both sides of the spine and the curve is gently straightened. Small bone grafts taken from the spine and ribs are placed next to the spine. These bone grafts act like cement. As the bone grafts heal, the spine will become solid and the curve will not progress. Until the bones have healed, they need support to keep them from curving again. The rods attached to the spine hold everything in place and support the spine until the bones fuse together.

Your spinal fusion surgery may be performed from the back (posterior), the side (anterior) or both. Your surgeon will determine which is best for you.

Why do it?

Some of the reasons teens say they are glad they had this surgery are:

• Less back pain
• Better posture
• Clothing fits better
• Prevention of a larger curve with larger side effects.

What can you do to prepare for a back surgery?

You can do yourself a huge favor by exercising and being physically active before your surgery. Daily stretches, stomach crunches, and leg stretches are all examples of exercises that help you heal faster and recover more easily. Exercising is also a great way to relieve the stress that may be building up inside you.

In the months or weeks before your surgery, it is very important to maintain a positive attitude. Try not to dwell on what is ahead. Have as much fun as you can, safely. Stay active, keep busy, and most of all, don't feel sorry for yourself! Try to think of things to do that you may not be able to do right after your surgery. Some suggestions include swimming, horseback riding, water park slides, roller coaster rides, rollerblading, ice skating, dancing, golfing, and driving. The night before your procedure, you may want to spend some time by yourself. It will be awhile before anyone lets you do something by yourself again.

Donating Blood Before Your Surgery

It is normal to lose blood during surgery. The surgeons will use multiple advances in medicine to reduce the blood loss during surgery, despite the use of this technology, some patients will require blood transfusions during hospitalizations. There are different ways of preparing blood donations for your surgery:

• You may donate your own blood before your surgery (lots of kids and teens do this!).
• Your family or friends can donate their blood for you.
• You may get blood from the blood bank here at the hospital.

To donate blood prior to the surgery, please refer to OneBlood at www.oneblood.org or call 954-777-264 for locations, hours of operation and to schedule an appointment online. As a reminder, please take the prescription for blood donation with you to the donor center.

Medications

To decrease the risk of excessive bleeding during surgery, you will be asked to avoid taking aspirin-containing medications or non-steroidal anti-inflammatory medications (Advil, Ibuprofen, Motrin, Aleeve) starting at two weeks prior to surgery. You may not resume taking these medications again until instructed by the surgeon.

Your Hospital Room

In the hospital, you will be assigned to a room where you will stay throughout the duration of your admission at Nicklaus Children's Hospital. This is your room and you can bring items with you to make it feel "like home." In addition to essentials, you may want to bring some sources of entertainment, as well as special items that make you feel comfortable. Here is a list to get you started:

• Pillow
• Favorite blanket or comforter
• Personal items:
  • toothbrush, toothpaste, lotion, deodorant, hair ties, hair brush or comb, sanitary pads, etc (Yes, the hospital provides these, but it is nice to have your own)
• Stuffed animals, toys
• Books
• Pictures of your friends, family and pets
• Laptop/tablets/cell phones and battery charger
• Lip balm
• Slippers with a non-slip bottom

What Clothing Should you Bring?

The clothing you bring should be very loose, comfortable, and very easy to put on and take off. Here are a few suggestions:

• Choose shorts or pants with a loose waistband. Boxers work great!
• Button-up or oversized shirts are good choices that will eliminate the need to lift your arms over your head when changing.
• You may also wear hospital gowns the entire time, if you prefer. It’s your choice!

More Helpful Hints

• Do not wear any jewelry the day of surgery.
• If you have long hair, try to avoid leaving it loose. A good way to prevent the tangles associated with lying in bed for several days is to part your hair down the middle and put it into two French braids. Regular braids also will work.
• Bring things to help pass the time (music/headphones, magazines, card games, etc).
• If you want to keep a journal, this is a great time and place to work on it.

Admission

The first place you will go the day you are admitted is to Patient Access, located on the first floor. This is where you will check into the hospital.

Once you have checked in, you will be sent to the laboratory for blood and urine tests. This does involve a needle prick, but it only hurts a little and is over quickly. The information we get tells us how your body is working on the inside. You will also be given a small container and asked to give a urine sample. This tells us how your kidneys are working.

