Story by: Norton Children’s on August 5, 2022
When a child is being treated for adolescent idiopathic scoliosis (AIS), many parents have questions about what to expect after spinal fusion surgery: What will my child’s recovery be like? What happens before and after the operation? How will the treatment team ensure my child remains as comfortable as possible?
Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine, has developed a detailed post-operative spine protocol that addresses those questions in addition to providing several benefits to patients and their families, including shorter hospital stays and multimodal pain management.
“Under this protocol, our patients have an accelerated recovery,” said Kent L. Walker, D.O., pediatric orthopedic surgeon with Norton Children’s Orthopedics of Louisville. “Children generally have shorter hospital stays; they don’t require an admission into the ICU (intensive care unit); they don’t need as many narcotics; and they’re able to be active sooner in physical therapy.”
Norton Children’s Orthopedics of Louisville was one of the first in Kentucky and the first in Louisville to implement this protocol. The following instructions offer patients and their families additional context for what to expect after spinal fusion surgery.
One to two weeks prior to surgery, the patient and family will have a pre-admission testing visit, where the child will have labs drawn, a chest x-ray, EKG, and they will meet the anesthesiologist and a physical therapist. The physical therapist will start discussing spine precautions and which movements are allowed and those that should be avoided. During this time, the child also will begin Mupirocin, an antibiotic ointment to decolonize them from MRSA, as a preventative measure to help reduce the risk of infection.
The morning of surgery, in the preoperative area, the child will take acetaminophen (a pain reliever), Valium (for muscle spasms) and gabapentin (for nerve pain) with only a sip of water. Starting these medications early has proven to decrease pain after surgery and lessen the narcotics used for pain management.
“We start controlling their pain prior to making any incision. Patients are pre-dosed with their medications in the pre-op area so that fewer narcotics are being used, even in the operating room,” said Natalie R. Jennette, DNP, APRN, FNP-C, nurse practitioner with Norton Children’s Orthopedics of Louisville.
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Patients usually are able to sit at the edge of their bed on the same day as the operation, and even can mobilize the day after surgery. For the spinal fusion procedure, hospital stays typically were five days — but the current protocol has reduced it to around three days.
“This is all due to using a multimodal pain protocol where medications are specifically spaced to give patients a steady stream of medications and never letting them have peaks and valleys in their pain control,” Natalie said.
Patients are regularly administered acetaminophen, ibuprofen and gabapentin, while oxycodone and Valium may be requested as needed.
A patient is ready for discharge when they can meet the following criteria:
The following is a typical schedule for what to expect after spinal fusion surgery, including movement and nutritional benchmarks.
Day 0: Day of operation
Day 1 post-op: Getting stronger
Day 2 post-op: Prep for discharge
Day 3 post-op: Discharge