Scoliosis surgery

As part of your preparation for surgery, you will need some specific tests and procedures. These will include:

• Photographs: medical photographers will take pictures of your back. This may feel embarrassing as you will need to remove all your clothes except your underwear. Please know that female and male photographers are available, and you are welcome to have a family member with you for support. Find out more about clinical photography

• Blood tests: to check your general health and blood count.
• Electrocardiogram (ECG): a tracing of your heartbeat to assess your heart health.
• Lung function test: a breathing test to assess your lung capacity.
• Urine test: to screen for infection. A pregnancy test will also be carried out for girls aged 12 years and over. There is a leaflet to help with taking a pregnancy test.

• X-rays: detailed images of your spine to help plan your surgery.
• ISIS body surface scan: a non-invasive scan to create a 3D image of your back surface, used for ongoing monitoring of your curve.
• Routine swabs and decolonisation: to check for and treat
  any common bacteria that could increase the risk of infection.

• Parents: visiting is open to parents throughout the day. One parent can stay overnight. The ward will provide a camp bed or chair bed to sleep on.
• Other family members: visiting for other family members is from 11:00 to 19:00, with no more than two people at the bedside at one time. Only siblings are permitted as child visitors.

• Parents: visiting is open to parents throughout the day. One parent can stay overnight. The nursing staff will put out a camp bed for them to sleep on.
• Other family members: visiting for other family members is from 08:00 to 20:00, with no more than four people at the bedside at one time.

On the morning of your operation, you need to come to the Children’s Surgical Admissions Lounge (CSAL), D Floor, Clarendon Wing, at 07:30 am. The nursing team will go through your paperwork to check that there have been no changes since pre-assessment. You will also be seen by the Anaesthetist, Spinal Nurse Specialist, and a member of your consultant’s team.

For your surgery, it is essential that your stomach is empty. This means you will need to fast, which involves not eating or drinking anything after certain times.

On the morning of your operation, you must stop eating all food, including chewing gum and boiled sweets, from 02:30am.

You can continue to drink clear fluids (water or diluted juice) freely up to 07:30am. After this time, you may only have sips of clear fluids until you are taken to the theatre.

For female patients aged 12 years and over, a urine sample will be taken on the morning of your surgery for a pregnancy test.

In preparation for theatre, local anaesthetic cream will be applied to the back of your hands and you will receive a pain killer called gabapentin. Your Anaesthetist might also prescribe a pre-medication to help you relax.

Once these steps are complete, your nurse on CSAL will ask you to change into a hospital gown before walking with you to the anaesthetic room.

The anaesthetic room is a dedicated area where you will be gently put to sleep before your scoliosis surgery begins. A nurse from the CSAL team will escort you to this room, where the Anaesthetist and an Operating Department Practitioner (ODP) will be ready to take care of you.

The ODP will ask you some simple questions to make sure you are comfortable and check you understand what is happening. They will also attach some monitors to you, these are soft, painless devices that help the medical team keep track of your heart rate, breathing, and oxygen levels during the surgery. Before you go to sleep, a small plastic tube called a cannula will be gently inserted into a vein, usually in your hand or arm. This allows the team to give you medications and fluids safely.

Both of your parents or caregivers can accompany you as far as the theatre doors. Then, one parent can come with you into the anaesthetic room and stay by your side until you are fully asleep.

Your body has an amazing control centre: your brain and spinal cord. Together, they are called the ‘central nervous system’. Think of your spinal cord as a super-important cable running down your back, safely tucked inside your spine. It carries all the messages from your brain to your body and back again – like telling your leg to kick a football or your hand to wave hello!

Because your spinal cord is so important, we have specific ways to protect it during surgery. Doctors use something called spinal cord monitoring. This means they will be gently checking the messages travelling along your spinal cord all the way through your operation. It is like having a special safety monitor to make sure everything is working perfectly and to protect your spinal cord function. It is a very important way we keep you safe!

Sometimes during surgery, you might lose a little bit of blood. We have a sophisticated machine called a ‘cell saver’ that collects your own blood, cleans it, and then gives it back to you. This is good because it often means you will not need blood from someone else.

