Scoliosis Surgery: Preparation Steps and Surgical Risks

• Most patients are permitted to exercise to 'tolerance'. Preoperative conditioning will help speed postoperative recovery.
  
• Patients who smoke must stop as smoking interferes with fusion and increases the risk of anesthesia.
  
• The patient is asked to donate their own blood (autologous) or have family members donate on their behalf (donor-designated) in many cases. The question as to how many units should be donated can be answered by your surgeon. To some extent, the decision is up to the patient / family and amounts to how much insurance you want to have to minimize the need for transfusion of blood from the blood bank.

Surgical Risks
This topic is covered not to frighten, but to provide some information about the potential risks of surgery. Keep in mind, the majority of patients who undergo surgery do so without serious complications. Several potential problems are outlined below.

Neurological risk: The risk of injury to the spinal cord or nerves is very small; less than 0.5% in most cases. This risk is minimized by using spinal cord monitoring during surgery. A specialist continuously observes electrical signals in the spinal cord and nerves during surgery and reports changes to the surgeon. Spinal cord monitoring also allows the surgeon to assess how much curvature correction is safe. Both sensory and motor (movement) tracts of the spinal cord are monitored so that a complete picture is available to the surgeon almost instantaneously.

Bleeding: Bleeding occurs during all major surgery. However, bleeding is kept to a minimum by careful surgical technique and hypotensive anesthesia (low blood pressure anesthesia technique). Blood pressure is lowered but kept in a safe range for the patient. Cell saver is used to collect blood in the operative field, filter and wash it, and then immediately return it to the patient. If the patient donates blood before the surgery, they are unlikely to receive a blood transfusion from the community blood bank in most cases.

Infection: The risk of a wound infection is low. Antibiotics are given before, during and after surgery to minimize this risk. If an infection does develop, it might require an operative procedure to cleanse the wound followed by a period of antibiotics given intravenously and / or orally.

Instrumentation problems: The risk of an implant becoming loose or breaking is low. If such a problem developed, a relatively small procedure could be performed to revise the instrumentation.

Blood clots: Blood clots are uncommon after spine surgery. The concern about blood clots is their potential to dislodge and move to the lungs blocking normal oxygenation of the blood stream. Special stockings (TED stockings, Thrombo-Embolic Deterrent) and compression wraps are worn by the patient in the hospital to reduce the risk. Mobilizing the patient out of bed and having them exercise their legs when in bed and out also lowers this risk.

Anesthesia complications: The anesthesiologist speaks to the patient about their personal risk the day of surgery. If the patient has a significant medical condition, they will meet with the anesthesiologist before the surgery date.