AIS surgery

Adolescent Idiopathic Scoliosis (AIS) is the most common type of scoliosis. The curve tends to progress quickly at times of rapid growth, especially around the growth spurt in your teenage years.

When might I be offered surgery?

If you are offered surgery, the most important consideration is how you and your family feel. There isn’t usually any urgent need for an operation to be done straight away in children with AIS, so families do not need to feel under pressure to make a quick decision. Some people find it easy to make a decision whereas some want to think about the situation and take time to do so.

Specialists will sometimes have slightly different ideas about when surgery is necessary, but all will consider factors such as; how big your curve is and how much growing you have left to do. As a general rule, if your curve is around 45-50 degrees or more, your surgeon will talk to you about the possibility of surgery. Your specialist will be able to look at your pelvis on the X-ray and tell how much growing you still have to do, this reading of the pelvis is called the Risser Sign and this coupled with other information, such as when a girls’ menstrual cycle starts or when facial hair begins to grow in boys, gives the surgeon an idea of the remaining rate of growth.

If you still have a lot of growing to do, your curve might progress and get bigger as you grow but equally if you have finished most of your growth, but you have a curve of 50 degrees or more, it may continue to get bigger as an adult. The goals of surgery are to prevent your scoliosis getting larger and to correct the curvature as much as can be done safely. Predicting how the curve may worsen can help patients and families make a decision about whether to progress with surgery.

If I am offered surgery, do I have to have it?

Surgery isn’t the right option for everyone, and if your specialist recommends an operation you will be given a choice about whether or not to go ahead with it. The operation can be more straightforward for a younger person, since their spine will be more flexible than it is when they are older. For some young people surgery is needed to help with pain, but for most AIS patients, it is intended to straighten the spine, to reduce the visible appearance of scoliosis, and to stop the curvature getting worse.

Before the operation, various tests will be done, including a Magnetic Resonance Imaging scan (MRI) of your spine, from the base of your brain to the bottom of your spine, to rule out any underlying problems that might have caused the scoliosis.

Additionally, the surgeon will want to test the flexibility of your spine using special X-rays, which help to decide how much of the spine they need to operate on. Finally, clinical photographs are very useful for recording the shape of your spine before surgery so it can be compared with how it looks afterwards, and any immediate improvements can be noted.

The operation to correct your scoliosis involves a large team including nurses, doctors, an anaesthetist, neurophysiologists (who monitor the function of your spinal cord during surgery), radiographers (who take X-rays of your spine while you are asleep), and finally the surgeons. Before the operation you will be given a pre-med, which will make you sleepy and you will then be given anaesthetic. The anaesthetic will be administered to you throughout the operation so that you stay asleep, and then stopped after it is over, so that you wake up. After the surgery, the recovery nurses and the intensive care team will look after you and, once back in the ward your family, will be with you. Some people feel sick after the operation because of the anaesthetic, but this will pass. There are lots of different ways to give you pain relief after surgery and your anaesthetist will discuss this with you, most people have discomfort, but it is rare for people to be in severe pain.

What will the surgeons do to my spine during the operation?

Surgery for AIS is called spinal fusion. Spinal fusion uses metal implants (screws, wires and/or hooks) that are attached to the vertebrae in your spine and then connected to a single rod or to two rods. During the operation bone graft is placed over the implants.

These implants and rods are used to hold the spine in place until the bone graft grows over the implants and fuses the vertebrae together. This happens over a period of about 12 months and forms a solid column of bone in that area. The screws, wires and hooks are made of metal-titanium, cobalt chromium or stainless steel and can stay in your body safely. Surgeons will use slightly different types of implants and rods, and can have different techniques and will chose the techniques and materials that are suited to your particular spinal curve, it’s size, and how much growth you still have to do.

The aim of the surgery is to fuse the fewest number of vertebrae together as possible, whilst keeping the head centred over the pelvis when viewed from the front and from the side. It is not usually necessary to make the spine completely straight to achieve this correction. The fusion of the bone in your spine stops that part of your spine growing. Dependent on which part of the spine the curve is, you may lose some flexibility where your spine has fused, however, a lot of the bending we do is from the hips, and lots of people report very little change to how they can move after the operation.

Surgical incisions that allow access to the spine can be made from the back (posterior), from the side (anterior), or a combination of the two for very stiff, large curves. Sometimes, if the ribs are prominent, small portions of them can be removed to improve appearance. The rib removal procedure is called a costoplasty.

How long will it take me to recover from my surgery?

After the operation, you will feel exhausted and have some pain. The nurses and doctors looking after you will give you medication to help with the pain and sometimes this can cause constipation. The sooner you start to eat, drink and move about, the better you will feel.

The time you will spend in hospital depends on many factors that your healthcare team will explain but this is especially dependent on how extensive your operation has been. Usually, the stay is about 4 to 7 days. By the time you are ready for home, you should see some of your mobility returning.

Once you are home you can gradually build up the amount of activity you do. The general guideline is for patients to return to school or work after approximately 6 weeks, but some people feel well enough to go back more quickly. Your specialist will tell you what you can and can’t do, but generally you can start to do some exercise after you go back to school or work. Many patients will be back to doing most of their normal activities after 6 months or so, but some activities such as football or other contact sports should be avoided for longer.

It is important to keep moving as this will help you to recover after your operation.

If you need help or advice please call our Helpline on 020 8964 1166 or email info@ssr.org.uk.