You have developed a curvature of your spine called scoliosis.
Scoliosis and other back problems are treated by a bone and joint
specialist called an orthopaedic surgeon. The purpose of this booklet
is to give you some information concerning scoliosis and possible
treatments. We hope that knowing a little bit about scoliosis
treatment will help you and your parents be better prepared for your
visit with the orthopaedic staff
What is Scoliosis?
Scoliosis is a problem with your backbone, or spine, causing it to
bend sideways and twist. Scoliosis can occur in either the upper back
(thoracic), lower back (lumbar), or very rarely, in the neck
(cervical region). Idiopathic scoliosis (scoliosis of an unknown
cause) is the most common type of scoliosis in the United States.
Eighty percent of diagnosed cases are of the idiopathic type.
Idiopathic scoliosis is usually noticed at the onset of puberty and
is more often seen in females. People with scoliosis often have
uneven shoulders or hips, and a shoulder blade which sticks out.
Changes are especially noticeable when the person is bending over.
Most scoliosis is found during school screening.
If the spinal curvature progresses despite the use of conservative
measures such as bracing, the doctor might recommend surgery called a
"posterior spinal fusion with instrumentation." The purpose of this
surgery is to halt progression of the curve and stabilize that
portion of the spine. Doctors recommend surgery when the curve gets
to a certain size, usually 45-50 degrees. If the curve is getting
bigger and it's not treated, it can cause physical deformities and
possibly lead to back, lung and heart problems in later years.
How the Surgery Works
Deciding to have surgery is a big decision and can be very
frightening for you and your family. This booklet was prepared to
answer your questions about surgery if you and your doctor decide it
is necessary. If you have any further questions, please write them
down so you will remember to ask your doctor.
Risks Related to Surgery
There are always risks involved with the surgery itself, and with
being put to sleep during surgery. Some of these risks include the
possibility of infection or problems with the metal rod the doctor
will attach to your spine. The chance that these complications will
occur is very low, and we do everything we can to prevent them. The
doctors and nurses will make sure you know what the risks are and
answer all your questions before surgery.
To straighten your spine, the doctor attaches two stainless steel
rods to either side of your spine by hooks attached to the vertebral
bodies. A piece of bone from your hip (a bone graft) will be applied
to portions of your spine to fuse it. This bone will grow into the
spaces between your backbones (vertebrae) and will hold them
straight, acting like a cement. This is called a "spinal fusion."
Until these bones heal together, they need to be supported and kept
from curving again. This is the purpose of the rods. The rods are
attached to your backbone and hold everything straight until the
bones are fused together. Many types of instrumentation (rods) are
available including the Cotrel Dubosset (CD) and Moss Miami (MM),
which are used at this hospital.
X-rays taken before surgery will tell the doctor where on the
spine to put the rods and hooks and how long and how curved to make
the rods. By using two rods, your curve can be straighten back to
front and side to side. Casting or bracing is usually not necessary
All patients lose some blood during surgery, and sometimes you need
to get some back afterwards. You may get blood either from our blood
bank, or, if you're medically able, you may donate your own blood
prior to surgery. Then if you require transfusions, you will receive
your own blood. This is called autologous blood donation. The first
unit of blood must be given within 42 days of the surgery and the
last, not less than seven days before your surgery. Your doctor
usually asks that patients donate four units of blood. You may be
asked to give the first unit of blood here at the University of Iowa
Blood Bank. You and your parents will have all your questions about
donation answered and will sign the necessary paperwork.
The blood bank staff will then attempt to make arrangements to
have the rest of the blood drawn nearer your home. Blood taken
elsewhere is transported here automatically, so you will not need to
be involved with this.
When donating blood, you may not be on antibiotics and you must be
healthy, without a cold, flu or infection, as you could get this same
illness when your blood is given back to you. Eat a nourishing meal
two to four hours prior to donation, and avoid strenuous exercise for
twelve hours following the procedure.
The blood donor center will check your blood counts before drawing
any blood. To help keep your red blood cell count high, you'll get a
prescription for iron tablets. Iron may cause you to be constipated,
so it is a good idea to increase the fluids, fruits and vegetables in
What Happens on the "Work Up" Day?
