Following an operation for scoliosis, your child will be closely monitored by their health-care team before they are deemed ready to go home. The team will ask your child various questions about their pain levels, appetite, bowel and urinary function, and the sensation in their back and extremities, 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 recovery 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 your child is complaining of pain, they may receive as-needed doses of intravenous (IV) pain medication, which may continue to be given on the inpatient unit. During the surgery, a Foley catheter is placed in the bladder. The catheter will drain the urine from your child’s bladder so they will not need to go to the bathroom to urinate. The catheter will remain in the bladder for approximately one day following surgery. It is typically removed 6:00 am the following day after surgery.
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 them 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.
The constant observation room is usually shared with six 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 closely monitored 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 following things will be closely monitored:
Pain
After the surgery, your child’s pain will be measured on a scale of 0 to 10, with 0 being ‘no pain’ and 10 being ‘a great amount of pain’. Your child will be asked to rate their pain. This helps the health-care team 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 by mouth or IV. Before going home, your child will need to be able to manage their pain by taking medication by mouth instead of through an IV.
Scoliosis and pain management
Vital signs
Your child will have a vital sign assessment at least every four hours throughout the day and the night while they are 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
The health-care team will perform various tests to check your child’s muscle strength and sensation. This is important to make sure there has been no injury to their spinal cord. These tests may include:
- 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 a health-care provider 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
Everything that your child drinks and eats will be closely monitored, along with the IV fluids that they require. They will also be closely monitored for how much they are voiding (urinating). This is measured through the urinary (Foley) catheter bag every hour. When your child is deemed ready to go home, the catheter will be removed; and your child will be able to urinate on their own. The health-care team will still regularly measure how much your child is urinating using a toilet hat, a collection container that is put over the toilet seat.
Abdomen
Your child’s abdomen will be closely monitored for distension and to make sure that all your child’s bowel sounds are present. It can take up to two to three weeks 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 health-care team will want to make sure that your child’s stomach and intestines are working normally again before going home. A bowel routine will be started for your child 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 stay hydrated. This will prevent bladder infections and also help to prevent constipation. Moving their body, like getting out of bed and sitting or 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 some painkillers can make abdominal bloating worse.
Diet
Immediately following surgery, your child can have ice chips and small amounts of water to start. They can then progress to a full diet as tolerated.
As your child’s intestines start to "wake up”, your child will start to pass more gas and have louder bowel sounds when listening to their abdomen with a stethoscope.
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 adhesive strips (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 a clear purple glue that is placed along the incision to keep it tightly sealed. A member of the health-care team 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 after five days.
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 adhesive strips tend to dry up and peel off by themselves. Sometimes, adhesive 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 adhesive strips get wet before removing them. This is like removing a wet bandage.
The glue 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 glue 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 fully inflated and clear of fluid.
Positioning in bed
After surgery your child can still lie on their back. A pillow or roll will be placed under your child’s knees for support. The health-care team 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. A roll will be placed behind your child’s back and a pillow will be placed between their knees to help keep them in this position.
Mobility
Your child will be taught 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 come up from recovery. It is important for your child to ambulate with someone from the health-care team until their ability to ambulate independently is assessed. You and your child will learn 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 hours to being upright again.
Your child will work up to short walks and, eventually, longer distances. Most children who have had scoliosis surgery find they feel better when they move around.
Menstrual period
If your child menstruates, they may get their menstrual period around the time of the surgery. This is a normal response to stress. Many young people who menstruate 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 health-care team is very familiar with this situation and will do everything they can to make your child 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 three 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.
- Your child must be passing gas and/or have a bowel movement.
- Your child must be able to drink fluids and eat 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.
- Your child’s back incision needs to be healing properly.
Your child will be given 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 4.5 kilograms (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 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.
- Smoking and vaping also interfere 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.