When you wake up after your operation, you might notice some tubes or lines connected to you. It is totally normal for big surgeries and they are there to help you recover well!

• A ‘catheter’ is a small, soft tube that helps your body get rid of urine (wee) without you having to worry about it.
• ‘Drains’ (like wound drains or chest drains) are thin tubes that gently help any extra fluid leave the area where you had surgery. This helps you heal.
• Venous Cannulas: you will have small tubes (cannulas) placed into veins, usually in your hand or arm, to give you medicine and fluids.
• Arterial Line: in addition to the venous cannulas, you will also have a line placed into an artery. This is used for precise blood pressure monitoring during your operation and allows our team to take blood tests after surgery without using a needle
• All these tubes are temporary and will be taken out by the nurses when you do not need them anymore as you get better.

The evening after your spinal fusion surgery, the focus will be on your comfort and beginning your recovery journey.

• Eating and drinking: you can start drinking and eating small amounts as soon as you’re back on the ward. Following surgery, it is common to experience abdominal bloating and discomfort. Chewing sugar-free gum when you are awake and passing wind can help to alleviate this by stimulating your appetite and bowel. Nurses will encourage you to drink plenty of fluids.
• Pain and sickness management: you will have strong pain relief through your IV drip along with oral pain relief. We will gradually switch your pain medicine from the IV (PCA) to oral medicine, usually on Day 1 or Day 2. You will also be given regular anti-sickness medicine to prevent nausea. Please tell your nurse if your pain is not well controlled or if you feel sick. We may ask you to rate your pain on a scale (e.g. from 0, no pain, to 3, worst pain imaginable) to help us manage it effectively.
• Movement and physiotherapy: try to sit up in bed as much as you can, aiming for what feels comfortable for you. When moving in bed, it is very important to log-roll. This means keeping your spine straight, like a log, and moving your head, shoulders and hips all at the same time. Do not twist your back. Nurses and physiotherapists will guide you on this. You will be encouraged to move yourself around the bed to aid circulation and prevent stiffness. Your physiotherapist will see you on Day 1 to begin mobilising.
• Breathing exercises: it is important to do deep breathing exercises regularly to help your lungs recover and prevent chest infections. Your nurses or physiotherapist will show you how to do this effectively. Aim for 5 to 10 deep breaths and a gentle cough every hour while you are awake.
• Preventing blood clots: to help prevent blood clots in your legs, you will be encouraged to move your ankles and feet regularly, even while in bed (e.g. pointing and flexing your toes). You will have specialised compression boots (Flowtrons garments) to wear and / or an injection to thin your blood.
• Toileting: you will have a urine catheter in place, this will be removed once you are more mobile, usually around Day 2 or Day 3.
• Surgical site: your incision will be covered with a dressing. It is normal to feel some tenderness or discomfort around the wound and nurses will regularly check it.

Remember, Day 0 is about resting and allowing your body to begin the healing process. Do not push yourself too hard. Listen to your body and the advice of your healthcare team.

On the first day after your spinal fusion surgery, you should feel a gradual improvement as you continue your recovery. The focus today will be on managing your pain, staying hydrated and gently increasing your movement. You will typically be stepped down from L47 (Children’s Critical Care Unit) to L41 (Surgical Ward) today as we aim for discharge home around Day 4.

• Eating and drinking: we will continue to encourage you to drink plenty of fluids throughout the day. You should try to eat small amounts frequently as your appetite allows. Chewing gum can also help stimulate your appetite and bowel. As you drink enough and your bowels start to wake up, we will gradually be able to stop the fluids from your IV drip.
• Pain and sickness management: you will receive regular oral pain medicine to help keep you comfortable. We will continue the process of switching your pain medicine from the IV drip (PCA) to oral medicine, if not already completed. You will also be given regular anti-sickness medicine to prevent nausea. Please tell your nurse or doctor if your pain is not well controlled or if you feel sick.
• Toileting: you will have a urine catheter in place. Once you are mobile, the catheter will be removed typically around Day 2 or Day 3, and you can then start using the toilet. We will also give you medicine (a laxative) to help you have a bowel movement.
• Physiotherapy: the Physiotherapy team will work closely with you today. They will re-emphasise logrolling (moving your body as one unit, without twisting your spine) when getting in and out of bed.

