By the four-week mark, she felt well enough to start easing back into school. Background: Adolescent idiopathic scoliosis (AIS) is the most common form of idiopathic scoliosis, and surgery is considered as one of the therapeutic options. Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. What are some problems I can expect in the first few weeks after surgery? Will I require a blood transfusion as a result of the surgery? You can sleep in a regular bed. … Is it possible to get my own blood back if I need a blood transfusion? Top things to know 1. After meeting with Dr. Sponseller, Maggie’s parents made the decision that it would be best to move forward with the surgery he suggested. When can I return to my sports, dance and other physical activities? A healthy spine provides the main support for the body, allowing a person to stand and sit upright, walk, bend, and twist. This condition results in higher incidence of back pain and discontent with body image. However, be sure to discuss this with your surgeon prior to surgery. Severe scoliosis can be disabling. There are no restrictions to how you lie down after surgery. However, with modern anesthetic techniques and monitoring, you do not need to worry about waking up during the surgery by accident. Scoliosis screening is designed to identify adolescents with abnormal spinal curvature. You will wake up with this catheter in place. Your surgical staff and the nurses will work on activities and medicines that will help with your bowel movement. The thoracic pedicle screws were placed using a tap 1 mm smaller than the screw diameter and a straightforward trajectory that runs parallel to the superior endplate. Don’t forget the chargers! Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. Unfortunately, this means we are unable to accept phone calls to schedule COVID-19 vaccinations at this time. affecting children between ages 10 to 18; it’s found in as many as 4 in 100 adolescents Adolescent idiopathic scoliosis, also called AIS, is a condition that affects children between the age of 10 and young adulthood and is characterized by the presence of an abnormal curve of the spine to the right or the left in the shape of an S or a C. Adolescents with scoliosis are generally healthy. How can I make my scar as minimal as possible? Yes, in fact, there are two ways to get your own blood back. Afterwards, you will go to the bathroom the same way you always do, either using the toilet or a bed pan. Researchers discovered a gene that is believed to be associated with adolescent idiopathic scoliosis only a few years ago. Once all of the pedicle screws are in position, the spine is derotated, correcting the rotational deformity caused by scoliosis. However, your surgeon will ultimately decide if physical therapy may be of benefit to you after you leave the hospital. Adolescent Idiopathic Scoliosis Surgery in New Jersey. We retrospectively investigated 63 patients, who underwent posterior spinal surgery for AIS from January 2015 to January 2018. Web: www.srs.org, © 2021 Scoliosis Research Society. Most surgeons use specific protocols with a variety of medicines to control your pain after the surgery. Spine implants rarely set off metal detectors. Most cases of idiopathic scoliosis occur between age 10 and the time a child is fully grown. The majority of individuals with adolescent idiopathic scoliosis (AIS) do not need surgery but rather are observed (monitored over time) or braced. Adolescent idiopathic scoliosis has no clear causal agent, and is generally believed to be multifactorial. Doctor’s notes or implant cards do not change the need for a secondary screen and are not necessary for travel. Maggie was given a dose that was calculated according to her weight and had a button to push to give herself an extra dose of pain medication as needed. If you smoke, or if family members smoke inside the house, ask your doctor about methods to try to quit smoking well in advance of any scheduled operations. Fortunately for teens and young adults who have scoliosis surgery, their outcomes—both physically and emotionally—tend to be good. Maggie also started taking a stool softener and laxative, as the narcotic leads to constipation. The risks of surgery should be substantiated by a body of scientific research, which should show a clear superiority of surgery over observation, both in the short term and the long term. Many parents have said that reading to your child, even an older child, is a great way to entertain a child who may not feel like doing anything active. Meet Maggie. Should I take my regular medications before surgery? She was able to ride in a car with the support of an extra pillow for comfort, so along with her parents, she made