Information for young people having surgery for Adolescent Idiopathic Scoliosis
Paediatric Spinal Team
This document can be provided in different languages and formats. For more information please contact:
Centre for Spinal Studies and Surgery
Queens Medical Centre Campus, D Floor, West Block
E40 ward: Tel: 0115 9249924 extension 89040
To share what to expect on each day you’re in hospital and what you can do to help your recovery.
Why? We’ve found having goals to achieve each day can help your recovery. Most patients are ready to go home around day 4 onwards but if you do really well you could be home earlier. You won’t need to stay in the hospital any longer than needed.
It will cover:
When your surgery is done, you will wake-up either in theatre or a special recovery area called Post Anaesthetic Care Unit (PACU). You'll stay there while the nurses check on you. You’ll have your first set of checks to see how your nerves are working, and the team will give you any extra pain medicine you need to keep you comfortable. Once the team is sure you're doing well, a family member will be able to come see you.
A doctor from your surgical team will talk to you and your family after you wake up to explain how the surgery went and let you know if there were any problems. Once it's safe to leave the PACU and your pain is under control, you'll go back to the ward E40. You will be in a 4 bedded enhanced observation area of the ward.
On E40, you can move around in bed to get comfy, and you’ll be allowed to eat and drink. You should start with something light like toast, ice cream, or yoghurt. Think about what you normally like to eat when you’re ill and start with that and slowly build up to eating more.
Nurses will check on you every 30 minutes, then every hour during the night to make sure you’re okay. This might make it hard to sleep, but it’s important to keep you safe and well. Later that evening, one of the medical team will come by to see how you’re doing.
When you wake up, you’ll notice a small tube called a catheter inside your bladder, which help you wee without needing to get out of bed. It’s totally normal to have one after long surgeries, and it will be taken out once you’re able to go to the toilet on your own, which usually happens on the second day after surgery.
For girls, you might get your period around the time of surgery, even if you weren’t expecting it. This is a normal response to stress, so don’t worry. The nurses will help take care of you and make sure you're comfortable. The hospital has pads, but you can bring your own if you want. Just remember, you won’t be able to use tampons until you are able to get up and use the toilet yourself.
One parent or carer (over 18) can stay with you on the ward overnight if you’d like their support. Just let us know who you would like to have around, and we’ll make sure they can be with you. During the day we ask for 2 visitors maximum at the bedspace, siblings can visit but please make sure bedspaces aren’t overcrowded.
In some cases, you might be taken to the Paediatric Critical Care Unit (PCCU) instead of going straight to the ward. This could happen if the doctors want to keep a closer eye on things like your vital signs and how your body is recovering until the doctors and nursing team are happy you are well enough to move to the E40 ward.
After your surgery, you’ll have strong pain relief to keep you comfortable. For the first 48 hours you will have a drip that helps control your pain.
Alongside these stronger medicines in a drip, you’ll also be given other regular pain relief to swallow. These are really important building blocks that work together to control your pain. The doctors and nurses will check on you often to make sure your pain is well managed. If you’re feeling uncomfortable at any time, just let them know so they can adjust your medicines to help you feel better. There is more information about this in the ‘Managing Pain After Surgery’ section.
You will also be given laxatives drinks to take to help you go to the toilet. You can add squash to these to make them taste nicer. Drinking them will help you to feel more comfortable as you won’t have to wait as long to have a poo.
In most cases you can lie in any position you feel comfortable in. If there is a specific position, you will be told after your surgery. Please ask if you are unsure.
After spending your first night in the hospital, you’ll be seen by the spinal doctors during their morning ward rounds. The nurses will keep checking on you every 30 minutes at first then every hour, but later in the day, they’ll switch to checking every two hours, then every 4 hours. You’ll also be encouraged to start moving around and sitting up in bed. You may feel sick due to the pain medication you’re taking.
If you feel well enough, with the help of the hospital staff, you’ll be encouraged to:
The first time you sit up, you might feel dizzy or lightheaded. This is normal and happens because your body needs a little time to adjust after lying down for so long.