Your goals for today will include:

• Sitting on the edge of the bed.
• Standing briefly beside the bed.
• Taking your first few steps, often with assistance, perhaps to a chair or a short walk in your bed space.

They will also continue to guide you through your breathing exercises to keep your lungs clear. You will be encouraged to move around your bed space to aid circulation and prevent stiffness throughout the day. Your physiotherapist will see you twice today, once in the morning and again in the afternoon.

• Preventing blood clots: continue to regularly move your ankles and feet (pointing and flexing your toes) throughout the day, even when resting in bed. You will also continue to wear your specialised compression boots (Flowtrons garments) and / or receive an injection to thin your blood as advised by the team.
• Toileting and bowel movements: you will likely still have a urine catheter in place. The healthcare team will help you sit on the edge of the bed and possibly stand as you become more mobile. The catheter is typically removed around Day 2 or Day 3, once you are moving well enough to use the toilet independently. It is very common for your bowels to be slow after surgery and pain medication. We will continue to give you medicine (a laxative) to help prevent constipation. Please do not worry if you do not have a bowel movement today.
• Surgical site: nurses will continue to monitor your surgical incision site for any changes.

Remember, the goal for today is to start your recovery gently and safely, making small steps forward. The medical team will be there to support you throughout your recovery.

On your second day after spinal fusion surgery, you should feel more confident in your movements and more independent. The focus today is on building strength and endurance, continuing safe mobility, and ensuring you are comfortable with your pain management. For many patients, this day is also about consolidating skills needed for discharge.

• Eating and drinking: continue to maintain good hydration by drinking plenty of fluids. You should now be able to eat more regular meals as your appetite returns. Staying hydrated and eating well will help with your overall recovery and bowel function.
• Pain and sickness management: your pain will continue to be managed with oral medication. The goal is to ensure you are comfortable enough to participate in your physiotherapy and other activities. Please continue to communicate openly with your nurses about your pain levels so adjustments can be made. It is important to take your pain medication as prescribed, especially before physiotherapy sessions.
• Movement and physiotherapy: your physiotherapy sessions will continue twice today (morning and afternoon). The team will assess your progress and help you to become more independent with your mobility.
  Your goals will typically include:
  • Becoming more confident with log-rolling and getting in and out of bed by yourself, or with minimal assistance.
  • Increasing the distance and frequency of your walks, with assistance as needed. You may walk further in the bed space or begin to walk in the ward corridor.
  • Practising getting up from a chair.
  • Continuing with stair practice if you have stairs at home and are ready.
  • Performing your breathing and ankle exercises independently.

The physiotherapist may start discussing strategies for managing daily activities, while protecting your spine.

• Toileting and catheter removal: today, if you are moving well and feeling stable, your urinary catheter will typically be removed. This means you will start using the toilet independently. Please let your nurses know if you experience any difficulty urinating after the catheter is removed. It is common for bowels to be slow, continue to take your prescribed laxatives to aid bowel movements.
• Preventing blood clots: continue to regularly move your ankles and feet (pointing and flexing your toes) throughout the day. Depending on the team’s advice, you may still be wearing your specialised compression boots (Flowtrons garments) and / or receiving an injection to thin your blood as advised by the team.
• Surgical site: your surgical incision will continue to be monitored by the nursing staff. The dressing will typically remain in place, unless there are specific reasons for it to be changed.
• Planning for discharge: the healthcare team may start discussing your discharge plan in more detail. This might include:
  • Booking your x-ray.
  • Confirming your travel arrangements.
  • Reviewing your pain medication schedule for
    when you go home.
  • Arranging your community nurse follow-up.
  • Booking your first follow-up appointment.

Remember, every step forward, no matter how small, is progress. Continue to listen to your body and follow the guidance of your nurses and physiotherapists.

By Day 3, you should feel more confident and independent. The main focus is consolidating your strength, perfecting safe movements, and ensuring you are fully ready for discharge.