the hour trip to her home in Pennsylvania. Have a positive attitude towards your upcoming surgery. A computerized delivery system is used, allowing the medication to be given as a slow, constant drip. Adolescent Idiopathic Scoliosis Discharge Instructions. Maggie was scheduled for a preoperative visit, during which time new X-rays were taken. Some surgeons may discuss taking medications such as iron to help rebuild red blood cells after surgery. This form of scoliosis affects girls more than boys. Betz RR, Bunnell WP, Lambrecht-Mulier E, MacEwen GD. Surgical intervention for adolescent idiopathic scoliosis (AIS) should be proven to alter the natural history without introducing iatrogenic complications. She was breathing on her own with stable vital signs and didn’t need to spend any time in the intensive care unit. However, the typical surgery for idiopathic scoliosis is a posterior spinal fusion. In adolescent idiopathic scoliosis (AIS), the cause is unknown. Who will be in the operating room with me? Many surgeons utilize a technology called cell-salvage where blood that is lost is collected into a special system that cleans and concentrates the red blood cells. There are many theories as to why this type of scoliosis develops, but the root of the condition has yet to be discovered. The treatment chosen for idiopathic adolescent scoliosis will very much depend on the severity of the curve and how far along the child is in skeletal maturity. No, the metal implant does not rust and is not subject to rejection by the body. Adolescent idiopathic scoliosis affects children between 10 and 18 years old. Surgery; Treatment for idiopathic scoliosis also depends upon the severity of the curvature, the spine's potential for further growth, and the risk that the curvature will progress. This is to see if your scoliosis is worsening. Although it can develop in toddlers and young children, idiopathic scoliosis … 1 – 3 Although only 10% of patients require surgery, spinal instrumentation and fusion for adolescent idiopathic scoliosis is the most common procedure done in pediatric orthopaedics. There are several different types of scoliosis that affect children and adolescents. I am able to hike, play sports, swim and do lots of other things without pain! The catheter is usually removed 1-2 days after your surgery. Your surgeon may want you to avoid taking aspirin and similar medications such as ibuprofen and naproxen for a few days before surgery, as these can act as blood thinners and increase bleeding during surgery. She was only 11 at the time. International Journal of Spine Surgery … A physical therapist visited Maggie the day after surgery to help her learn the basics of moving in a way that avoided pain. Now I don’t hurt when I run or play. Even if you were braced prior to surgery, modern implants do not require brace support. Adolescent idiopathic scoliosis effects just over 2% of females aged 12–14 years. Adolescent Idiopathic Scoliosis - case report of a patient with clinical deterioration after surgery Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological … Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis (over 80% of cases) that has no clear causal agent. While in the hospital, you will get daily physical therapy to help you get up and around. There is usually no need for a brace after surgery. Avoid contact with sick people if at all possible. Yes. They were home with Maggie for the next four weeks, helping her through this phase of recovery. Surgery for Adolescent Idiopathic Scoliosis FAQs, General Spinal Deformity & Scoliosis FAQs, Pediatric Orthopaedic Society of North America, SRS Adolescent Idiopathic Scoliosis Handbook, Presence of increased or decreased kyphosis, Pain (rare in adolescents, more common in adults). In those situations, your surgical team may recommend delaying surgery to avoid complications during and after surgery. Akazawa T, Minami S, Kotani T, et al. It doesn’t hurt to take out, but does feel funny. J Bone Joint Surg Am 1987; 69:90. (Or will my waist, back and shoulders be perfect even after surgery?). Diet: High fiber and high protein- encourage small frequent meals with plenty of hydration. If your surgical team determines that you are very anemic as a result of the bleeding during surgery, you may be given a blood transfusion to prevent side effects of the anemia. Maggie stayed in her hospital bed and was taken to the 10th floor, where she stayed for the next three nights in the adolescent medical-surgical nursing unit. Her surgery took 4 ½ hours, and when she opened her eyes again, mom and dad were the first people she saw. To avoid getting too far behind, many schools offer a home tutor that can help you keep up with your studies. The