Scoliosis Surgery: Potential Risks and Postoperative Care

Scoliosis surgery is extensive surgery and is only recommended when scoliosis curves are progressing rapidly enough to potentially cause severe deformity. It is important for patients to understand the risks of surgery and the post-surgery experience.

Surgery Risks

1. Paraplegia
The most concerning risk with scoliosis surgery is paraplegia. It is very rare (about 1 in 1,000 to 1 in 10,000 chance) but is a devastating complication. To help manage this risk, the spinal cord can be monitored during surgery through one of two methods:

• Somatosensory Evoked Potentials (SSEPs). This test involves small electrical impulses that are given in the legs and then read in the brain. If there is the development of slowing of the signals during surgery this can indicate compromise to the spinal cord or its blood supply. Another way to monitor the cord is with Motor Evoked Potentials (MEPs), and often both are used throughout a surgery.
• Read more with Somatosensory Evoked Potentials (SSEP).
• Stagnara wake up test. This test involves waking the patient during the surgery and asking them to move their feet. The patient does not feel any pain during this procedure and will not remember it afterwards.
•  If either of these tests indicates spinal cord compromise, the rods can be cut out and the surgery abandoned. Fortunately, this situation is extremely uncommon, and many procedures can be rescheduled if the patient is found to be neurologically intact after the surgery.
  2. Excessive Blood Loss
  Another risk with scoliosis surgery is excessive blood loss. There is a lot of muscle stripping and exposed area during the surgery. With proper technique the blood loss can usually be kept to a reasonable amount and blood transfusions are rarely needed. As a precaution, many surgeons will ask the patient to donate his or her own blood prior to surgery (autologous blood donation), which can then be given back to the patient after the surgery. Also, during scoliosis surgery the patient's blood can be collected and transfused back to the patient.
  3. Other Potential Risks and Complications
  
• The rods breaking or the hooks or screws dislodging (although with modern instrumentation systems, this type of hardware failure is quite uncommon)
• Infection (less than 1%)
• Cerebrospinal fluid leak (rare)
• Failure of the spine to fuse (about 1%-5%)
• Continued progression of the curve after surgery

Postoperative Care

Following scoliosis surgery, patients usually can start to move around about 2 to 3 days after the procedure. The total hospital stay is usually about 4 to 7 days. Patients can return to school about 2 to 4 weeks after surgery, but activity needs to be limited while the bone is fusing.
It is important to note that the more immobile the spine is kept the better it will fuse. Bending, lifting, and twisting are all discouraged for the first three months after surgery. For this reason, some surgeons will prescribe wearing a back brace for a period following the surgery which helps to restrict movement. Any physical contact or jarring type activities are restricted for about 6 to 12 months after surgery.
Generally the patient will be monitored with intermittent examinations and X-rays for 1 to 2 years after the surgery. Once the bone is solidly fused no further treatment is required.
For the most part, patients can resume normal activity levels after a thoracic fusion since fusing the thoracic and upper lumbar spine does not change the biomechanics of the spine all that much. Female patients who have had a scoliosis fusion can still become pregnant and deliver babies vaginally.