Paediatric Scoliosis Correction

What is scoliosis?

Normally, the spine is straight when viewed from the front or back, but in people with scoliosis, it curves to one side.

A curvature of more than 10 degrees is termed scoliosis.
It can lead to the trunk and shoulders no longer being symmetrical. Sometimes the shoulders aren’t level anymore. Sometimes the head is not level, or the pelvis is not level. The rib cage can also push out on one side to become prominent- known as a rib hump. The severity of the abnormalities can vary between people and can change with time.

When is surgery indicated?

Surgery for scoliosis is typically considered a treatment option when the degree of spinal curvature is severe (usually greater than 45-50 degrees) and if the curve is likely to progress further. The decision to perform surgery is based on several factors, including the age of the patient, the degree and location of the curve, the risk of the curve progressing, and the presence of other health conditions.

What happens during the Posterior Scoliosis Surgery for Adolescent Idiopathic Scoliosis?

Before the procedure, the patient will typically undergo a thorough evaluation by the surgeon to determine the underlying cause of their scoliosis and whether surgery is an appropriate treatment option. This will also include an anaesthetic assessment for fitness for surgery.

The surgery is usually performed under general anaesthesia, and the patient lies face down on the operating table.

The surgeon makes an incision in the back depending on the length and severity of the curve. Typically starting just below the shoulder blades and extending to the lower back.

Next, the surgeon exposes the spine by gently moving the back muscles aside and then uses special instruments to place screws, hooks, or wires into the vertebrae. These instruments are then connected by rods or other devices, which are used to straighten and align the spine.

To further stabilise the spine and promote fusion, the surgeon may also remove the bony protrusions on the vertebrae (the lamina and spinous processes) and portions of the discs between the vertebrae. The bone graft material is then placed in the spaces created by removing the bone, which will eventually grow and fuse the vertebrae together.

The spinal cord will be monitored throughout the surgery to minimise this risk and detect any possible damage to the spinal cord and nerves at the earliest.

After the surgery is complete, the surgeon closes the incision with sutures or staples, and a dressing is applied. The patient is then moved to the recovery room, where they will be closely monitored as they wake up from the anaesthesia. The length of the hospital stay varies depending on the patient and the specific surgical approach used. Rehabilitation typically involves physical therapy to help the patient regain strength, flexibility, and mobility in the spine.

Pre and post operative x rays operated by Mr Karpe

Are there risks to the procedure?

Every surgery involves some risk, and spinal surgery carries certain risks. Your child's surgeon will thoroughly discuss these risks and will explain which ones apply to your child. The goal of the investigation day is to identify these risks ahead of time to help you decide whether surgery is appropriate and safe for your child.

Anaesthesia generally does not cause complications, but the anaesthesiologist will discuss how your child's existing condition could affect the anaesthesia used and any potential side effects afterwards. While it is rare, damage to the major blood vessels surrounding the spine can occur during surgery, which may result in significant blood loss.

Infection can happen with any surgery, but your child will receive antibiotics to minimise the risk of any issues with the surgery site. The nursing staff will regularly check the surgical site. In some rare cases, additional surgeries may be required to clean out the wound.

There is a slight possibility of damage to the spinal cord or nerves running from it during any spinal surgery, which could cause weakness or paralysis in the legs and bladder or bowel dysfunction. The spinal cord will be monitored throughout the surgery to minimise this risk.

This surgery aims to fuse the spine, so if this does not happen, the rods and/or screws placed to support the spine may break and necessitate further surgery. Finally, there is a slight possibility that the surgery may not produce the expected results, such as if the rods fail or do not adequately straighten the spine. In this scenario, repeat surgery may be required.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results, and other important medical information that pertains to the Posterolateral Fusion procedure.

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Paediatric Scoliosis: Delve into the specifics of Paediatric Scoliosis and its impact on children's spinal health.

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