Preparing for Surgery

• Scoliosis is a condition where the spine twists and curves to the side.

• As a result of the twist or rotation of the spine, the ribs or shoulder blades on one side of your body stick out a bit more.

• You might notice one shoulder being higher than the other, or that one side of your back or ribs looks a little different. There may also be some asymmetry of your hips.

• Scoliosis can happen at any age, but it's most common between the ages of 10 and 15.

Let’s break down what Adolescent Idiopathic Scoliosis means:

• Adolescent – Refers to young people, usually aged between 10 and 18

• Idiopathic – Means that doctors aren’t exactly sure what causes it. It happens for reasons we don’t fully understand yet

• Scoliosis – Term used when the spine curves to the side

If you have scoliosis, you’re not alone. Many young people live with this condition, and there are treatments and support to help you along the way.

You can also find lots of helpful information on the website of Scoliosis Support and Research. They help people affected by Scoliosis by:

• Providing a dedicated helpline to call or email for advice, support or just someone to talk to

• Provide up to date information on scoliosis and related health matters

• Provide online support groups facilitated by a qualified counsellor covering various age groups

• Hold patient meetings across the country which include talks from specialists and an opportunity to meet others

We would strongly encourage you to do exercises at home whilst you wait for your operation to help improve your movement and strength before surgery.
This will also improve the speed of your recovery following surgery.

Videos from the spine school to help you prepare:
https://www.nuh.nhs.uk/exercise-videos-spine-school

The pre-operative assessment takes place before you have surgery, it is all about getting prepared for your surgery and making sure you are as ready as possible physically and mentally.

You will have 3 to 5 appointments.

• You will meet with your surgeon, spinal nurse specialist and other healthcare professionals, this will give you an opportunity to discuss any questions you may have. They will ask about your health history, any medications you are taking, and any allergies you might have.

• You will have some tests done, including blood tests, x-rays, medical photographs, MRSA swabs, and sometimes a lung function test, or a nerve test (SSEP).

• It is also a time to talk about any worries you might have and to learn about what will happen before, during, and after the surgery.

The anaesthetic assessment will be conducted by the anaesthetist or the spinal nurse specialist and will include taking a full medical history, blood tests and a medication review.

Blood tests

You will need to have a blood test to check your overall health and blood group. When the needle goes in you might feel a small pinch or sting, but this only lasts a few seconds.

Medication review

During your medication review the anaesthetist or spinal nurse specialist will:

• Go over all the medicines you currently take.

• Ask you about any allergies you may have, or if you have had any reactions to medications in the past.

• Ask you about any vitamins or supplements you use.

This helps the doctors and nurses take care of you before, during, and after your surgery.

You may need to go for a lung function test, which checks how strong your lungs are. This is done by measuring how much air you can breathe out in one forced breath.

This involves blowing hard into a tube. You will be asked to take a big deep breath and blow out as hard as possible. The machine records how fast and how much air is blown out. The measurements are repeated a few times to get the best values.

You may be given an appointment for SSEP investigation before your surgery.
SSEP stands for Somatosensory Evoked Potential and is a way of testing the nerve pathway that runs between your arms, legs, and brain.

During the test, several small electrodes, which look like small metal disks, will be placed on certain points of your body, like your head, shoulders, neck, back, or legs. You will be asked to either sit or lie down and small electrical pulses will be applied to create a twitch in your hand or toes. Although the pulses can be felt, they aren’t too uncomfortable. The test usually takes one hour.

Please inform us if you have a cardiac pacemaker or defibrillator before your appointment.

Things to remember:

• Come with clean, dry hair, free from any hair care products.

• Wear loose fitting clothing as we need easy access to backs of knees, ankles, wrists, collar bones, and lower part of neck.

During this visit you will meet with healthcare professionals including your surgeon and/or spinal nurse specialist. You will:

• Discuss your consent for the surgery

• Have your height and weight measured

• Be given a prescription for gabapentin

• Be given a special wash to use before surgery

• Have an x-ray

• Have medical photographs taken

• Have an MRSA test

The discussion during this clinic is very important. The surgeon needs to know that you have a clear understanding about the surgery and all of the potential risks so you can make the decision that is right for you.

Please ask any questions that you may have at that appointment. You will be asked if you agree (consent) to having the surgery and you will be asked to sign a few forms.

