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Home Care Instructions - Pediatric/Adolescent Patients Following Spinal Fusion with Instrumentation

Your child is recovering from a procedure called a spinal fusion (anterior / posterior). Bone graft was placed along your child's spine in an attempt to achieve a solid fusion in that area. Also, implants were used to provide correction and help increase the chance of fusion by immobilizing the spine internally, thus reducing or eliminating the need for a brace or a cast. If a brace is required, the amount of time required to wear this appliance may be much less due to the instrumentation's strength. Bony fusion of the spine may take 6 to 12 months to occur, thus, special care is required to help this healing process. Below are guidelines for your child to follow after he/she is discharged from the hospital.

PAIN MANAGEMENT
Initially, your child may complain of pain and soreness directly related to the surgery: The incision, the bone graft site, positioning from surgery, etc. This is expected and should decrease over the next few weeks. Pain medication will be prescribed and can be given as needed. Follow the directions on the bottle. If a refill is needed, have your pharmacy call your doctor's office ( refills are not processed on weekends ). Please do not allow your child to take any non-steroidal anti-inflammatory drugs (Advil, Motrin, Aleve, etc.) until your surgeon allows this. This type of medication can interfere with healing.

If the surgery was for scoliosis correction, your child may complain about soreness between the shoulder blades or in the rib cage region. This is expected. Part of this surgery involves partial correction of the curve(s). As a result, the body has “shifted” from its former “comfortable” position to its new corrected position, which puts pressure on the structures that connect to the spine. This soreness will slowly subside and may take weeks to months to completely resolve.

INFECTION
Infection is not expected after surgery, but it can occur. It is important to look at your child's back at least once a day until the first office visit. Once the dressing as been removed, the incision should appear pink and the edges should be together. Showering is permitted about 7-10 days after surgery (unless otherwise advised). Please inquire about the exact date with your doctor after surgery. Tub bathing should be postponed until the incision is completely healed and your doctor's allows this form of bathing. Any redness, swelling or drainage should be reported to your doctor without delay. This could be a sign of infection and treatment should begin as soon as possible. Call your doctor's office as soon as possible. It is also important to report a fever greater than 101.0 (taken by mouth).

DIET
No restrictions in diet are necessary. It is important to encourage liquids, fruits and vegetables to reduce the risk of constipation, which often occurs after surgery. You may wish to give your child a multi-vitamin with iron regularly. This will help the body heal and produce new blood cells, which were lost during and after surgery.

ACTIVITY
At first, your child's activity will be self-limiting due to discomfort. After the first several weeks, however, you will need to monitor your child's activity to prevent injury and to allow the fusion to heal.

Twisting or bending forward at the waist and heavy lifting is strongly discouraged. Squatting to pick up items off the floor or bringing a leg up to the chest to put socks and shoes on is allowed. The initial weight restriction is no more than 10 pounds (a gallon of milk is 8 pounds). This will be increased during the first year as your child shows evidence of healing.

Walking, stair climbing, riding in a car or school bus is okay. You will be instructed when activities can be allowed or increased at each office visit.

Physical education is not allowed for a period of one year, unless otherwise noted by your doctor.

A note can be provided upon request.

Return to school is allowed approximately 3 weeks after the day of surgery unless otherwise instructed. Carrying schoolbooks is allowed, provided they are held close to the body (in front, not over the shoulder) and provided the weight does not exceed 10-15 pounds. This can be increased over time as you get stronger, upon your doctor's approval.

BRACE TREATMENT
On occasion, brace treatment is required to assist the metal implants with immobilizing the spine. In most cases, the brace should be worn when your child is out of bed. It does not need to be worn in bed or when showering (unless your doctor has instructed that around-the-clock treatment is necessary). Please instruct your child not to bend or twist at the waist when out of the brace.

The most standard brace prescribed is solid plastic. It is important to note that body lotion and body powder should not be used on the skin in the region where the brace is in contact with the body. Instead, rubbing alcohol should be used on the skin at least twice a day to keep the skin dry and cool. The brace may cause increased perspiration and the alcohol helps to reduce this. Also, a form-fitting cotton undershirt should be worn under the brace.

If an adjustment of the brace is necessary after discharge, please call your Orthotist. An adjustment may be required if the brace is: too loose, too tight, causes a distinct red spot on the skin or is otherwise too uncomfortable to be worn as prescribed.

SCAR CARE
Exposure of the healing incision to sunlight or tanning beds can be potentially harmful and bad sunburn may occur. It is recommended to apply a strong sun block over your child's incision the first year unless otherwise advised by a doctor.

FOLLOW UP
A return visit to the doctor's office is expected 3-4 weeks after surgery. After that visits should be scheduled at 3, 6, 12, 18 and 24 months after surgery. X-rays of the spine will be required at each office visit . If you have a health plan that requires that x-rays be taken elsewhere, please arrange for x-ray orders to be sent to the appropriate x-ray facility before your appointment. Your surgeon's office can assist you with this.

This instruction sheet has been written to give you useful information following your child's spinal fusion. This is not a substitute for, or in place of your doctor's instructions. If you have been advised differently based on your child's individual needs, please follow your doctor's recommendations. If you have any questions, please call your doctor's office.