One to three days before surgery you will come to the Orthopaedic
Clinic for what we call your "pre-op workup." You can plan on being
at the hospital approximately five hours on this day. The doctor will
listen to your heart and lungs, and in general make sure you are in
good shape for surgery. If you are sick on this day, or a few days
before, notify the doctor or nurse. Your surgery might have to be
postponed if you are sick.
The nurses and doctors will ask you and your parents some
questions and answer any questions that you may have. This will
enable them to give you the best care while you are hospitalized.
Urine and blood samples will be obtained. We will give you a
bracelet that matches you to your blood sample. You may either put
the bracelet on when your blood is drawn or take it home with you and
put it on before you come for your surgery. It is very important to
keep the band clean and dry so that your name and hospital number are
legible. Remember to have the band with you on your surgery day, or
another blood sample will need to be taken.
You will have several x-rays taken. A medical photographer will
take some pictures of you and your back, so we can compare how you
look before and after surgery.
You may need to go to a special laboratory for an EEG
(electroencephalogram) so we can check the nerve messages going
through your spine before and during your surgery. The technologists
do this by attaching special wires to your head and your legs. This
doesn't hurt. The wires will be removed after this first test, and
then put back on the day of your operation.
You will also spend some time talking to the surgeon who will do
your operation, as well as to the doctor who will be putting you to
sleep. This doctor, the anesthesiologist will explain to you how they
put you to sleep, and will answer any questions you might have about
that. You will talk about any medications that you take on a daily
basis. The anesthesiologist may instruct you to take these
medications with a small sip of water the morning of your operation.
You should tell the doctors or nurses about any allergies you may
have to medications, foods, tape or latex (rubber products).
The nurses will describe what will happen the day of your surgery
and give you general information about being in the hospital. You
should make plans to be in the hospital for 7 days.
We will teach you how to use a small breathing device (incentive
spirometer or voludyne. You will use this device after surgery to
'exercise' your lungs by making you cough and breathe deeply.
Coughing and deep breathing are extremely important to help clear
your lungs and prevent pneumonia. We will also teach you how you'll
need to roll over after your surgery. This is called logrolling
(turning as a unit). It's a good idea to practice rolling like a log
so it'll be easier to do later. The nurse will also teach you leg and
ankle exercises to keep the blood moving in your legs while you are
recuperating. We'll also make sure you know the various ways we'll
monitor and treat any pain you might have. One of these methods is
called a PCA pump (patient controlled analgesia), which is a machine
to give you pain medicine through a needle in your arm. We'll give
you a booklet about the pump so you'll know all about how it works.
We'll also talk to you about pain rating scales we use to find out
how well the pain medicine is working.
The operating room people will call you the day before your
surgery to let you know what time you need to be at the hospital. You
do not have to spend the night before your operation in the hospital.
The nurse will give you two scrub brushes with iodine soap in
them. You'll use them to scrub your back and right hip on the night
before surgery and then again the next morning. This will help remove
any germs on your skin and cut down on the risk of infection. If you
are allergic to iodine, please let your clinic nurse know and we can
give you some other kind of soap. You can do the scrubs in the shower
or tub, but will need help from another person to make sure you get
everything really clean. You will need to wash your hair the night
before surgery, and remove any finger or toenail polish.
Your stomach needs to be empty when you go to sleep. Therefore,
you may not eat or drink anything after midnight the night before
surgery. This will help keep your stomach from getting upset
afterwards. You may want to avoid salty foods the night before
surgery to prevent waking up really thirsty.
You cannot have a sunburn, bad rash, or sores on your back at the
time of surgery, as this could be a potential source of infection.
Please feel free to ask any questions you might have (even if you
think they sound silly or stupid). We want to make sure you know
everything you need to before you leave the hospital on your workup
The Day of Surgery
Before you come to the hospital, you need to wash your back again
with another scrub brush for five minutes. Go ahead and brush your
teeth and rinse out your mouth, but do not swallow the water. Do not
When you get to the hospital, you'll need to check in at the pre
surgical area on the 5th floor (Elevator H). The nurse will record
your vital signs (temperature, pulse and blood pressure), talk
briefly with you and apply your identification and blood bands.