Before your appointment, please take the time to read all the education materials that have been provided to you and especially the section on ‘Surgery’ which contains details about the surgery and the risks.

The information in the materials shared by your healthcare team is not intended to try and discourage you from having surgery but does form a vital part of the consent process to ensure you understand what you are having done and the potential for things to go wrong.

• You will be given a prescription for gabapentin to manage post-surgery pain,

• You will be provided with a special wash to help reduce infection risk.

• If you have acne on your back, the surgeon or spinal nurse specialist may prescribe antibiotics to help it clear up before surgery.

• You might also need to have a repeat blood test.

X-ray

When getting your x-ray, you will need to change into a hospital gown and stand, bend or lie still while a technician takes images of your spine. These x-ray images will show the shape and curve of your spine and will help with surgical planning.

Medical photographs

As part of the pre-operative consent clinic, you will need to have detailed photographs taken of your spine. Below are details of why this is an important step, and what to expect.

why are photographs important:

What to expect during your photography session:

What to wear

MRSA (Methicillin-resistant Staphylococcus aureus) is a type of bacteria that can cause infections. This ‘bug’ is on the skin of many people and doesn’t usually cause any problems, but when having surgery, the skin needs to be clear to avoid infection. At pre-assessment you will need to have an MRSA test, which checks if you have MRSA on your skin or in your nose.

The spinal nurse specialist will use a small cotton swab to take samples from some areas of your body, like your armpits or groin. The process takes a few minutes. The results usually take a few days to come back.

During one of your appointments with your healthcare team you will be asked for your permission for your details to be shared with the British Spine Registry (BSR).

• The BSR is a database set up by the British Association of Spine Surgeons for the collection of information about spine surgery in the UK.
• It helps your Consultant Spine Surgeon and other medical practitioners understand more about spinal procedures and how to better improve patient care for you and future patients.

What information is collected?

• Details of your spinal diagnosis, operation and complications will be recorded on the BSR by your hospital.
• Personal details included, but not limited to, your name, address and telephone number are gathered, but they will never be shared with any other third party or used for anything other than anonymised research and data analysis.

What is Consent?

• Your consent will allow the British Spine Registry (BSR) to examine details of your diagnosis, surgical procedure, any complications, your outcome after surgery and your questionnaires. These are known as ‘service evaluations’ or ‘audits.’
• The information collected in this registry may also be shared with NHS commissioning organisations (NHS England and Clinical Commissioner Groups) to ensure they can meet their statutory duties. When this is required, NHS Digital collect your identifiable information using their powers under the Health and Social Care Act 2012.
• The data collected will then go through a process of pseudonymisation (de-identification) before being provided to commissioning organisations under a strict governance framework. You will be consented separately for any other research studies where specific data may be collected using the Registry.

Do I have to give my consent?

On the morning you come into hospital please:

• Come with clean, dry hair, free from any hair care products.
• Have washed with the special wash you were provided with
• Avoid using moisturiser on the day of your operation
• If you have long hair, it would be helpful to put this in two loose plaits starting low at the hairline to enable us to attach electrodes to your scalp, and in addition prevents your hair from getting too tangled.

Things to pack

• Ear plugs (the ward can be quite noisy at night)
• Something to keep you entertained during the day, e.g. book, puzzle, headphones
• Comfortable shoes: well-fitted slippers or trainers – not heeled shoes or flip-flops
• Night clothes: loose-fitting nightwear and a dressing gown
• Day clothes: loose-fitting clothes for during the day

Personal toiletries

• All medicines you currently take including prescription, over the counter and herbal medicines, inhalers, sprays, patches, injections, drops, creams etc.
• Your glasses or contact lenses
• Pocket sized snacks (recommend High-fibre foods, such as dried fruit)
• Mobile phone and charger (please charge up before bringing to hospital)

What not to bring?

• Valuables, including jewellery. The hospital cannot take responsibility for any valuables that go missing
• Large suitcases and bags, the storage space for these and for belongings is limited

For more information please contact:
Centre for Spinal Studies and Surgery
Queens Medical Centre Campus, D Floor, West Block
Telephone: 0115 924 9924

Choose the appropriate extension number for the waiting list coordinator based on the consultant whose care you are under:

• 81024 – Rachael Blow (Mr Patel)

• 88469 – Christine Pickard (Mr Yoon)

• 86230 – Julie Russell-Laing (Mr Shafafy & Mr Bayley)