deformity occurs with rotational misalignment, often marked by a hump in the ribs or low back, as well as loss of the normal sagittal curves of the spine: Adolescent. The personnel usually includes: your surgeon and their assistant(s) to perform the actual surgery, an anesthesiologist to put you to sleep and monitor you during the surgery, a scrub tech to hand instruments to the surgeon, circulating nurses to ensure everything is running smoothly, a radiology technician to run imaging machines like fluoroscopy and x-rays, and, typically, a neurophysiologist to monitor the spinal cord during the procedure. However, the only people who will be performing the actual surgery are your surgeon(s) and their assistants. Physical therapy is needed while in the hospital. When you get home, we encourage you to be as active as possible while maintaining comfort. The diagnosis is made in adolescence. With this procedure, implants will be attached to your back bones (usually screws and/ or hooks) and then a rod is connected to these implants to move the spine … Yes. Slippers with soles that grip help with walking around on the hospital floors. Even though you will not have eaten for many hours by the time your surgery is over, it is unlikely that you will feel hungry right away. However, the typical surgery for idiopathic scoliosis is a posterior spinal fusion. Retrospective analysis of outcome in terms of incidence of surgery for adolescent idiopathic scoliosis during a period when bracing was not practiced. Adolescent Idiopathic Scoliosis. Fax: 414.276.3349 Can I shower when I go home from the hospital? You will be in the hospital for a few days, and being prepared will make it a little easier. Stool softening medications are usually prescribed to prevent the constipation that results from the surgery and the use of pain medication. Afterwards, parents are typically required to leave and do not watch the surgery. However, check with your surgeon for specifics. Scarring is a major concern for most patients. Button-down shirts and loose-fitting clothing are comfortable and easy to put on, as raising your hands over your head may be painful for a little while after surgery. Finally, any medicines you were taking before the surgery will be continued. Then she stood and took a couple of steps to a bedside chair. Clinical outcomes of patients with adolescent idiopathic scoliosis (AIS) who have undergone surgery during adolescence—defined as <18 years of age—is well researched.It is generally believed that clinical outcomes differ when correction surgery … Adolescent idiopathic scoliosis is a common disease entity facing spinal surgeons who treat pediatric patients. In adolescent idiopathic scoliosis (AIS), the cause is unknown. It is defined as a lateral curvature of the spine greater than 10 degrees … She asked Maggie to reach for her toes and noticed that when she did, the right side of her rib cage was very prominent. Some of the theories include . The nurses used interventions like oxygen, adjusted dosing of pain medication and comfort measures to help Maggie through her first few days of recovery. Will I be able to go up and down stairs at home? Objective: ... For the spinal surgeon, idiopathic scoliosis is one of the most frequent presentations of spinal deformity in the paediatric clinic. Email: info@srs.org However, it is associated with a variety of irreversible complications, in spite of the benefits it provides. The thoracic pedicle screws were placed using a tap 1 mm … You can feel free to bring your own hygiene products in anticipation of this happening. Some people simply heal with fainter scars than others. Surgery for Adolescent Idiopathic Scoliosis Host: Clinical Nurse Manager, Jennifer Bowden, R.N. Please ask your surgeon and nurses about your specific pain management protocol. For a child with severe adolescent idiopathic scoliosis, a posterior spinal fusion with instrumentation is the most common surgery performed by the Department of Orthopaedic Surgery’s highly specialized pediatric spine surgeons. POORIA HOSSEINI, ALLEN CARL, MICHAEL GREVITT, COLIN NNADI, MARTIN REPKO, DENNIS G. CRANDALL, UFUK AYDINLI, ĽUBOŠ REHÁK, MARTIN ZABKA, STEVEN SEME and BEHROOZ A. AKBARNIA. The aetiopathogensis of this disorder remains unknown, with misinformation about its natural history. This type of scoliosis typically presents during adolescence, but it can also start earlier in childhood or infancy. Adolescent idiopathic scoliosis, also called AIS, is a condition that affects children between the age of 10 and young adulthood and is characterized by the presence of an abnormal curve of the spine to the right or the left in the shape of an S or a C. Adolescents with scoliosis are