Following an operation for scoliosis, your child will be closely monitored by their health-care team before they are deemed ready to go home. Doctors and nurses will ask your child various questions about their pain levels, appetite, bowel and urinary function, and the sensation in their back, to ensure that your child’s spinal cord has not been injured. It is important that your child answers as many of the questions asked as possible, even if they are feeling tired or grouchy.
The recovery room
In the recovering room
Immediately after your child has surgery, they will be brought to the recovery room, also called the post anaesthetic care unit (PACU). It is normal for your child to be drowsy after the procedure.
Your child will be connected to a monitor throughout their stay in the PACU. Their vital signs will be taken every 15 minutes, and an initial head-to-toe examination, and pain and sensory/motor assessment will be completed. If applicable to your child, a patient-controlled analgesia (PCA) pump will also be set up in the recovery room. This is a computerized pump that delivers pain medication to your child through their IV line. During the surgery, a Foley catheter is placed. Your child will have the Foley catheter in their bladder for one to two days following surgery. The catheter will drain the urine from your child’s bladder so they will not need to go to the bathroom to urinate.
Visitors in the recovery room
Only one to two family members will be allowed to visit your child in the recovery room once they are awake and stable. During peak times in the PACU, only one visitor may be allowed.
Eating and drinking in the recovery room
While in the recovery room, your child will only be allowed to have some ice chips and small sips of water. Once they are moved to their hospital room, your child’s nurse will slowly help your child eat other foods. It is important to follow the nurse’s instructions regarding eating right after surgery.
Duration in the recovery room
Your child will stay in the recovery room for about one hour. They will only be transferred to another hospital room once they are stable.
The first night post-surgery
Every child who has surgery recovers differently. Some children are admitted to the intensive care unit or the constant observation room on the inpatient unit for their first night following surgery. The next day, they may then be transferred to the room where they will stay for the rest of their time in hospital. Others may go to their hospital room directly after surgery.
If your child is not sent directly to their hospital room, they will be admitted to the intensive care unit or placed in the constant observation room for their first night after surgery. The constant observation room is usually shared with 6 other patients. Due to limited space, you will not be able to sleep in a cot next to your child’s bed but may sit at their bedside. Only one parent can stay with their child overnight. Your child will be assigned a nurse who will be closely monitoring them throughout the first night. Monitoring will include doing spinal cord assessments, checking your child’s vital signs, ensuring that your child’s pain is managed, and repositioning your child in their bed.
The next morning, your child will be moved to their own private room. This room will have a cot for one parent to stay overnight and a washroom with shower.
The recovery period
During your child’s recovery in the hospital, the nurse looking after them will be closely monitoring your child’s:
Pain
Pain is measured on a scale of 0 to 10, with 0 being ‘no pain’ and 10 being ‘a great amount of pain’. A nurse will ask your child to rate their pain. This helps the nurses make sure that your child is getting the right amount of pain medication. The pain team will also be involved in your child’s care; they will help ensure that your child’s pain is managed. After surgery, your child may get pain medicine through an IV via a PCA pump. Before going home, your child will need to be able to manage their pain by taking pain medication by mouth instead of through an IV.
Scoliosis and pain management
Vital signs
The nurse looking after your child will take a vital sign assessment at least every four hours throughout the day and the night while your child is in the hospital. A vital sign assessment will include your child’s heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature.
Spinal cord function and sensation
Both doctors and nurses will test your child’s nervous system. This is important to make sure there has been no injury to their spinal cord. Nurses and doctors will perform various tests to confirm that your child has sensation in their spine and other limbs:
- Touching your child with something sharp and dull while your child’s eyes are closed and asking your child if they can tell the difference between the sensations.
- Asking your child to wiggle their toes.
- Asking your child to firmly grasp the hand or finger of their nurse or doctor and squeeze hard.
- Touching your child’s toes while your child’s eyes are closed and asking them to identify which toe is being touched.
Fluid intake and output
The nurse will closely monitor everything your child drinks and eats, along with the IV fluids that they are getting. The nurse will also closely monitor how much your child is voiding. This is measured through the Foley catheter bag every hour. Once the catheter is removed, your child will be able to urinate on their own in the washroom using a toilet hat, which is a collection container that is put on the toilet for measuring.
Abdomen
The nurse will closely monitor your child’s abdomen for distension and to make sure that all your child’s bowel sounds are present. It will often take a few days before your child returns to their normal appetite after surgery.
The anaesthetic and pain medication will have made your child’s stomach and intestines move very slowly. As a result, your child may not have a bowel movement for a few days after surgery. They will likely have stomach bloating and pass a lot of gas. This is a normal response. The doctor will want to make sure that your child’s stomach and intestines are working normally again before going home. Your child’s nurse will start a bowel routine on the first day after surgery. The bowel routine involves giving your child different types of medication to help them have a bowel movement.
It is very important that your child drinks as much fluid as possible. This will prevent bladder infections and also help to prevent constipation. Getting out of bed and walking around will also help your child to pass gas, reduce bloating, and prevent constipation. Make sure that when your child takes painkillers, it is for the pain in their back and not for their abdominal discomfort. This is because painkillers can make abdominal bloating worse.
