Scoliosis is a difficult diagnosis for any parent to receive news of their child. When patients learn that spinal surgery is part of their course of treatment, the prognosis might seem even direr. The good news is that modern surgical techniques can either completely fix the curvature or at least prevent it from getting any worse.
Many cases of paediatric scoliosis are initially treated with non-surgical methods, such as observation, spine bracing, or even specialist physical therapy. However, spine surgery may be necessary if the curve is 45 degrees or greater or worsens despite bracing.
There are a variety of surgical approaches your spine surgeon can take when treating scoliosis. The surgeon's prescription is tailored to your child's scoliosis case, considering the child's age, health background, and the severity of scoliosis.
Spinal fusion is a common topic of discussion when discussing surgical options for treating scoliosis, whether as primary surgery or as a supplementary technique. During a spinal fusion procedure, the bone graft promotes new bone development, which "fuses" or biologically welds together two vertebrae in the spine. Fusion provides additional support for a spine that has been surgically realigned.
When performed on a child, spinal fusion may either halt the aberrant curvature's progression or fix the curve permanently. Your child's unique situation will determine whether the fusion will prevent the curve from getting worse or correct it for good.
A spine surgeon may recommend an in-situ spinal fusion if your child has a slight or moderate curvature that is expected to worsen. The term "in-situ" indicates "in its original location." By taking preventative measures, this method can smooth out the curve before it causes any trouble. The fusion may not reverse the curve, but it should at least halt its advancement. Spinal adjustment of varying degrees will be accomplished for most children.
If your child is too young for spinal instrumentation, they must wear a cast or brace after surgery to help them heal properly.
"hemivertebra" refers to an abnormally formed vertebra in the spine (vertebral body). A normal vertebra is rectangular, but a hemivertebra is more triangular. A foetus can have congenital scoliosis if a hemivertebra occurs during pregnancy.
Scoliosis can progress, causing your child to lean and be off balance, and the surgeon may recommend removing the hemivertebra to prevent this. Your child's doctor may employ an anterior approach, a posterior approach, or a combination of the two to eliminate the abnormal bone. The hemivertebra is often excised (removed), and the spine is straightened using a posterior approach. Spinal fusion involves joining the bones above and below the excised hemivertebra; spinal instrumentation maintains the correction while the fusion heals.
Modern medical procedures, such as the Rapid Recovery System, have allowed children with scoliosis shorter hospital stays, less pain after surgery and a speedier recovery.
The Rapid Recovery Joint Replacement programme was established in 2015 at CHoP in Philadelphia with the primary goals of facilitating a speedier recovery (and shorter hospital stays) and minimising pain for patients, as well as speeding up treatment and restoring function (such as getting patients up and walking within hours of surgery).
What, then, is this RRS thing that everyone keeps talking about? Historically, post-operative pain was treated by administering opioids and other painkillers to the patient. Once the patient is under anaesthesia and ready for surgery, Rapid Recovery helps with pain medication, such as non-addictive methadone and a steroid.
The aim is to prevent the normal pain stimulus from reaching the child or adolescent at any point throughout the surgical procedure. This reduces the body's response to pain by blocking the release of chemicals that normally induce tense muscles, elevated blood pressure, and heightened discomfort.
Previously, doctors had their patients pass gas before allowing them to eat again. However, medications taken after surgery often slow down bowel movements. The Rapid Recovery System increases the likelihood that the patient will have regular bowel function and begin eating sooner, which aids in the patient's speedy recovery. The patient can move around sooner and with far less pain after surgery.