generally healthy. Before the surgery it was hard for me to walk or stand for long periods of time. Jennifer knew it must be scoliosis. She had a discussion with nurse practitioner Kristen Venuti and asked Dr. Sponseller some follow-up questions. This bright, articulate 12-year-old is active in soccer and swimming, and she loves school and hanging out with her friends. Deciding on this course of action was the best thing we could have done for Maggie. A visit to Johns Hopkins pediatric spine surgeon Paul Sponseller confirmed the diagnosis of adolescent idiopathic scoliosis. Hospital to Home: Generally 3-4 days. When it comes to Adolescent Idiopathic Scoliosis surgery, New Jersey spine surgeon Dr. Joshua Rovner has the comprehensive experience patients trust. The first three to four days of recovery from scoliosis surgery are spent in the hospital. However, you should talk to your surgeon for specific timelines on a return to sports and physical activities. In fact, the appearance of scars after surgery have more to do with the patient’s own healing than the surgeon closing the wound. The most common approach to adolescent idiopathic scoliosis is the posterior (back) approach. She was tired and sat in her chair for an hour before it was time to get back in bed. The reason for th Patients taking narcotics for a short period of time post-operatively are unlikely to become addicted. (OBQ14.38) A 16-year-old female with adolescent idiopathic scoliosis undergoes posterior spinal fusion with instrumentation. Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. Scoliosis and pregnancy. The time in the hospital is influenced by the length of the surgery, patient mobility and comfort and hospital practices. By following these tips, you will set yourself up for a successful outcome after surgery. There are also commercially available scar products but there is no proof that these are any better than simply keeping the scar moisturized and out of direct sunlight. Abstract: Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine consisting of a lateral curvature, apical vertebral rotation, and an impairment of the sagittal profile. Maggie then spent an hour in the pediatric postanethesia care unit, where her vital signs were monitored and her pain was addressed. Terms of Use. If a child is still growing, a scoliosis curve can worsen rapidly during a growth spurt. Marc A. Asher and Douglas C. Burton Maggie was cared for around the clock by a staff of highly trained pediatric registered nurses. At 6 weeks after surgery, backpacks are usually not an issue. Scoliosis surgery should not impact fertility, the ability to carry a baby safely to term or the ability to deliver a baby vaginally or by C-section. All Rights Reserved Download PDF. Children with severe scoliosis… Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. Additionally, some surgeons recommend a special skin wash before surgery to minimize the risk of infection. She started with half days and then quickly felt energetic enough to return to a full day of school by six weeks after her operation. Maggie felt strong enough to get out of the house for visits with friends and to do a little shopping. Read more COVID-19 Vaccine Information, Patient Care Options | Visitor Guidelines | Coronavirus Information | Self-Checker | Get Email Alerts. Each vertebra has a strong strut of bone on either side called a pedicle, where 2-inch screws made of titanium are placed. What is adolescent idiopathic scoliosis? It affects more teenage (thus the term “adolescent”) girls than boys (about 70% of the time), and their curves tend to be more progressive. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Pain management after surgery is a very important aspect of recovery after surgery and your surgical team places a lot of emphasis on making sure you are comfortable after surgery. Steps include pedicle screw placement using real-time X-ray (fluoroscopy) for guidance and continuous monitoring of the activity of the spinal cord. Phone: 414.289.9107 Scoliosis is a complex three-dimensional deformity of the spine, which occurs primarily in growing children and adolescents. Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. Younger children: Boys are affected slightly more than girls and the curve is often left-sided. Adolescent idiopathic scoliosis (AIS) is a deformity of the spine deformity that develops without a known cause in an adolescent, generally aged 11 to 18. A specialist called a neurophysicist is in charge of interpreting the spinal cord monitoring and alerting the surgeon of any changes. The prevalence of severe curves (>30) is much lower, approximately 0.03%. We didn’t really doubt the need for surgery, but of course we were nervous. As Maggie’s parents, we wanted the best for our daughter. Please notify your surgeon if you feel ill before your surgery. Discuss any questions you may have about your surgery with your surgical team. Even a common cold can affect your recovery after surgery. No. Surgical options include anterior and posterior approaches. The first week at home, Maggie faced challenges with decreased appetite and constipation — common side effects of narcotic pain medication. For more details, please read the. Does smoking interfere with bone healing? Do I need to do anything special before my surgery? The significant growth she had ahead of her was sure to lead to further worsening of this deformity if left untreated. Adolescent idiopathic scoliosis (AIS) is a progressive growth disease with unknown etiology, characterized by a three-dimensional deformity of the spine (frontal translation, sagittal modification, and torsion of the spinous processes on the concave side of the scoliotic curve on radiographs). You should talk to your surgeon about specific restrictions. Adolescent idiopathic scoliosis (AIS) affects 1–3% of children in the at-risk population of those aged 10–16 years. We truly believe she had been living in pain and had accepted it as “normal.”  She didn’t know how bad she hurt until she didn’t hurt anymore! This is the name given to a scoliosis which starts after the age of 10 years in an otherwise healthy person and has no obvious cause. Most curves can be treated without surgery if detected before becoming too severe. Shoulder asymmetry is less predictable, but usually improves as well. The rods made of cobalt chrome are then threaded through the screws, and the screws are locked down. Download PDF. Activity: Encourage getting moving. When considering only large curves, females are ten times more commonly affected than males, but the ratio is closer to 1:1 for cases with smaller curves. You may want some extra pillows to help support you. An X-ray was done in the office, showing Maggie’s spine had curved severely, to 72 degrees. In most practices, plastic surgeons are only used in complex cases where there is concern about getting the wound closed. Many surgeons suggest not carrying or lifting anything more than 10 pounds for the first few weeks after scoliosis surgery. To determine whether centers with an active bracing policy have lower numbers undergoing surgery for adolescent idiopathic scoliosis than a center where nonintervention is the practice. You can try to arrange your last dose of pain medicine in the hospital to be about 20-30 minutes before you take the ride home. Instead of growing straight, the spine develops a side-to-side curvature, usually in an elongated "S" or "C" shape; the bones of the spine are also slightly twisted or rotated.. Adolescent idiopathic scoliosis appears during the adolescent … How will the rods affect my spine's mobility and my activities? How will I go to the bathroom after my surgery? What factors influence the recommendation for surgery? You can check to see if your surgeon is a member of the Scoliosis Research Society (SRS) by going to the Find a Specialist tool. Maggie learned how to logroll and sit up in bed. Spine (Phila Pa 1976) 2012; 37:402. Maggie’s mom called the Johns Hopkins staff for advice; laxatives, time and more walking did the trick. When will I be able to go back to school? Information was provided to us before, during, and after surgery. Surgery for Adolescent Idiopathic Scoliosis: Maggie's Story, Learn more about scoliosis in our Health Library, Visit the Setting Scoliosis Straight website. Radiation Exposure in Scoliosis; Scoliosis Surgery Techniques; Kyphosis; Spondylolysis; For Adolescents; For Adults ; Juvenile Idiopathic Scoliosis. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Maggie felt well enough after three nights in the hospital to be discharged to home and was excited to get back to her own room. What should I bring with me to the hospital? Now, all she had to do was wait two weeks for her surgery date. The patients were divided into the following groups: Groups A (drainage group) and B (nondrainage group). Her parents brought the school’s form for homebound instruction and their own FMLA paperwork to be signed. Maggie was scheduled to have a posterior spinal fusion with instrumentation in February 2014. Preservation of Spine Motion in the Surgical Treatment of Adolescent Idiopathic Scoliosis Using an Innovative Apical Fusion Technique: A 2-Year Follow-Up Pilot Study. Pain symptoms or neurological deficits should alert the surgeon to other diagnoses. This is when the spine will curve sideways … While not as common as cell-salvage, particularly in children, this technique has patients donating