Getting on and off bed
This will be the most comfortable technique for you and will avoid putting any unnecessary strain through your back.
Tips for Day 1:
On the second day, the nurses won’t need to check on you as often, and hopefully, any feelings of sickness will have stopped.
If everything else is going well, you’ll be encouraged to:
Some patients might still be feeling unwell from the surgery and might not be ready for these steps yet, and that’s okay.
You'll continue to be encouraged to get out of bed and move around more, as long as you’re feeling well.
The team will help you practice:
Because you are moving more and more aware of yourself and surroundings again, this is also when your pain might feel worse than before, so don’t hesitate to tell the nurses if you need more pain relief. Even though it may be uncomfortable, staying active is a key part of your recovery.
You’ll need to walk around the ward on your own and sit in a chair long enough for a car ride before going home, or if you have a long journey home you can allow a couple of stops. You should also feel confident that your pain is well-managed with regular painkillers.
Most patients are ready to go home around Day 4 onwards but if you do really well you could be home earlier. You won’t need to stay in the hospital any longer than necessary.
You can take a shower whenever you feel ready. If your wound dressing gets wet it will need to be changed after the shower. An X-ray will also be taken before you go home to check how the surgery went.
It’s normal if you haven’t had a poo before going home. If you’re not feeling sick and everything else is going well, there’s no need to worry. We’ll also give you some medicine to help make it easier for you to go for a poo. Most people can go to the toilet by around Day 10.
Everyone is different but here is a rough guide to show you what you can expect to happen each day you stay in hospital.
Day 1 |
Day 2 |
Day 3+ |
|
· Sit up in bed · Stand and walk around bed · Sit out in chair |
· Sit out in chair · Move around bed and to bathroom · Catheter removed so you can wee normally |
· Move about further · Practice climbing the stairs when you are ready and if you have stairs at home · Sit in chair for the length of your journey home (or with breaks) · Preparation to go home |
When you come into hospital you will meet our friendly team. You may have already met some people whilst you were preparing for surgery. Everyone is there to help you and we will explain in this section the different ways we do this.
First, to help you know the role of the people you see on the ward, most roles have a specific coloured uniform. Look at the picture to see the types of uniforms and who they belong to. If you see people wearing ‘normal’ clothing or theatre scrubs they are likely to be a doctor. There are different kinds of doctors including paediatricians, spinal doctors and anaesthetists.
The table shows some more information about the roles of the people you will meet during your time in hospital. You will meet many other healthcare professionals who also contribute to your care and recovery.
Role |
How they help you |
|
Anaesthetists |
An anaesthetist is a specialist doctor who will discuss and agree a plan for your anaesthetic (so you are sleep during surgery) and for your pain control during and after your surgery. |
|
Clinical Nurse Specialists (includes spinal nurse specialist and pain team) |
Nurse Specialists are advanced registered nurses. Their main role is to coordinate your care during preparation, hospital stay and the recovery stage. Members of the pain team are clinical nurse specialists. They will talk to you about your pain and make sure you have what you need to manage any pain you have. You can let any of the team know if you have issues with pain. |
|
Occupational Therapist |
The occupational therapist will help you with many of the practical parts of your returning to your normal life after surgery. If needed, they may ask about your home environment to assess your personal needs for the recovery period at home. |
|
Paediatrician |
A paediatrician is a doctor who specialises in treating children and young people. They will see your regularly when you are on the ward. |
|
Physiotherapist |
The physiotherapist will work with you to help you get moving again after surgery starting the day after surgery and continuing for the rest of your stay. They will also give you exercises to do when you go home. |
|
Play Specialist |
Play specialists promote and provide a quality play service for all children from birth to adolescence including providing both normalising and therapeutic play helping young people come to terms with their fears and anxieties and master their experiences. |
|
Spinal Surgeon |
The spinal surgeon is a doctor who specialises in treating spines and the nervous system. You will already have met your surgeon (or a member of their team) at your clinic visit. The spinal surgeon and the team they work with will perform your surgery and monitor your recovery. |
|
Ward Nurses |
You will first meet the ward nurses on the morning of your operation and then following surgery, you will be assigned to a bed in the spinal ward E40 where nurses are specialised in spinal care. There are lots of different staff on the ward including staff nurses, deputy sisters/charge nurse, and the ward manager., Look at the different uniforms to see who’s who. |
Why is play important?
