Your child has been scheduled for surgery to treat their scoliosis. The information on this page describes what a child may experience at home and while in hospital prior to scoliosis surgery.
Generally, there are several steps that need to be taken before surgery can happen. A nurse will review all of these steps with your child in a teaching session. During the teaching session, the nurse will outline what will happen during your child’s hospital stay and how your child can prepare themselves physically for surgery.
About scoliosis surgery
Your child is having surgery to correct or improve the curve in their spine and to keep the curve from getting bigger. Your child’s surgeon will already have discussed the reasons for your child’s surgery, and the benefits and risks of having surgery with you and your child in detail.
Things to avoid before surgery
Hormone-based birth control
Hormone-based birth control comes in many forms and is used for many different reasons. Hormone-based birth control will need to be stopped before surgery to prevent blood clots.
- If a hormone-based oral/topical patch/contraceptive ring is being taken (e.g., for acne, period regulation, or birth control), it will need to be stopped at least one month before surgery to prevent blood clots.
- If a hormone-based intra-uterine device (IUD) or contraceptive injection is being used/taken (e.g., for period regulation, PCOS management, or birth control), it will need to be removed or discontinued. It is very important you inform the nurse if your using any of these methods of birth control.
- After surgery, once your child has been discharged from the hospital, they will need to wait until their next complete menstrual cycle finishes before resuming hormone-based birth control.
Nicotine cigarettes, marijuana cigarettes, vaping and second-hand smoke
Teenagers who engage in smoking cigarettes or vaping will need to stop prior to surgery and avoid second-hand smoke for up to one year after surgery to ensure the bones in their spinal column heal in a straight position.
- Smoking may keep the bones and hardware from fully fusing after surgery. This is called mal-union. If this happens, your child may need more surgeries.
- Smoking also can slow down wound healing, which can increase your child’s risk for infection after surgery.
- If your child has stopped smoking or vaping in preparation for surgery but uses nicotine replacements (gum or patch), let the nurse know. These therapies can continue after surgery.
- For more information on helping your child quit, see The Substance Abuse Program at the Hospital for Sick Children.
Alcohol and drugs
Alcohol and drugs can react badly with your child’s anaesthetic and other medication while in hospital. It is important to let the nurse and anaesthesia team know if this is a concern for your child.
- For more information on helping your child with substance abuse, see Substance use disorder: How to help your teen at home.
Infections
It is very important your child is healthy before surgery. Your child should avoid being around anyone who is sick with something contagious like the flu. If your child is sick or has an infection close to the surgery, you should call your surgeon’s office to notify them. If your child is sick on the day of surgery, the surgery may be delayed until your child has recovered. It is also important your child avoids getting any tattoos or piercings before surgery because of the risk of infection.
Constipation
If your child is easily constipated, they may want to increase their water intake, take prune juice or over-the-counter polyethylene glycol (PEG 3350) the week before surgery. Constipation can be experienced after scoliosis surgery because of the spine’s new, straighter positioning, the duration of the surgery and as a side effect of certain medications, such as some pain medicines. Ensuring that their bowels are empty when they go in for surgery will help your child avoid constipation.
If you are unsure if your child may have constipation, below are some indicators:
- Your child strains when passing stool
- Passing stool is painful
- Streaks of blood or mucus are seen when wiping
Your child may also ask their nurse during the teaching session teaching about how to alleviate constipation.
Herbal medications
It is recommended that all herbal medication be stopped between 4-6 weeks prior to elective surgery. If you have any questions about the herbal medications your child may be taking, you can always ask the orthopaedic clinic nurses or the pre-anaesthesia clinic team when you see them.
Tests before surgery
Your child will need certain tests before surgery:
- Spinal X-rays: The surgeon requires current spinal X-rays to plan their surgical approach. This will help them reassess the scoliosis and determine the placement of the hardware.
- Clinical photos: Some surgeons like to have before and after photos taken. This will help your child and their surgeon to see the changes that take place to the shape of your child’s body after surgery.
- Blood work: Some basic blood work is required so that the surgeon knows your child’s blood type, iron and hemoglobin levels. Hemoglobin is a protein in the red blood cells that carries oxygen. Knowing these levels before surgery will help the surgery and anaesthesia team ensure your child’s spinal cord is safe and getting enough oxygen-rich blood during your child’s surgery. Some additional blood work may be required that is specific to your child. The nurse will let you know if this is the case for you child during the teaching session.
Additional tests
- Pulmonary function testing: This test looks at how well your child’s lungs are working. Depending on the size of their curve, your child’s lung function may be affected. Generally, this happens with very large curves only. Some surgeons and/or anaesthetists may request this test to be completed before surgery to measure your child’s lung function. After surgery, depending on the results, a repeat test is recommended a few months later. Your child’s health-care team will inform you if this is needed for your child.
