|
Preparing for Spinal Surgery |
 |
| Preparing for Spinal Surgery
If you or your child require surgical correction of scoliosis, you probably
have many questions and concerns. We have prepared this guide to help
answer many of your questions. We will explain the common surgical treatment
for scoliosis, preparing for the surgery,
Scoliosis is defined as a lateral curvature of the spine. Scoliosis can
occur in either the upper back (thoracic), lower back (lumbar), or rarely,
in the neck (cervical). Scoliosis is the most common spinal deformity
affecting adolescents 10-16 years of age. Most cases (about 80%) of scoliosis
are idiopathic, or have no known cause. Idiopathic scoliosis is much more
common in females, and is usually noticed at the onset of puberty coinciding
with the "growth spurt." Scoliosis is usually discovered during
regular check-ups with the pediatrician, or during school screening programs.
The most common signs are asymmetry of the spine, uneven shoulders or
hips, waist and ribcage asymmetry. These changes are especially noticeable
when the child is bending over.
What is a Spinal Fusion? If the spinal curvature progresses despite the use of conservative measures,
it may be necessary to proceed with surgical intervention. The surgery
most often performed for scoliosis is called a "posterior spinal
fusion with instrumentation. The goal of this surgery is to create a solid
"fusion" of the curved part of the spine. The fusion is created
by operating on the bones of the spine (vertebrae), adding bone graft,
and allowing the vertebral bones and bone chips to slowly heal together
to form a solid mass of bone. The bone graft may come from your hip (iliac
crest) or from the hospital's bone bank. Often, the spine is also partially
straightened with internal metal rods and wires (spinal instrumentation).
The rods and wires hold the spine in place until your fusion has had a chance to heal. This spinal instrumentation is left in your back without causing any problems. Before Surgery: Donating Blood: All patients will lose some blood during surgery, and sometimes it is necessary to get transfusions during or after the operation. There are several different options for donating blood. Autologous Donations: You will donate your own blood for transfusions
after surgery. The first unit of blood must be given within five weeks
of the surgery, and the last, not less than seven days before the surgery.
It is important to eat a nourishing meal 2-4 hours prior to donating blood.
The blood donor center is located in the Gray Building on the first floor
at Mass General Hospital. The nurse will check your blood counts before
any donation. If patients are donating their own blood before surgery,
they will often be given a prescription for iron pills. Iron may cause
constipation, so it is a good idea to increase the fluids, fruits, and
vegetables in your diet. Since the body replaces blood very quickly, healthy
patients can donate and still be ready for surgery soon after.
Designated Donations and Blood Bank: If you do not meet the minimum weight requirement (less than 90 lbs) or you do not wish to donate your own blood, family or friends may donate their blood at MGH. If their blood type matches yours and meets special standards, it can be used for donation. Properly matched blood is also available from MGH's blood bank. Contact for Questions regarding Pre-Operative Blood Transfusions: (617) 726-3718 Aspirin and Other Medications: Aspirin, bufferin, and non-steriodal
anti-inflammatory medications such as Advil, Motrin, Naprosyn, or Aleve
may cause extra bleeding at the time of surgery. These medications should
be stopped three weeks prior to surgery. Tylenol (Acetaminophen) can safely
be used for pain relief prior to surgery. If you are unsure whether you
should stop medication, consult with your physician or nurse practitioner.
Pre-Admission Testing: One to two weeks before surgery, you will
need to come to Mass General Hospital for pre-admission testing. Please
plan on being at the hospital for four to five hours on this day. You
will meet with a physician or nurse practitioner who will perform a physical
examination, and make sure you are in good shape for surgery. The nurses
and doctors will ask you and your parents some questions and answer any
questions that you may have. This will enable us to give you the best
care while you are hospitalized. Please call the orthopaedic office if
your child is sick the week prior to surgery. While at the pre-admissions
testing center, urine and blood samples will be obtained. In addition,
you will meet the anesthesiologist (the doctor who will be putting you
to sleep). He/She will explain how you will be put to sleep for the operation,
as well as how pain will be controlled post-operatively. Be sure and tell
the nurses or doctors about any allergies to medication, foods, tape,
or latex (rubber products).
The Night Before Surgery: The night before surgery, you must remember not to eat or drink anything after midnight. This includes water, chewing gum, and candy. Your stomach needs to be empty when you go to sleep. This will help keep your stomach from getting upset afterward. It will also help you avoid aspiration which is a potentially life threatening problem. Eat a well-balanced dinner the night prior to your surgery. You may also want to avoid salty foods the night before surgery to prevent waking up excessively thirsty.
Pre-Surgical Area: When you get to the hospital on the morning
of your surgery, you will need to check in at the pre-surgical area in
the Wang Building, 3rd floor. The nurses will record your vital signs
(temperature, pulse, and blood pressure), and you will change into a hospital
gown. An IV line (intravenous) will often be started while in the pre-surgical
area. The IV is started using a needle that is removed once the line is
in place. This leaves a small plastic tube inside your vein through which
you will be receiving medicine and IV fluids.