their blood several weeks prior to surgery and then get the blood back, if needed, during or after their surgery. Study design: Retrospective analysis of outcome in terms of incidence of surgery for adolescent idiopathic scoliosis during a period when bracing was not practiced. However, the pain generally improves over several days and can be managed with a variety of medications. Rihn JA(1), Lee JY, Ward WT. Below are the highlights from this episode: What are the different treatment options for adolescent idiopathic scoliosis (AIS)? In addition to questions about the surgery’s potential benefits, risks, and recovery period, it is normal to wonder what life will be like in the years afterward. When you return to school, it may be easiest to do half-days for the first few days so you can ease back into a normal schedule. Lips and skin can get dry after surgery, so lip balm and skin cream can be very helpful in maintaining comfort. Smoking has been found to delay healing of tissues, including bones. Can a metal implant (spinal instrumentation) rust or be rejected? Adolescent idiopathic scoliosis is the most common type of idiopathic scoliosis and the most common type of scoliosis overall. Surgery is recommended in adolescents with a curve that has a Cobb angle greater than 45°-50°. MRIs are safe with the traditional spine implants used during scoliosis surgery. Objectives: To determine whether centers with an active bracing policy have lower numbers undergoing surgery for adolescent idiopathic scoliosis … What causes idiopathic scoliosis is currently unknown. Anterior instrumented fusion is suitable in Lenke type 1 and 5 curves. As one of the states leading destinations for spine surgery in NJ, Adolescent Idiopathic Scoliosis is a spinal condition that Dr. Rovner and his advanced surgical team treats. Before making a decision about having surgery for adolescent idiopathic scoliosis, it is common for patients (and their parents) to have concerns and questions about what a spinal fusion might entail. These adhesive stitches fall off on their own, after the skin has knit itself back together. What if I am having my period at the time of surgery? If they do, you will be required to undergo a second screen according to TSA regulations. While most patients do not require a blood transfusion as a result of their surgery, a few patients will. When should I screen patients for adolescent idiopathic scoliosis (AIS)? The nurses monitored the movement and feeling in her legs, her pain and other vital signs, her digestion, and the surgical site. Each day brought more energy and a decrease in pain. Milwaukee, WI 53202 The second day after surgery, Maggie worked with the physical therapist again, this time walking in the hall. 1-3 However, it is a major surgery and a big … The best information about your specific condition typically comes directly from your surgeon. We are so pleased with the care and treatment she received at Hopkins! A second option is called auto-transfusion. Adolescent idiopathic scoliosis, also called AIS, is a condition that affects children between the age of 10 and young adulthood and is characterized by the presence of an abnormal curve of the spine to the right or the left in the shape of an S or a C. Adolescents with scoliosis … However, if your lower lumbar spine has been fused as part of your scoliosis surgery, it may not be possible to place an epidural catheter for pain control during delivery. There will be hours of rest following surgery, so be sure to bring things to keep you occupied. We are experiencing extremely high call volume related to COVID-19 vaccine interest. Sitting in a seat that reclines with lots of pillows can be very helpful. To prepare for her surgery, Maggie started taking an iron supplement a month before surgery. Expert … It also found fair evidence that treating adolescent idiopathic scoliosis decreases pain and disability in only a small proportion of patients, and that treatment of adolescent idiopathic scoliosis detected through screening leads to moderate harms (e.g., unnecessary use of braces and refer… Maggie’s parents learned how to recognize pain, give her pain medication, and provide assistance with mobility and other activities of daily living. Adolescent Idiopathic Scoliosis (AIS) is an abnormal curvature of the spine exceeding 10 degrees, diagnosed in adolescence and in which the cause is unknown. Do I need a plastic surgeon to close my incision? It takes a lot of people to perform spine surgery safely. Check with your surgeon to see if any medications or tests are advised prior to surgery. If you have stairs at home, therapy will work with you on stairs in the hospital. 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