- Echocardiogram: An echocardiogram helps the surgeon and anaesthetist look at your child’s heart function and ability to circulate oxygenated blood during the surgery. This test is generally ordered for children with larger curves or for children with pre-existing heart conditions to ensure your child’s safety during surgery. This test is completed by using ultrasound imaging, and it is noninvasive and pain-free.
- Magnetic resonance imaging (MRI): This diagnostic test may be required by the surgeon to make sure there are no concerns with your child’s nerves or spinal cord before surgery. Usually, an MRI is ordered for children with larger curves or for children with other medical conditions.
- Computed tomography (CT scan): This diagnostic test is usually required for children with neuromuscular scoliosis. A CT scan helps the surgeon identify where to place hardware during surgery.
Blood transfusions
Blood may be ordered for the surgery in case your child needs it. The blood will be coming from a blood bank. Canadian Blood Services no longer uses the autologous blood donation program (where a patient’s own blood is collected before surgery) or donation from parents.
Your child may also receive cell-saver blood. This is your child’s own blood that is cleansed and given back to them to minimize blood loss.
Iron before surgery
Iron supplements are generally started on the day that your child is booked for surgery. Even if your child has a well-balanced diet and is not anaemic, the iron supplements will still have to be started to further boost their iron stores. The iron supplements will help minimize the risk of blood product exposure and contribute to better postoperative healing. You will be given a handout that has a list of different formulations of iron that your child can take. A blood conservation coordinator will follow up on your child’s blood tests and give you a call to discuss your child’s blood work and iron dosage.
Fasting before surgery
Before the scheduled time of your child’s operation, it is important to follow the NPO guidelines. Please keep in mind that any food or liquid in your child’s stomach while under anaesthesia can flow up to their mouth and pass down into their lungs, which is very dangerous for your child. Surgery may be cancelled if fasting rules are not followed.
Bathing/showering before surgery
It is important that your child bathes or showers before their surgery to prevent infection.
Your child will need to bathe/shower two times before the procedure*:
- 48 hours (2 days) before surgery
- 24 hours (1 day) before surgery
*Be sure your child uses liquid soap (any kind) and not a soap bar.
Once you arrive to the hospital, your child’s nurse will give you a package of bathing wipes to wipe your child down one last time before they put on their surgical gown.
Areas of focus for bathing wipes
A nurse will give you instructions on how to preform a pre-operative bath and provide the necessary supplies, including a special pair of pajamas and slippers to wear in surgery.
Watch this video on how to preform a pre-operative bath using wipes.
Arriving at the hospital for scoliosis surgery
- You and your child will meet a nurse at the pre-operative waiting room. Here, the nurse will do a basic assessment of your child, weigh your child, check their vital signs, assess their current level of health, and review their chart.
- You will be given a pack of wipes that you will use to wipe down your child prior to putting on their surgical gown.
- The surgeon, or a member of the surgical team, will come out to speak with you and your family.
- Your child's anaesthesiologist will come and meet with you in the waiting room before your child goes to surgery. The anaesthetist you meet is the doctor who will be monitoring your child during their surgery. If your child is very nervous, they may be given some medication that will help them relax in the waiting room. This decision will be made by the anaesthetist, yourself and your child.
- You and your child will also meet the nurse who will be looking after your child in the operating room. Once all questions have been asked and answered, your child will go to the operating room with the anaesthetist and nurse.
- Child life specialists are also available to patients and families. They are a great resource if your child is very anxious about the surgery or has a developmental disability. If helpful, a child life specialist can also speak to you before the surgery to create a pre-operative coping plan for your child.
- At this point, you may go to the waiting room. You can wait here while your child is in the operating room. The surgical waiting room is also where the surgeon will come to meet you after the procedure. Please note that you will not get updates during the surgery; you will only see the surgeon before and after the surgery.
- Your child’s surgeon may be able to give you an idea of when the surgery will be finished. If you are unable to stay in hospital, please provide the nurse with a number at which you can be reached. When the surgery is over, your child’s surgeon or a member of the surgical team will come and talk to you.
What to bring to the hospital
Before you leave home to go to the hospital, make sure your child brings the following items with them:
- Their health card.
- Any paperwork the hospital has asked for.
- Any medications your child is taking. The medications should be brought in their original container with the original label on each bottle/container.
- A toothbrush and toothpaste.
- A hairbrush.
- Soap (liquid) and deodorant.
- For females: pads, but no tampons.
- Pajamas and a housecoat. Your child will be in a hospital gown at first, but they may wear their own clothes within a few days. Make sure they pack full-brief underwear and that their clothes are easy to put on and take off, such as a large T-shirt and shorts.
- A pair of shoes that are easy to put on and have good grip.
- A favourite pillow or blanket from home.
- Books, tablets or other forms of entertainment and chargers.
- Pictures of family, friends or pets.