The recovery after scoliosis surgery is variable, depending on the nature of the surgery performed. In general, after having 2–8 or more hours of surgery, time is spent initially in the Recovery Room. In this area the patient is allowed to wake up from the anesthesia and regain voluntary breathing. There are times when it is necessary to maintain respiratory support on a ventilator for one or more days following this surgery. If this is required or there are other indications to do so, the initial postoperative period may be spent in an Intensive Care Unit. This allows for ventilatory support of the respiratory system, as well as close monitoring of the cardiovascular system.
There are several options for managing pain in the initial postoperative period. These include intravenous narcotic medicines, such as morphine or Demerol. Once the patient is drinking/eating, the transition from IV to oral pain medication will be initiated. The intravenous route is convenient and can be delivered either by the nurse or with a patient-controlled anesthesia (PCA) system. This allows the patient some control over the timing of administration of pain medication.
Immediately After Surgery
In the initial postoperative period, there may be several tubes in place. The tubes will be placed while the patient is under anesthesia. These may include:
- A nasogastric tube to drain the stomach contents, the tube will be in place while the intestines “wake up” or recover from the effects of anesthesia usually 2-3 days. After the intestines start to work again (bowel sounds and flatus present), the patient may then start to drink and eat again. Generally the diet is advanced gradually, starting with liquids and progressing to solid food.
- There will be a bladder (urinary) catheter inserted during surgery.
- Surgical drains may be placed in the back to allow for drainage of fluids.
- If surgery in the chest area is performed, a chest tube will be required to drain fluid from the chest (thoracic cavity).
- Intravenous lines will be in place to administer both medications and fluids. There may also be an arterial line for the same purpose, as well as to assist with blood pressure monitoring.
These monitoring lines and drainage tubes will be removed sequentially in the days following surgery when they are no longer necessary.
First Day or Two After Surgery
In the first day or two following surgery, there is little physical activity required of the patient, though the nurses will be repositioning the patient in bed every 1–4 hours. There will then be a gradual increase in activity/mobilization, generally starting with sitting, then standing, then resuming walking. The timing and rate of the increase in activity will vary, depending on the type of surgery done. Depending on the patient and/or the type of surgery performed, some patients may need to wear a brace for 3-4 months after surgery. The brace provides external support to the trunk while the fusion is healing. This brace comes in various forms and the form will depend on the patient and type of surgery performed. This brace is to be worn at all times except when in bed. This brace will be fit and provided to you prior to discharge from the hospital.
In general, requirements for being discharged from the hospital following surgery include:
- Tolerating oral liquids and food
- Comfortable on oral pain medications
- No fevers
- Ability to ambulate (if ambulating prior to surgery)
- Able to urinate and have bowel movement
Recovery at Home
After discharge from the hospital to home it usually takes several weeks for pain to completely resolve and in general, a gradual weaning from narcotics to Tylenol takes place naturally. It is not uncommon for patients to be comfortable on Tylenol during the day and need narcotics at night for comfort during this weaning process.
In general, school age children/teens are ready to return to school 3–4 weeks after surgery, depending on the child and the type of surgery. Some children tolerate a return to school for just half days initially, but we encourage returning as soon as possible to a “normal” schedule.
Physical activity and sports are restricted after surgery for 6–12 months, depending on the type of surgery. We encourage children to begin walking for exercise (if child is ambulating prior to surgery) at the time of discharge. Bending, twisting, and lifting activities are to be avoided. At each follow-up visit, x-rays will be done to access healing of the fusion. This will allow your surgeon to make decisions regarding easing off on both bracing and activity restrictions. As healing occurs, brace wear will be discontinued, and permitted activities may be increased. Generally at 1 year following surgery, children may participate in all activities without restriction.