Diet
Immediately following surgery, your child can have ice chips and small sips of water as tolerated. It will take a while for their stomach and intestines to wake up from the anaesthetic.
As your child’s intestines start to "wake up”, your child will start to pass more gas and the nurse will hear louder bowel sounds when listening to their abdomen with a stethoscope. At this point, your child can gradually work up to a full diet before going home.
Back dressing
Your child will come out of surgery with a large dressing on their back incision. During your child’s stay, the dressing will be changed once. Under the dressing, there may be Steri-Strips—which look like small pieces of tape—that are placed along the incision to keep it well-aligned for healing. Or, there may be Dermabond, which looks like a clear purple glue, that is placed along the incision to keep it tightly sealed. The nurse will remove the large dressing and replace it with a much smaller one on the second day after surgery. This smaller dressing can be removed four days after surgery (two days after it has been applied).
The surgeon will use stitches to close up your child’s incision. If the stitches are internal (meaning they are under the skin), they do not need to be removed and will dissolve on their own. If the stitches are external, they will need to be removed in seven to 10 days.
The Steri-Strips tend to dry up and peel off by themselves. Sometimes, Steri-Strips will stay stuck to your child’s back. It helps to take them off after a shower, usually about a week after surgery. Make sure the Steri-Strips get wet before removing them. This is like removing a wet band-aid.
The Dermabond adhesive will lift off on its own in 10 to 14 days by itself. It is very important that you do not pick or pull the Dermabond off because it can pull the healing skin.
Breathing
Most people tend not to breathe deeply when they are in pain. However, your child should occasionally try to take deep breaths and cough during recovery to open up and clear their lungs. This will also help to keep the lower lobes of their lungs clear of fluid and fully inflated.
Positioning in bed
After surgery your child can still lie on their back. Their nurse will place a pillow or roll under your child’s knees for support. The nurse will help your child log roll to their side after surgery. A log roll involves keeping the back straight and avoiding twisting when turning from side to side or onto the back. Your child’s nurse will place a roll behind your child’s back to help keep them in this position. Your child will bend their knees and the nurse will put a pillow between your child’s legs.
Mobility
The nurse will teach your child how to safely ambulate (move) after surgery. In some cases, your child may start to ambulate or sit up in a chair as soon as they get to their room. It is important for your child to ambulate with the nurse, until the nurse assesses their ability to ambulate independently. The nurse will teach your child some techniques for getting in/out of bed, and in/out of a chair after surgery to ensure their safety.
Ambulating is done gradually, as your child may feel very dizzy and lightheaded the first time they walk or sit. This is a normal response. It takes a while for their body to adjust from lying down for several days to being upright again.
Your child will work up to short walks. Eventually, they will be able to walk longer distances, such as down the hall. Most children who have had scoliosis surgery find they feel better when they get up and move around.
Menstrual period
Most girls will get their menstrual period around the time of the surgery. This is a normal response to stress. Many girls worry about having their period while they are in the hospital when they will be unable to care for themselves like they usually do. Try to reassure your child. Their nurses are very familiar with this situation and will do everything they can to make them feel comfortable. The hospital has a supply of pads, or your child can bring their own if they want to. Your child won’t be able to use tampons while in the hospital.
Going home/discharge goals
Discharge criteria
Most children who have scoliosis surgery stay in the hospital for two to five days. There are a few things that need to happen before your child can go home:
- Your child’s pain must be well controlled with oral medication.
- If your child is on IV antibiotics, they must finish the course prior to being discharged. Some children may have a drain. Your child will usually continue on IV antibiotics as long as the drain is still in.
- Your child must be passing gas and/or have a bowel movement.
- Your child must be drinking and eating small and frequent snacks/meals.
- Your child must be able to safely ambulate and use the stairs.
- Your child may need to have a spinal X-ray taken.
- Your child may need blood work done before they go home.
- Your child’s back incision needs to be healing properly before going home.
The doctor will give your child a prescription for pain medication. It is a good idea for your child to take some before getting in the car to go home.
Some patients will need to wear a brace after their surgery. This depends on the surgeon’s preference and the type of surgery your child has had.
Helping your child at home
- Your child will not need any nursing care or physiotherapy after going home from the hospital. No special equipment at home will be needed. Specific physical activity restrictions will be discussed with you prior to leaving the hospital.
- In general, your child should not lift more than 10 pounds for one year after surgery.
- Your child should try to avoid persistent forward bending, side bending or twisting of their spine for six months after surgery.
- They should engage in no other physical activity or sports except for walking for six to 12 months after surgery – the duration is specific to your child’s surgeon.
- You will need to help your child with everyday activities when you get home, such as showering and getting dressed. Your child will slowly work towards doing everyday activities on their own.
- Make sure your child does not take any ibuprofen or aspirin-based drugs without the surgeon’s permission.
- Smoking also interferes with bone healing and should be avoided. This includes second-hand smoke.
Follow-up
Your child’s next appointment to see the surgeon will be in about two to six weeks after discharge. At this point, the surgeon may take another X-ray of your child’s spine.