There are two types of spinal fusion procedures: Anterior Spinal Fusion and Posterior Spinal Fusion. Here you'll learn about the differences between the two as well as how each procedure works.
Anterior spinal fusion
With certain kinds of spinal curves, the correction and fusion is best done anteriorly, or from the front. This process is known as anterior spinal fusion.
How the procedure works
The front of the spine is approached from the side of the patient. An anterior approach may be indicated if the curve that needs correction is in the lower spine (thoracolumbar or lumbar curves). During this procedure, there is a discectomy (removal of the disc) stabilizing the spine with screws and rods, and adding bone graft which provides the eventual fusion. This is a highly successful way of correcting a child’s spine deformity and obtaining good spinal balance with a shorter fused segment.
Ensuring the best outcomes
As with posterior spinal fusion and instrumentation, an anterior procedure is a complex surgery and not without risks. Monitoring of the nerves is performed throughout the procedure by a specially trained staff member. A blood transfusion may also be required during or after surgery. Pain after surgery is controlled by our pain management team. Total hospitalization is usually 3-4 days with a possible overnight stay in the Pediatric Intensive Care Unit.
Posterior spinal fusion
Posterior spinal fusion with instrumentation is the most common surgery for idiopathic scoliosis in a young person who is skeletally mature or close to skeletal maturity. Surgery is typically indicated if the spinal curve measures greater than 50 degrees.
Posterior spinal fusion with instrumentation is also used for the treatment of Scheuermann’s Kyphosis. The goal is to prevent progression into adulthood while achieving correction of the deformity.
How the procedure works
The spine is operated on through a long incision made straight down the back.
- Instrumentation, consisting of rods with screws, hooks or wires placed into the vertebrae of the spine, are used to partially straighten the spine and hold the spine in a better position.
- Bone graft, which consists of chips of bone, is then placed along the spine. Bone graft is typically obtained from the bone bank, but occasionally may be obtained from the patient’s own pelvis.
The rods and screws hold the spine in its corrected position until the bone graft becomes solid and the spine can no longer curve. Typically, the instrumentation is left in place after the fusion is complete. This usually takes about 12 months for the fusion to fully heal.
Your surgeon will discuss what limitations of activity they would like for your child to follow once surgery has been completed. Bracing is not usually necessary after surgery.
What to expect with surgery
A posterior spinal fusion is a long complex surgery and not without risks.
- Time: The surgery typically takes approximately four hours for an otherwise healthy young person with idiopathic scoliosis. It can take a little longer for a patient with Scheuermann’s Kyphosis. In more medically complex children, such as with neuromuscular scoliosis, this surgery may take closer to 5-6 hours.
- Blood transfusions: Some children will require blood transfusions during and sometimes after the surgery. Your surgeon will discuss your child’s risk of needing a blood transfusion at their preoperative discussion.
- Spinal cord monitoring: Most children have neuromonitoring throughout the operation by a staff member specially trained in this technique.
- Infection prevention: your child will receive many interventions to cut down on the risk of infection.
- During your preoperative discussion, you will be provided with a prescription for a strong antibiotic ointment (Mupirocin) that you will place in your child’s nostrils and along their future incision site (usually down the middle of their back) for 5 days before surgery.
- Additionally, your surgical team will instruct you on the use of chlorhexidine wipes prior to surgery as well. These will be provided for you by your spine team.
- During the surgery, your child will receive high-dose antibiotics regularly throughout the case and after it is completed to combat any infection risk as well.
- The spine teams are continuously working to find new ways to keep our patients free from infection.
- Pain management: Pain after surgery is controlled and monitored by a special pain management team. Most patients will be on a patient-controlled analgesia machine (pain pump) immediately following surgery, but will transition to taking pain medications by mouth as soon as they can tolerate
- Hospital stay: Total hospitalization time is usually 3-4 days. Intensive care stay is not indicated for this surgery in an otherwise healthy young person. However, more medically complex children may require immediate postoperative stay in the Pediatric Intensive Care Unit and a longer hospitalization.
What to expect after surgery
Most patients will be in the hospital for 3-4 days after a posterior spinal fusion. If your child is more medically complex, they may stay a little longer. Your child will be discharged once they are eating normally, having bowel movements and having good pain control on medications by mouth.
Once your child is discharged home, they should be able to walk stairs and sleep in their own bed. They will be discharged with pain medication as well.
Normally, patients are out of school from anywhere between 3-6 weeks. Your spine team can provide a note with clear instructions to facilitate a smooth transition back into their school life. They should not, however, return to gym or sports until cleared by their spine surgeon.
Halo Gravity Traction
This technique applies traction to the spine using a halo (metal ring that surrounds the head). The goal of halo gravity traction is to stretch out the spine slowly and carefully prior to a scheduled spine surgery.
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