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Instrumentation & Fusions

Spinal Instrumentation and Fusion is major surgery, usually lasting several hours. In this procedure, rods, hooks, wires, or screws are attached to the curved part of the backbone and the spine is carefully 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.

Although the basic procedure is the same, there are a variety of specialized techniques that can be used to do spinal fusion. There are many different types of spinal instrumentation for the treatment of scoliosis. In addition, 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 factors, including the child's age, spinal maturity, the location and severity of the curve, the expertise of the surgeon, and the preference of the child and parent.

The surgical technique most often used to straighten and stabilize the spine is to do surgery from the back, called the posterior approach.

Another option is to perform the surgery from the front of the body, called the anterior approach.

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 the technique used, some people may be fitted for a brace, but this is much less common today.

By the time the person leaves the hospital after surgery, he or she will be able to dress, bathe, feed himself or herself, and walk around. Children may not return to school for 3 to 4 weeks. Medication used to reduce pain will be gradually decreased over a few weeks.

After surgery, it is important to avoid any extreme bending, twisting, stooping, or lifting of objects weighing more than 10 lb (4.54 kg). The person should spend the first weeks at home with occasional rest periods throughout the day.

Surgery is indicated for:

• A child with a severe spinal curve (greater than 40 to 45 degrees) that is likely to progress over time.
• An adult with a severe spinal curve (greater than 50 degrees) that is likely to progress over time.
• A person with a severe spinal curve that continues to progress even after bracing.
• A person with an unstable spine

Other factors considered before surgery include:

• Age, skeletal age, and status of puberty.
• Location of the curve.

Surgery may be considered in some situations, such as:

• An adult with trouble breathing or with disabling back pain caused by scoliosis.
• A very young child who has a severe spinal curve(s).

Surgical success depends on many factors, including the flexibility of the curve and the technique used. In general, successful spinal fusion is more difficult in adults because curves are more rigid in a mature spine.

Spinal fusion techniques involve attaching rods to the spine by hooks, wires, and/or screws.

Multiple-hook and double-rod systems improve the shape of the spine and back as seen from the back and side.!¯ The objective 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 adult scoliosis usually improves or goes away.

1. Risks of surgery include blood clots, infection, and lung problems.
2. Surgery in an adult carries a higher rate of complications and risks than in an adolescent, including pseudoarthrosis, infection, and neurological complications.

Early complications of surgery include the following:

• Ileus (lazy bowel) is a common complication after spinal fusion. To treat this complication, food and drink by mouth is withheld 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.
• Deep wound infections. These may require reoperation, however, they are rare.

Late complications after surgery include the following:

• The most common late complications of spinal fusion are pseudoarthrosis and back pain.
• Rod or instrument breakage usually indicates a pseudoarthrosis. However, if there is no pain and the curve seems stable, a broken rod need not be removed.
• 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, some centers use intraoperative electronic monitoring of spinal cord functioning.

Studies have shown that smoking can decrease the success of spinal fusion. It is important that you quit or at least cut down on smoking as soon as you are scheduled to undergo a spinal fusion.

Non-steroidal anti-inflammatory medications (ibuprofen, Advil, Aleve, Naprosyn) also have been shown to decrease the success of spinal fusion. You will be informed of when to stop these medications prior to surgery and when you may resume using them. Acetaminophen or Tylenol may be used without affect on your spinal fusion.