The spine surgeon, including his or her staff, will guide the patient through the process of preparing for scoliosis surgery. For example, the patient will be required to obtain 'medical clearance' from their primary care physician or pediatrician. This is required by the hospital to admit the patient for surgery.
X-rays: PA (posterior-anterior, back-front), lateral (side), bending x-rays are almost always required. Some patients with kyphosis will require hyperextension views (e.g. extended backward).
MRI: Most adult patients require an MRI so the surgeon can visualize the lumbar (low back) discs. Patients with congenital scoliosis, under age 10, unusual curve patterns, rapidly worsening curvature, severe back pain, neurofibromatosis (nerve tumors), or other tumors are sent for MRI.
Myelogram and CAT Scan: These tests tell the surgeon much about the patient's nerves, spinal cord and bones using dye to outline the nerve structures.
Renal Sonogram: Patients with congenital scoliosis have up to a 25-30% incidence of kidney or urological abnormality. It is important to check renal function before surgery.
Echocardiogram: This test uses ultrasound to examine the heart. It is required in patients with congenital scoliosis (up to 10% of these patients have congenital heart abnormalities), those with Marfan's syndrome (connective tissue disease), and patients with a history of heart disease.
Other Tests: Some patients will need an ophthalmological evaluation. Specifically, patients with Marfan's syndrome need a slit lamp examination to examine the interior of the eyes in which lens abnormalities may be found under magnification. Genetic testing may be necessary for patients with other syndromes. The patient's primary care physician or pediatrician may also order tests.
Part of preparing for scoliosis surgery is being aware of the risks involved in surgery. 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.