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.
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 iliac crest. The rods and screws hold the spine in its corrected position until the bone graft becomes solid and the spine can no longer curve. This fusion usually takes twelve months to become completely solid. Typically the instrumentation is left in place after the fusion is complete. Bracing is not usually necessary after surgery.
What to expect after surgery
A posterior spinal fusion is a long complex surgery and not without risks. The surgery typically takes six-eight hours for an otherwise healthy young person with idiopathic scoliosis. In a more medically complex child such as with neuromuscular scoliosis, this surgery may take 8-12 hours. Most children will require blood transfusions during and sometimes after the surgery. Most children have neuromonitoring throughout the operation by a staff member specially trained in this technique. Pain after surgery is controlled and monitored by a special pain management team. Total hospitalization time is usually five-seven days with an overnight stay in the Pediatric Intensive Care Unit the night after surgery.