Surgery

Help you to prepare for your consent clinic appointment by explaining key details about the surgery to give you time to review before your appointment.

Why? Your treating surgeon will go through all the information in clinic during the consent process. It can be a lot of information to take in if you’re hearing it for the first time. We recommend you look at the information below to prepare and write down any questions to ask at the appointment.

It will cover:

• Video: Introduction to surgery from a spinal surgeon

• Information on surgery and the benefits and risks

• Spinal cord monitoring during surgery

• Surgery performed from the front: Anterior approach

Surgery is typically offered when scoliosis has a Cobb angle of 50 degrees or more, to prevent the curve worsening in adulthood.

This helps avoid pain, heart or lung issues later in life. If you’re still growing, scoliosis may worsen faster.

Surgery improves the shape of your back but doesn’t usually make it completely straight. Some people are still unhappy with how their back looks afterward. Back pain may or may not improve and could be worse after surgery.

Surgery is under general anaesthetic and includes spinal cord monitoring.

Once you’re asleep and the monitors are in place, you're turned onto your tummy. The surgery usually involves a long cut down the back. (Anterior approach is described later.)

Muscles are moved off the spine to insert screws, hooks, or bands. Joints may be removed to allow flexibility. Screws are attached to rods that straighten and stabilise the spine.

The outer bone surface is removed so new bone can grow across the operated areas — this is called spinal fusion.

From 2am

• No food. Clear fluids (water) only allowed.

7:30am–8:15am

• Surgical/anaesthetic teams visit you

• Nurses perform final checks

8:15am–9am

• Theatre team collects you

• You walk or are taken on a trolley

• Anaesthetist meets you in anaesthetic room

9am–11am

• You are given anaesthetic

• Drips and monitors (including spinal monitoring) are attached

• A catheter is inserted while you are asleep

10:30am–11:30am

• Surgery begins (typically 4–6 hours)

• You are lying face down; red pressure marks may appear temporarily on your front

Early evening

• You wake up in theatre or recovery

• Neurological checks are done

• Pain is managed

• Family may visit once safe

Later evening

• You return to the ward when stable

• You may eat/drink light food

• You can move in bed

Overnight

• Nurses check on you hourly

• A medical team member visits

Visit the Royal College of Anaesthetists website for child-friendly info:

• General Anaesthetic – A brief guide for young people

• “Rees Bear has an anaesthetic” – story for younger children
  https://www.rcoa.ac.uk/patients/patient-information-resources/information-children-parents-carers

Intraoperative NeuroMonitoring (IONM) ensures your spinal cord is working well during surgery. It helps prevent complications like paralysis by detecting changes early.

Signals from your body are measured (e.g. SSEPs and MEPs):

• SSEPs: Feelings

• MEPs: Muscle movement

Performed by specially trained Clinical Physiologists or Scientists.

Before surgery:

• Wash your hair, no product

• Don’t use moisturiser

• Put long hair into two low plaits

On surgery day:

• Electrodes placed on scalp, arms, legs, etc.

• You’re asleep, so you won’t feel them

Benefits

• Early detection of spinal cord problems

• Reduced risk of paralysis or weakness

Risks

• Bite to tongue/mouth from MEP stimulation

• Rare seizure or heart rhythm changes

• Temporary hair loss from scalp electrodes

• Rare risk of nerve injury or infection from electrodes

• Used if the curve is large or as a single-stage correction

• Fewer spinal levels are fused

• Cut is on the left side, along rib and into abdomen

• Chest drain used for 1–2 days after surgery

Most people are happy with the results, but some complications can occur:

General risks (1–5%):

• Reoperation in up to 5% of cases (within 10 years)

• ~80–100 surgeries are performed annually at NUH

Medical complications

• Urine/chest infections

• Rare kidney or heart damage

Ileus (bowel slowdown)

• Can cause bloating, vomiting

• Usually improves over days

Blood clots

• DVT: <0.01%

• Pulmonary embolism: ~0.03%

Infection

• 0.4–1%

• Can require antibiotics, further surgery, or removal of metalwork

Bleeding

• Can be significant; managed with cell salvage

• Rare risk of epidural haematoma and paralysis

Nerve injury

• 0.3% (3 in 1000)

• May cause leg pain, weakness or numbness

CSF leak/dural tear

• 0.2% (1 in 500)

• May require additional surgery

Lateral cutaneous femoral nerve injury

• 1 in 4 affected temporarily

• Usually resolves, may need pain relief

Metalwork issues

• Malposition (5–12%)

• Rare need for revision surgery (0.35%)

Damage to other organs

• Bowel, lungs, vessels

• Can cause life-threatening bleeding or require drains

Non-union

• ~1%

• May cause pain or require further surgery

Add-on phenomenon

• 1 in 8 may need extended fusion

• Benefits: shorter initial fusion in most cases

Back pain

• May persist or worsen for some patients

Shoulder imbalance

• Often improves post-op, with physio

Proximal Junctional Kyphosis (PJK)

• May cause forward bending at top of spine

• Rarely leads to paralysis; emergency surgery may be needed

Blindness

• <0.02% risk

• Eyes are protected and checked during surgery

Risk to life

• 0.01–0.18% (1 to 18 in 10,000)

• Due to bleeding, infection, or complications

Paralysis

• ~0.1–0.11% (1 in 850–1000)

• Due to spinal cord injury or loss of blood flow

• Wake-up tests may be used to check spinal cord function

• In worst cases, patient may be permanently paralysed

You will speak with your consultant before surgery. Bring questions.

This information is not meant to discourage surgery, but to ensure full understanding before giving consent.