Scoliosis surgery tends to improve sitting posture and trunk length. A straighter trunk will increase the child’s/young person’s overall height. This should be born in mind if your child/young person travels in an adapted vehicle. It will also prevent further collapse of the spine and the pain and discomfort that this can involve. It will benefit the child's posture, and eliminate the long-term need for a brace or support in his/her wheelchair. It will reduce the effects of a progressing scoliosis on respiratory function.
Are there any disadvantages?
Balancing the risks and benefits of your child/young person prior to having any major operation is essential. Stabilising the spine in a rigid manner, from just below the neck to the pelvis, does restrict the mobility of the trunk. For some children/young people this will make eating more difficult because they cannot lean forward and so their hands can no longer easily reach their mouth. This may be overcome by the use of simple aids such as mobile arm support. For some a combination of loss of appetite and difficulties of self-feeding can cause some additional weight loss. This is mostly recovered within the first few months following surgery. Spinal surgery restricts further growth of the spine. This is not a problem if the child is close to the end of the growth, but will have an effect on a very young child. As far as possible surgery it is postponed in very young children unless the curve is severe. There are also new procedures which allow the spine to growth even after spinal surgery, although they can require repeated surgical interventions and have increased rate of complications
The decision
The decision as to whether to undertake this operation ideally is made by the parents of young children or by the young person in consultation with the family and an experienced multidisciplinary team. This team may include:
- a paediatrician;
- an anaesthetist experienced in neuromuscular disorders;
- an orthopaedic surgeon experienced in spinal surgery;
- a nurse specialist;
- a speech therapist who is experienced in assessing swallowing;
- a physiotherapist who will talk to you both about the exercises that will help your child recover from the surgery;
- an occupational therapist who will help you access any equipment your child will need when they have had the surgery and are at home;
- a dietician who will talk to you and your child about the importance of good nutrition to help cope with the surgery. He/she may also advise on extra nutrition supplements.
- a social worker who may talk to you about how you will cope at home after the surgery and liaise with local services to help you access what you need;
- friends or other individuals affected by similar conditions are often the best people to provide a firsthand advice on the pros and cons of spinal surgery. The nursing or medical team may have names of families who are able to help you in this way
Conclusion
Scoliosis surgery remains the treatment of choice of progressive scoliosis in children/young people with neuromuscular disorders. It should not be viewed as a failure of other management regimes. The choice of performing surgery and the timing depends on the progression of scoliosis and the associated complications. An experienced multidisciplinary team being involved may help in this decision making process. Improved surgical techniques along with careful spinal cord monitoring and skilled anaesthetic cover now make it possible for children/young people with a variety of neuromuscular conditions to have surgical correction of their spinal deformity. For all children/young people with neuromuscular disorders where surgical correction of scoliosis is discussed careful consideration of individual circumstances should be taken into account.
Other relevant publications
- Anaesthetics
- Making breathing easier
- Spinal surgery – questions to ask