Next, you will go to the Radiology Department, also located on the first floor. Here you will have X-rays taken. X- rays are special photos taken of your body. X- rays do not hurt!

You will then go up to the second floor where you will be given your room assignment. You will be assigned to a room. This is your "home away from home" for the next few days. You will be introduced to your nurse and will have the opportunity to ask him/her any questions you may have at that time. You may change into a hospital gown or stay in your clothing, whichever you prefer. Your family can stay with you until you fall asleep for the night. Your room includes a "sleeper chair" so that a member of your family can spend the night with you. You may ask your nurse for extra pillows and blankets.

Remember: NO FOOD OR DRINK AFTER MIDNIGHT!

The Day of Your Surgery

On the morning of surgery a technician will come and tape electrodes on your legs. These electrodes are just stickers that have a plastic wire glued to them and will be used during surgery to measure the small electricity signals that our body makes to communicate with the brain. This does not hurt! The stickers peel off easily and will be all gone by the time you wake up.

The nerve pathways that are normal for you are recorded as wavy lines on a piece of paper. During your surgery, these pathways will be monitored to detect any changes.

Before you leave for the operating room, you will be given a medicine that will make you a little sleepy and a lot less nervous! This is not the medicine that helps you to fall asleep for your surgery.

You may bring something comforting to the operating room with you such as a stuffed animal, music, photo or other familiar item.

Once you are in the operating room, you will be given special medicine through a mask. This medicine is called anesthesia. The anesthesia mask will be placed over your nose and mouth. You will need to take a couple of deep breaths and you will be asleep in no time! All IVs and cathethers are put in after you’re asleep, so you wont feel a thing!

Recovery Room

When your surgery is finished, you will be taken to the PACU (Post Anesthesia Care Unit). You will still be sleeping. In this area, we will take an x-ray of your spine and obtain labs after surgery. You will also be monitored by a nurse who will determine when you are awake enough to return to your room. Your parents will be allowed to come and see you briefly. When you wake up in your room you will be connected to a vital sign monitor, IVs for fluids and pain medication and have a plastic drain to collect fluid from the incision.

For the first three days after your spinal surgery, you will be on a special bed that turns you continuously, this bed is called a Hill-Rom Sport bed. The turning is done very slowly and you will usually stay in each position for about 15 minutes. This can be adjusted according to your comfort level. The only thing you have to do when being turned is RELAX, and tell us how we can position you more comfortably. Turning keeps you from getting stiff and helps to prevent pressure on your skin which can cause sore spots and the changing of position also helps your lungs stay in good condition.

Your Diet

You may not feel like eating at first. The day of your surgery, your nurse and your family may keep offering you something "clear" to eat or drink such as water, apple juice, popsicles, Jello® or Gatorade®. Eating and drinking helps you regain your strength more quickly.

The next morning, you will begin to eat regular food. You may eat whatever you like from the cafeteria or from outside the hospital. It is important that you eat because the pain medication that you will take by mouth will cause stomach pain, nausea and vomiting if taken on an empty stomach.

In order to prevent constipation and dehydration, it is important that you drink lots of fluids while in the hospital and at home.

Sitting, Standing, and Walking

Immediately after your scoliosis surgery your nurses will be helping you with any necessary movement, but by the time you are ready to go home, you will be walking out the door. How can this happen in less than a week? Your physical therapist is the key. He or she is the person who will help you and your family learn the correct way to move in bed, as well as to sit and walk properly. Together, you and your physical therapist will set goals for moving in bed, sitting up and walking.

You will meet your physical therapist the day after your surgery. Your physical therapist will talk to you and your family about moving in bed, sitting, standing and walking. Your therapist will assist you in sitting up on the edge of the bed. You will sit for several minutes to become accustomed to the change in position. The therapist will then help you to stand. You will stand for a few minutes while holding on to something to stabilize yourself. Deep breathing is often helpful when standing for the first time after surgery as it helps to relax your body and keep you calm. Day two is also the day you will begin to walk. The therapist will hold on to you to help keep you steady as you take a few steps. Your therapist will not make you walk farther than you can, but will ask you to set a goal to walk a little farther each time you get out of bed.

You will be walking more each day and will be able to venture out of your room, walk around the nurses’ station, down the hall, to the activity room located on the third floor, or as far as you can go.