[Remember: All tubes except for one IV are placed AFTER you are asleep] Anterior Fusion: If you are having an anterior fusion, you will have one of two possible incisions. If the scoliosis involves only the thoracic spine, the incision will be on one side of your rib cage from back to front. When the operation is on both the thoracic and lumbar spine, the incision will be across your lower rib cage and down the front of the abdomen. Again, the spine surgeon may use rods, screws, or staples to hold the correct position. Occasionally, it is possible for the anterior spinal fusion to be completed through thoroscopic surgery. Thoroscopic surgery of the spine utilizes microscopic cameras which magnify images for the surgeon. There are three to four tiny incisions where the camera is inserted and where the surgeon makes the repair. Thoracoscopic s urgery usually is usually less painful with a shorter recovery period. In addition, the scars are much smaller as well as more cosmetically appealing. You will usually need to have a "chest tube" after anterior
spinal surgery. This tube is placed to drain the fluid that collects outside
your lungs and to keep your lungs expanding properly. The chest tube is
covered with a large dressing, and is attached to a plastic container
that collects the drainage. The tube is usually left in place until postoperative
day three, and will then be removed by the surgeon. After the Surgery The Recovery Room (PACU): When you wake up from anesthesia, you
will be lying on your back in the recovery room or post-anesthesia care
unit (PACU). You may feel still from being in one position for a long
time. You may not even remember the PACU, because you will still feel
sleepy and groggy from the surgery. Your nurse and anesthesiologist will
be checking your vital signs frequently, and they will also make sure
that you are comfortable. If you are having any pain, the PACU nurse will
give you pain medicine through the IV. You will be receiving oxygen through
your nose or mouth, and you will be encouraged to cough and deep breath
to help clear your lungs. You will still have the IV, nasogastric tube,
and Foley catheter. A large dressing will be placed over your incision.
Occasionally, you will have an X-ray in the PACU to check the rods and
hooks in your back. Usually, patients will stay in the recovery room for
2-3 hours while they wake up from the surgery. It is possible to have
a parent visit in the PACU after they have met with the spine surgeon.
The PACU is located on White 3 next to the Main OR.
The Pediatric Intensive Care Unit [PICU]: You will most likely spend one night in the intensive care unit after your spinal fusion. In the ICU, you will still feel quite sleepy from the anesthesia and pain medications. You will continue to receive pain medications through your IV (usually the PCA). It is important to let your nurse know if you are having any pain or nausea. The doctors and nurses will be touching your hands and feet, and asking if you have any numbness or weakness in your arms or legs. You will have your blood checked periodically and will receive blood transfusions if necessary. You will be monitored very closely while in the ICU. The ICU is located in the Ellison building on the 3rd floor. Your parents will be able to visit while you are in the ICU, and they can sleep in a nearby room on the floor. You will usually only spend one day in the ICU before going to the adolescent floor (Ellison 18). Ellison 18: You will usually be transferred up to the floor after one night in the PICU. The adolescent floor is located in the Ellison building on the 18th floor. This is a twenty-four bed pediatric unit with children between the ages of five and twenty years. All the rooms are decorated especially for children and adolescents, and each bedside has a sleep chair/bed for a parent. Parents are welcome and encouraged to spend the night with their child. Child Life Specialists are dedicated to making the hospitalization as positive as possible. They help you in coping with illness/surgery, hospitalization, as well as separation from home, routine, and friends. Television, video games, movies, and other activities are also available on Ellison 18. Pain Medication: Your nurse will check your vital signs and assess
your pain frequently on the floor. The Pediatric Pain Team at MGH is available
for acute and chronic pain management. You will usually need to have pain
medication through your IV for three to four days. Once you begin to drink
and eat small amounts of food, you will be able to take pain medications
by mouth. You will be given a stool softener or laxative to prevent constipation
which is a common side effect of pain medications. Activity: It is common to feel quite tired following spinal surgery,
and you may need help turning from side to side initially. You will meet
with a physical therapist usually on the second post-operative day. The
physical therapist will assist with deep breathing, coughing, mobility,
and endurance. After your surgeon says it is okay, you may get out of
bed and sit in a chair ( usually on P.O.D The physical therapist will
work with you to teach you the correct way to get out of bed and walk
without twisting your spine. You will then progress to walking short distances
on the floor. Some patients get up the day after surgery, and others have
to wait a few days. Your individual pace of recovery is unique, and depends
on the type and extent of spinal surgery. You will be given additional
information about specific activity restrictions at your six-week follow
up visit. As a general rule, however, no contact sports are allowed for
six months after a spinal fusion surgery. It is important to advance your diet VERY slowly to prevent
nausea and vomiting! It may actually take two or three weeks for your
appetite to return to normal.
Most patients will remain in the hospital for about 5-7 days after surgery. When your pain is well controlled, you are able to eat and drink without nausea, and you are able to walk around on the floor, you will start to think about going home. Usually your surgeon will tell you when you can expect to go home about a day in advance. During your hospital stay, your parents will be taught how to take care of you. You and your family will be instructed on what problems to look for, as well as how to manage your diet and medications prior to discharge. Generally, no special equipment is needed at home following a spinal fusion. You will be given prescriptions for pain medication before you go home.
Plan to take a dose of pain medication prior to leaving the hospital,
as the ride home can sometimes be uncomfortable. If you still have pain
after taking the medication, please call the orthopaedic office and let
us know. It is possible to make an adjustment to your pain medications
to make you more comfortable. Also, if any of the following problems occur
after surgery, please let your spine surgeon know right away: Content Prepared by: Erin S. Hart, RN, MS, CPNP |
GOING
HOME !!!! 