• Eating and Drinking: Continue to eat regular, balanced meals and drink plenty of fluids.
• Pain Management: You should be managing your pain effectively with oral medication, comfortable enough to participate fully in activities. It’s important to take medication as prescribed, especially before physiotherapy sessions.
• Movement and Physiotherapy: Your physiotherapist will ensure you are fully independent with log-rolling, getting in/out of bed, and walking longer distances. You should be managing stairs safely (if you have them at home) and performing your breathing/ankle exercises on your own.
• Final Checks: Any remaining temporary lines (such as wound drains or IV lines) are typically removed today, if they weren’t removed yesterday.
• Discharge Readiness: The team will confirm your support needs at home and review your discharge plan in detail.

Today is the day you go home! The focus will be on final checks and ensuring you and your family have all the instructions and medications needed for continued recovery.

• Morning Routine: You will be encouraged to be independent with your morning washing and dressing routine.
• Final Medical Checks: The team will perform a final review of your wound, pain levels, and vital signs. Your physiotherapist will do a final safety check to confirm you can move independently.
• Medication Handover: Nursing staff will give you your discharge letter, prescriptions, and detailed instructions on when to take your medicines at home

You can travel home by car. The front passenger seat is generally recommended as it often allows you to recline the seat to a more comfortable position, helping to keep your spine straight.

For journeys longer than 30 minutes, it is important to plan for a safe stop-off.

Get out of the car, perform a short, gentle walk and perhaps some light stretches (as advised by your physiotherapist) to prevent stiffness and discomfort.

Remember to use your log-roll technique when getting in and out of the car.

You will be discharged with a supply of medicines, which may include pain relief, laxatives and potentially others. The nursing staff will provide you with clear, detailed instructions on how to take each medicine, including dosages and the next scheduled time.

We strongly recommend that you write down your medicine times to avoid confusion and ensure you take them correctly. Do not hesitate to ask the nursing staff any questions about your medications before you leave.

Regular, gentle walking is key to your recovery at home. Continue to walk frequently around your house. Gradually increase your walking distance as your comfort allows, building up your endurance.

Continue to sit up for meals and short periods, ensuring you use good posture. Remember the “BLT” precautions: avoid bending, lifting (anything heavy) and twisting your back. Your physiotherapist will reinforce these.

Depending on your specific surgery and individual needs, your surgeon may recommend wearing a spinal brace or jacket for a period after surgery.

If a brace is required, you will receive specific, detailed instructions from the team on how and when to wear it, how to care for it and when you can remove it.

A community nurse will be arranged to visit you at home to check on your wound. This visit is typically scheduled for
two weeks after your surgery.

Once the community nurse has removed the dressing, please take a clear picture of your wound and send it to the Spinal Nurse Specialist (contact details will be provided). This allows us to monitor your healing remotely. Until the dressing is removed and your wound is fully closed, you will need to take sponge baths or showers, carefully avoiding getting the dressing wet.

If you have any concerns about your wound (e.g. increased redness, swelling, warmth, discharge, new pain, or fever), please contact the Spinal Nurse Specialist immediately (contact details will be provided). Do not wait for the community nurse visit.

While serious complications are rare, it is important to know when to seek urgent medical advice after you go home.

Please contact the Spinal Nurse Specialist immediately, or go to your nearest Emergency department, if you experience any of the following:

• Sudden increase in pain that is not relieved by your prescribed medication.
• New or worsening numbness, tingling, or weakness in your arms or legs.
• Fever (temperature above 38°C) or chills.
• Significant redness, swelling, warmth, or pus from your wound.
• Difficulty breathing or persistent cough.
• Severe constipation or inability to pass urine.
• Any new, unexplained loss of bladder or bowel control.

• From six weeks: you can generally begin core stability exercises and gentle stretches, as advised by your physiotherapist.
• From three months: a graded return to most activities is usually possible, with the exception of contact sports.
• From six months: you can typically return to all activities, excluding contact sports.
• From 12 months (one year): there are usually no restrictions on activity; however, your return should be gradual, especially if you have not participated in that activity before this time. Your consultant and physiotherapist will provide specific guidance for you.