You'll get into a hospital gown and the nurses will help you onto a
special bed. From here you will go back to the EEG lab, where they
will put the special monitoring wires on your head. Sometimes they
will put these wires on in the operating room. The operating room
transport person will take you to the 5th floor Presurgical Care Unit
(PSCU) when it is time for your surgery.
While you are in surgery, your family can wait for you in the
Boulware Day of Surgery Lounge (Elevator H to 6th floor). The doctors
will talk to them periodically during and after your operation and
let them know how you're doing.
A nurse will greet you as you arrive in the operating room. The
room is sometimes cool and noisy. Please let the nurses know if you
are not comfortable. Warm blankets are available. In the operating
room, you will be connected to many monitors and a needle will be put
into a vein in your arm. This is called an IV. The anesthesiologist
will give you medications to put you to sleep. A mask may be placed
over your nose and mouth to help you breathe. After you are asleep a
tube is placed in the back of your mouth and throat to provide air to
your lungs. This tube will be removed before you wake up. Once you
are asleep, the doctor will begin the operation. You will lie on your
stomach on the operating bed with your arms and legs supported with
pads. Your back will be scrubbed before starting the operation. The
operation generally takes 4 hours, but you will be in the operating
room a total of 4 5 hours.
A tube, called a Foley catheter, is placed in your bladder while
you're asleep. The Foley drains urine from your bladder so the nurses
can measure it, and keep track of how well your body is getting rid
of fluids. This tube will be removed on Post-op Day 3 (the third day
after your surgery). After it's out, you'll be able to use the
A drain is placed in the incision during surgery. This is called a
Hemovac. It's a small tube that drains excess fluid from your back
into a little collection container. The doctors will remove it on
Post-op Day 2. There is a mild burning feeling when the drain is
Post Anestheia Care Unit (PACU or Recovery Room)
When you wake up you will be lying on your back in the recovery room
area. You'll already be in your bed. You may feel stiff from being in
one position for a long time. A nurse will check you frequently and
make you comfortable with warm blankets. You will receive oxygen and
be encouraged to cough and deep breath to help clear your lungs.
The nurse may ask you to rate your pain on a scale of 1 to 10 and
will give you pain medicine to make you comfortable. It's also not
uncommon to feel sick to your stomach after surgery just let the
nurse know we have medicine for that, too.
You'll have some more x-rays while you are in the recovery room.
You will be in the recovery room for 2-4 hours, or until the
anesthesiologist says you're awake enough and doing fine. If you are
16 or younger, your parents or 2 adults may see you in the recovery
If the doctor thinks you need to be hooked up to monitors
overnight (in case of breathing or heart problems) you will go to the
Pediatric Intensive Care Unit (PICU).
Your parents may see you in the PICU. Your doctor will decide when
you are ready to come to your room on the Orthopaedic Unit from
either the PACU or PICU. You will be taken to the Orthopaedic Unit in
Orthopaedic Unit After Surgery
After surgery the nurses will frequently take your vital signs (blood
pressure, temperature, respiration rate, and pulse). This is so
important that they'll even wake you up at night to do it.
The doctors and nurses will be touching your hands and feet, and
asking if you have any numbness or sleepy sensations in your arms or
legs. Let the nurse or doctor know if your arms and legs tingle or
feel numb or just plain funny.
The IV that was started in the operating room will give you fluids
during and after surgery. The IV will remain in until you are able to
eat and drink, usually 4 to 5 days after surgery.
During surgery the anesthetic slows the motion of your intestines
and may cause you to be nauseated or even vomit after surgery. The
nurses will listen to your stomach every few hours to determine if
your bowels are working again. You may not drink anything until your
bowels are returning to normal. This may take up to 4-5 days. You may
rinse your mouth out with water and brush your teeth. If you drink or
eat before your bowels are ready, you may become nauseated and
You will have pain medicine to keep you comfortable. For the first
few days, you'll get this medicine through your IV using the PCA
pump. The PCA is a computerized pump that has a tube of pain medicine
inside. This tube is attached to your IV line and gives you a small
amount of pain medicine continuously. You can push a button if you
need a little extra medicine. If you are unable to push this button,
either a family member or a nurse can push it for you. You may need
an occasional shot for pain along with the PCA. This depends on how
severe your pain is. Usually the PCA medicine keeps you comfortable
and you don't need any extra shots. Your PCA will continue until your
stomach wakes up and you are able to drink and take pain medicine by
mouth. Antibiotics will also be given through your IV. The
Antibiotics will decrease the chance of infection.