Because the physical therapist will only visit you once or twice a day, your nurse will often be the one helping you to do these things. Try to remember, the key to feeling better faster and returning home sooner, is to get out of bed and keep moving!

Once you are able to get out of bed and walk with the help of your family, you will be able to get up when you want to and soon will no longer need assistance each time you want to go for a walk.

Respiratory Therapy

It is important to keep your lungs healthy after surgery. When you return to your room after surgery, you will meet another important team member. The respiratory therapist will provide you with breathing treatments (medication you breathe in) to help you expand your lungs. Your nurse will also be reminding you to take deep breaths for several days after your surgery. You will be given a device called an incentive spirometer. This helps your lungs expand and keeps them clear and working at their best. You may get tired of everyone reminding you to use the spirometer. Please remember that it is important that you do as requested. Regular use of the spirometer is the best way to prevent fevers and avoid complications such as pneumonia.

The best way to make this an easier experience is to work together with the nurses, therapists, doctors and your family. Communicating with the care team will greatly benefit you and will help them take better care of you.

Your child will be groggy and sleep a lot during the first few days after surgery, and he/she might not remember much. Gradually, your child will be more alert and will begin to feel better. Improvement will be evident each day.

The following information is about some of the equipment you can expect to see after surgery.

• A cardiac monitor gives information about your heart rate, breathing, and blood pressure via stickers placed on the chest. The monitor is used during the first 48 hours after surgery.
• A pulse oximeter fits like a clip Band-Aid® or bandage on a fingertip and measures how much oxygen is in the blood. This is usually worn for the first two to three days post operation.
• An IV is usually placed in the arm or hand and sometimes in the neck. This is how your child will receive fluids and medicines until he/she is drinking enough on his/her own. One IV will stay in place for most or all of the hospital stay.
• Your child will have a PCA pump, this unit will be connected to your child’s IV. The PCA pump is the method through which your child will receive pain medication for the first two to three days after surgery. There is a button attached to the pump that your child can push to get medicine when he/she needs it. The PCA pump is programmed so your child cannot receive too much medicine. Make sure you contact the nursing staff immediately if your child does not seem comfortable enough with the current pain management plan. Your child’s nurse or doctor may have other options available.
• A urinary or foley catheter is inserted in your child’s bladder during surgery. This will drain urine until your child is able to use the restroom on his/her own. The catheter is taped to the leg and will not fall out when your child moves. The catheter will be removed three days after surgery.
• Patients will have a Jackson-Pratt, a drain placed in the incision during surgery, to help remove extra fluid from the back. This drain is normally removed the day after surgery. This does not hurt!

The first two or three days are the most difficult. After that, each day gets better.

You probably won’t have as much privacy as you are accustomed to during the first few days. Not being able to do some things for yourself may be embarrassing or it may not bother you as much as you think. Remember, you have more important things to be concerned about.

There are a lot of things you may have to do that you may not want to do or may not feel like doing. You may feel agitated because so many people are telling you what to do. Because you are frustrated and uncomfortable, you may feel emotionally explosive. Try not to take it out on the people around you.

Remember, they are doing everything they can to help you feel better and get you home faster. When you are feeling frustrated, try to think about what you can do today that you were unable to do yesterday. You have already come a long way!

The best way to make this an easier experience is to work together with the nurses, therapists, doctors and your family. Communicating with the care team will greatly benefit you and will help them take better care of you.

Everyone’s experience with pain after spinal fusion surgery is different. Your doctors, nurses and family all have the same goal: to help you be as comfortable as possible. Tension in your body and tightening of your muscles can make you hurt more, so it is very important to help yourself relax and stay as calm as possible. It is okay to ask for medicine for your pain when you need it. In fact, the medicine works best if you receive it before the pain becomes unbearable!

Pain After Spinal Fusion Surgery

Your nurse will frequently ask you the level of your pain. He or she will use what we call a "pain scale" from 0-10. The 0 represents no pain, while the 10 signifies pain that is the worst you’ve ever experienced. Your nurse may ask you to describe your pain with words such as sharp, burning, throbbing or dull. Please be honest with your nurses at all times. They are here to help keep you comfortable.