Below are some exercises to help you get back to your normal self. Unless your physiotherapist tells you otherwise, try to:
Watch the videos above of the exercises.
It is important that you keep your lungs fully open and clear. To help you do this your physiotherapist will show you some deep breathing exercises and how to cough using a pillow or towel for support if needed.
The muscles around your stomach that support your spine can be weak and this exercise will help to switch them back on.
1. Lie on your back with your knees bent or / sit
2. Take a slow deep breath in and as you breathe out slowly pull your tummy in making it tight. Do not hold your breath.
To help make you feel more balanced when standing and walking you need to strengthen your bottom muscles.
1. Lie on your front or stand
2. Squeeze your bum cheeks together and hold for 10 seconds
This exercise helps to strengthen the muscles around your shoulder blades which would have become weak due to your curve.
1. Sit upright and move your shoulder blades down and back so they are flat to your rib cage. Think of it as trying to tuck your shoulder blades into your back pocket.
2. Hold for 5-10 seconds.
Your back and sides will feel tight and stiff, especially on the side opposite your curve. This exercise will help you gently stretch out your back and sides.
1. Lie down on your back
2. Bend both your knees up
3. Roll them together to one side
4. Hold this for a few seconds
5. Then bring them back up to the centre
6. Repeat to the opposite side.
This will help reduce tightness around your back and rib cage.
1. Sit in a chair or over the edge of the bed
2. Keep upright and reach one arm to your opposite knee and turn slowly to that side
3. Hold for 5 seconds.
4. Return to the centre and then repeat to the other side.
After your operation your arms and shoulders may feel tight and heavy when you move them. It is important that you get the muscles to move and stretch. They may pull but you will not do any damage.
1. Sit in a chair or over the edge of the bed
2. Lift your arms up and put your hands behind your head
3. Hold this position for 5-10 seconds
4. Then move your hands down and put them behind your back, again hold for 5-10 seconds.
This exercise will help stretch out the muscles around your upper back and shoulders and prevent your shoulders tightening up.
1. Sit in a chair or over the edge of the bed
2. Keep your arms straight lift them out to the side and then lift above your head
3. Hold each position for 5 to 10 seconds.
This exercise will help gently stretch out the muscles at the top of your back and shoulders and help reduce any tightness or stiffness after your operation.
1. Sit in a chair or over the edge of the bed
2. Reach both arms forwards towards your knees and slowly lean forwards stretching your arms down your legs as far as you feel comfortable.
3. Hold this position for 5 to 10 seconds and slowly come back up.
Video to be added soon
Before you will be able to go home you will need to:
E40 ward: Tel: 0115 9249924 extension 89040
Betsy, Spinal Nurse Specialist: 07812279918
Children’s Physiotherapy Team: 0115 8493326
We asked for advice from young people who had just had surgery for AIS, they said:
“It’s over before you know it, the pain is not as bad as you’d expect, everyone helps and understands you, try and get moving as much as you can!”
“Have a mindset to deal with the pain. Drink lots, get out of bed quickly and sit up as much as possible. Do your deep breathing exercises often”
“Move as much as you can to help recovery. Ask if you need help”
“Some days are going to be hard, it doesn’t last. Drink lots, distract yourself and move whenever you can”
You can also find lots of helpful information on the website of Scoliosis Support and Research. They help people affected by Scoliosis by:
We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS):
Freephone: 0800 183 0204
From abroad: +44 115 924 9924 ext 85412 or 82301
Deaf and hard of hearing: text 07812 270003
E-mail: pals@nuh.nhs.uk
Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614,
Nottingham NG7 1BR
You can also visit www.nuh.nhs.uk/howwedid to leave patient, family or carer feedback.
If you require a full list of references for this leaflet please email patientinformation@nuh.nhs.uk
The Trust endeavours to ensure that the information given here is accurate and impartial.