The antibiotics will continue until one dose after your hemovac
drain and foley catheter are removed. We'll take a sample of blood
from you each morning after surgery for 3 days to check your blood
count. If you're short on red blood cells, it might be necessary to
give you a blood transfusion. In the operating room a big bandage is
applied to your back. This will be changed on Post-op Day 2 and
removed on Post-op Day 3. The stitches used to close your wound are
under your skin. Your body will just absorb them, so they do not have
to be removed. On top of your skin will be pieces of tape called
steri-strips- these will gradually fall off on their own after you go
The day of surgery you will be flat in bed. The nursing staff will
help you move from side to side by logrolling every 2 to 4 hours.
When turning, your shoulders and hips must go all at the same time,
like your back is one big log. We'll help you to move either onto
your back or your side and will use pillows to keep you comfortable.
You'll sit up in bed 3 times on the day after surgery with your hips
flexed at 90 degrees. You need to go slow to get your body used to
sitting up again. The second day after surgery you will get up into a
chair 3 times. On Post-op Day 3, you will be up walking with
assistance. You will gradually find it easier to get around. You'll
also go to Physical Therapy to get assistance with walking and going
up and down stairs.
The nurse or your parent may help you with your bed bath for the
first few days. However, it is important that you do as much as you
can for yourself to keep your arms and legs from getting stiff.
A Child Life Specialist will come to your room and offer you
activities to do while you are in bed. When you can be up and out of
your room, you will be invited to attend group activities in the
During your hospital stay, your parents will be taught how to take
care of you. The nursing staff will encourage them and you to do as
much as you are comfortable with. Please ask the nurses about
anything that you may have a question about.
We'll take X-rays of you standing up before you go home. This is
usually 5-7 days after surgery if no problems arise. No cast or brace
is usually necessary following surgery.
Keep your incision clean and dry. The steri strips will gradually
fall off. You may shower two weeks after surgery if your back
incision is well healed and has no drainage. Direct the water stream
on your front and shoulders, letting it trickle down your back. Do
not direct the water stream on your back incision. Your back incision
may be numb for 4 to 6 months.
We'll send you home with a prescription for pain medicine. You
should also continue taking your iron as you were before surgery.
No lifting greater than ten pounds (examples: 2 five lbs. sugar or
2 gallons of milk). No bending, stooping, or twisting. No lying on
your stomach for six months.
No driving for the first six weeks. Always wear your seatbelt.
You may return to school in 2-4 weeks depending on how you feel.
Walk for exercise as tolerated, gradually increasing the pace and
distance. Continue leg and ankle exercises. Jogging may be resumed in
If sexually active, do not resume this activity until checking
with your doctor at your 6 week follow-up appointment. Surgery may
cause irregular menstrual cycles.
Light exercise (like swimming - no diving) may be resumed
in two months. Stationary bike riding may be resumed in 3 to 4
months. Sit upright when using a bike. You may not participate in
contact sports for 6 months or until given permission by your doctor.
Your first return appointment will be about 6 weeks after your
discharge from the hospital, then 4 months, 6 months, and one year
after surgery, and then every year after that. It's really important
that you return for your scheduled appointments.
If any of the following problems occur, please notify your doctor:
- fever, chills, redness, warmth, or foul smelling drainage at the surgical site.
- increase in pain.
- numbness, tingling, or weakness in your arms or legs.
- change in bowel or bladder control.
We hope you've found this booklet helpful. Please let us know if
you have any questions or concerns. The orthopaedic nursing staff can
be reached at (319) 356-3844 (Orthopaedic Clinic). The orthopaedic
surgeon can be reached at (319) 356-1872, 8 a.m. to 5 p.m., Monday
through Friday. If you have urgent questions at any other times,
please call (319) 356-1616, and ask to speak with the orthopaedic
resident on call. If you need to change or confirm your return
appointment, call Orthopaedic Scheduling at (319) 356-2223.