Here are some suggestions that have helped other kids and teens relieve pain after scoliosis surgery:

• Change your position.
• Channel your pain. Think about the pain moving out of your body or concentrate on another part of your body such as your thumb or elbow.
• Listen to relaxing music.
• Have someone wash your face or hair. Feeling calm and fresh makes a world of difference.
• Have someone read to you.
• Change the look and feel of your room. For example, turn off the lights, close the blinds and turn on a fan to cool you.
• Use breathing techniques. Taking slow deep breaths sometimes helps your body to relax.
• Get up and move around.
• Go for a short walk (with help of course!).

The most important thing you can do is to identify what helps you relax and then make a plan for yourself. Share your plan with a family member who will be at the hospital with you or write it down. Always keep a positive attitude; each day will get better!

Going Home

Hooray! This is the day you have been working toward, and it is a very exciting time. You should know that along with all the excitement you may also have some feelings of discouragement. You may feel very weak and tired. It might be hard to find a comfortable position. You may not have much of an appetite. If you do, watch what you eat. Your stomach will be sensitive. Remember to eat before you take your medicine. You may have itching around or inside the incisions. When you are finally able to take a full shower, you will feel like a new person.

When you get home from the hospital, have your room or the place you will be sleeping ready and waiting for you. Have a table next to you with things you like and might need such as a phone, something to drink, an MP3 player, a laptop or a CD player, and of course, the TV remote control!

Enjoy being home. You have worked extremely hard to get there. Feel good about all you have accomplished.

School Re-entry

Depending upon the time of your surgery, you may need to think about returning to school shortly after you get home from the hospital. It is very important to set up a time to meet with each of your teachers to go over your surgery. A school re-entry letter is provided upon request, ask your Child Life Specialist. Accommodations will also be reviewed so that everyone is made aware of the special needs you may have. No backpacks! You should not be carrying anything more than five pounds. You may also want to consider a gradual return to school starting with half days and working your way toward full days.

Make sure you share these helpful ideas with your teachers and school so that a plan is in place before your surgery.

Tips for Parents to Prepare for the Return to School

It is very important that you contact your child’s teachers and school before surgery to create a plan and make sure that everyone involved with your child has the same information and expectations.

• Be sure all home schooling paperwork is signed before surgery.
• Arrange to get assignments from your child’s teachers.
• Arrange for your child to leave class five or 10 minutes early in order to get to the next class safely.
• Arrange an excuse from physical education.
• Request two sets of books, one for school and one for home.
• Inform the school of your child’s absence and surgery prior to the surgery so adjustments can be made in the attendance policy.
• Request access to elevators.
• Consider a shortened school day when you child first returns to school and gradually work up to a full day.
• Ask your Child Life Specialist for a school re-entry letter.

The following are suggestions from families of children or teens who have undergone spinal fusion:

• Bring a pad of paper and a pen to take notes and list questions you may have for the doctor. Doctors usually visit in the morning and during the course of a day, you may forget some of your questions.
• Bring a journal to record what happens during the hospital stay and your thoughts. This is a great stress reliever and opportunity for your child to look back on his or her experience.
• If your child has long hair, braid it before surgery.
• Bring a camera.
• Bring all needed phone numbers to the hospital.
• Set up a "calling tree" to help you update others about your child’s progress. For example, you might make one phone call to a friend or family member and then have that person call others.
• Limit all visitors until at least the third day after surgery.
• Bring comfortable clothes for you to sleep in during your hospital stay. There is little privacy.
• Bring a water bottle for yourself.
• For your child, bring button-front pajamas/shirts and loose-fitting clothing.
• Bring lip balm for your child.
• It is common for girls to menstruate during their hospital stay, so be sure to bring your own personal hygiene supplies.
• Your child may have swelling of the face, arms, hands or other areas after surgery. This is common and will decrease within a day or two.
• In the first few days after surgery, your child will receive a significant amount of medication to help him/her be comfortable. It is helpful to tell your child the date and time every time that he/she is awake.
• Do not allow visitors to sit on or bump your child’s bed. Instruct visitors to be gentle when they touch.
• Be prepared for your child to exhibit a wide range of emotions you may not be accustomed to seeing. This is very common after spinal fusion surgery.
• Limit perfumes and colognes as your child may be sensitive to even familiar scents.
• Bring several pillows for the car ride home.
• It may be helpful to use a baby monitor to help your child communicate at home.