What is Spinal Fusion in Children

Spinal fusion is a procedure to make two or more of the bones in the spinal column (vertebrae) grow together (fuse). This procedure stops the vertebrae from moving and rubbing against each other.

The goal of this procedure is to relieve pain and prevent deformity and weakening of the spine.

During a spinal fusion procedure, bone material (graft) is put in between the affected vertebrae to help them fuse. Hardware such as rods, screws, metal plates, or cages can be inserted to stabilize the vertebrae while they heal.

This procedure is used to treat conditions, including:

• Spinal injury.
• Herniated disk.
• Abnormal curvatures of the spine, such as scoliosis or kyphosis.
• Infections or tumors in the spine.
• Narrowing of the spine (spinal stenosis).
• A vertebra slipping forward and out of place on top of the vertebra that it sits on (spondylolisthesis).

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs, such as nerves near the spine.
• Spinal fluid leakage.
• Blood clots.
• Trouble controlling urination or bowel movements.
• The vertebrae not fusing together completely (pseudoarthrosis).

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from the health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

• Ask your child’s health care provider about:
  • Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
  • Giving medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do not give these medicines unless your child’s health care provider tells you to give them.
  • Giving over-the-counter medicines, vitamins, herbs, and supplements.
• Your child may be given antibiotic medicine to help prevent infection.

General instructions

• Ask your child’s health care provider how the surgical site will be marked or identified.
• Your child will have blood and urine samples taken.
• Your child may have imaging tests, such as:
  • X-rays.
  • CT scan.
  • MRI.
• If your child uses a car seat and you will be driving your child home within 24 hours of the procedure, plan to have another adult sit with your child in the back seat.
• Plan to care for your child for at least 24 hours after you take your child home from the hospital or clinic. This is important.

What happens during the procedure?

• To lower your child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Your child’s skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV will be inserted into one of your child’s veins.
• Your child will be given one or more of the following:
  • A medicine to help your child relax (sedative).
  • A medicine to make your child fall asleep (general anesthetic).
• If bone from another part of your child’s body (autogenous bone) is being used to fill the space between the vertebrae:
  • An incision will be made over the site of the bone graft. Often, the bone is taken from the hip (pelvic) bone.
  • A small part of the bone will be removed.
• An incision will be made over the vertebrae that will be fused. This incision may be on the back, abdomen, or side.
• The muscles will be moved aside.
• If the procedure is done to treat a herniated disk, part of the disk will be removed.
• The space between the vertebrae will be filled with autogenous bone, bone from a donor (allograft bone), or artificial bone material.
• Screws and rods or metal plates may be used to stabilize the vertebrae while they fuse.
• The muscles will be moved back into place.
• A small tube (drain) may be placed near one of the incisions to help drain extra fluid from the surgical site.
• The incision(s) will be closed.
• A bandage (dressing) may be used to cover the incision(s).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines he or she was given have worn off.
• Your child will:
  • Be given medicine as needed for pain.
  • Continue to receive fluids and medicines through an IV.
  • Be assisted to turn in bed frequently by moving his or her whole body without twisting the back (log rolling technique).
  • Be taught how to move correctly and how to stand and walk.
• Your child may:
  • Be given a brace to wear while he or she heals.
  • Have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in the legs.
• If your child uses a car seat and you will be driving your child home within 24 hours of the procedure, have another adult sit with your child in the back seat to:
  • Watch your child for breathing problems and nausea.
  • Make sure your child’s head stays up straight if he or she falls asleep.
• If your child is of driving age:
  • Do not let your child drive until his or her health care provider approves.
  • Do not let your child drive while taking prescription pain medicines.

Summary

• Spinal fusion is a procedure to make two or more of the bones in the spinal column (vertebrae) grow together (fuse).
• Before the procedure, follow instructions from your child’s health care provider about eating and drinking restrictions.
• After surgery, your child will be taught how to move correctly and how to stand and walk.

Care After Spinal Fusion

This sheet gives you information about how to care for your child after the procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the procedure?

After the procedure, it is common for a child to have:

• Back pain and stiffness.
• Pain in the incision area.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines (including any pain medicines) only as told by your child’s health care provider.
• If your child was prescribed an antibiotic medicine, give it as told by your child’s health care provider. Do not stop giving the antibiotic even if your child starts to feel better.

Driving

• If your child is of driving age:
  • Do not let your child drive until his or her health care provider approves.
  • Do not let your child drive while taking prescription pain medicine.

If your child has a brace:

• Make sure your child wears the brace as told by your child’s health care provider. Remove it only as told by your child’s health care provider.
• Keep the brace clean.

Managing pain, stiffness, and swelling

• If directed, put ice on the affected area.
  • If your child has a removable brace, remove it as told by your child’s health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your child’s skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

Incision care

• Follow instructions from your child’s health care provider about how to take care of the incision. Make sure you:
  • Wash your hands with soap and water before you change the bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your child’s dressing as told by your child’s health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your child’s health care provider tells you to do that.
• Keep your child’s incision clean and dry. Do not let your child take baths, swim, or use a hot tub until your child’s health care provider approves. Ask your child’s health care provider if your child can take showers. Your child may only be allowed to have sponge baths.
• Check your child’s incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Physical activity

• Have your child rest and protect his or her back as much as possible.
• Help your child follow instructions from his or her health care provider about how to move and use good posture to help the spine heal.
• Do not let your child lift anything at all, or anything that is heavier than the limit you are told, until your child’s health care provider says that it is safe.
• Do not let your child twist or bend at the waist until your child’s health care provider approves.
• Have your child avoid:
  • Pushing and pulling motions.
  • Sitting or lying down in the same position for long periods of time.
  • Raising hands or arms above the level of his or her head.
• Do not let your child exercise or be active until your child’s health care provider approves. After your child’s health care provider has approved exercise, ask him or her what kinds of exercises your child can do to make his or her back stronger (physical therapy).

General instructions

• To prevent or treat constipation while your child is taking prescription pain medicine, your child’s health care provider may recommend that your child:
  • Drink enough fluid to keep his or her urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Your child may have to wear compression stockings and walk one or more times every few hours as told by your child’s health care provider. Doing this will help to prevent blood clots and reduce swelling in your child’s legs.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has:
  • Pain that gets worse or does not get better with medicine.
  • More redness, swelling, or pain around the incision.
  • Fluid or blood coming from the incision.
  • Pus or a bad smell coming from the incision.
  • A fever.
  • Weakness or numbness in the legs that is new or getting worse.
  • Trouble controlling urination or bowel movements.
• Your child’s legs or feet become painful or swollen.
• Your child’s incision feels warm to the touch.
• Your child vomits or feels nauseous.

Get help right away if:

• Your child has severe pain.
• Your child has chest pain.
• Your child has trouble breathing.
• Your child develops a cough.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• After this procedure, it is common for a child to have stiffness and pain in the back and have pain in the incision area.
• Icing and pain medicines may help control the pain. Follow the directions from your child’s health care provider.
• Have your child rest and protect his or her back as much as possible. Do not let your child twist or bend at the waist until your child’s health care provider approves.