In order to minimize the risks of spinal deformity surgery for scoliosis, kyphosis, spondylolisthesis, spondylolysis, etc….. Obtaining a thorough medical history is necessary, along with a physical examination, blood work and imaging studies. Shared
decision-making is important during discussion about surgery, along with the
alternatives to surgery, the benefits of surgery, potential complications and
risks. Below is the first part of the routine
preoperative discussions on spinal deformity surgery in children and
adolescents.
decision-making is important during discussion about surgery, along with the
alternatives to surgery, the benefits of surgery, potential complications and
risks. Below is the first part of the routine
preoperative discussions on spinal deformity surgery in children and
adolescents.
Overall there are two layers of risks in spinal deformity
surgery: 1) Those common to any surgical procedure, and 2) those unique to
spinal deformity surgery. The below information
are those risks common to all surgical procedures which require general
anesthesia.
surgery: 1) Those common to any surgical procedure, and 2) those unique to
spinal deformity surgery. The below information
are those risks common to all surgical procedures which require general
anesthesia.
1.
Risks common to any surgical procedure: general
anesthesia and the need to incise the skin for the surgery
Risks common to any surgical procedure: general
anesthesia and the need to incise the skin for the surgery
a.
General Anesthesia = being asleep for the entire
procedure
General Anesthesia = being asleep for the entire
procedure
i. Statistically
there is a greater risk of a fatal car crash over a year (1 in 4,000 to 8,000) than there is of a
catastrophic event due to general anesthesia in a healthy adolescent or child
(1 in 100,000 surgeries). The riskiest
part of the day may be the drive to the hospital, so drive safely and buckle
up.
ii. Nausea
and vomiting are common after general anesthesia, in up to 30% of surgical
case. The Anesthesiology team give
medications during surgery to minimize nausea and vomiting after surgery
iii. Being
under general anesthesia is like taking a nap, only medication-produced. You won’t know how much time you have been
asleep until you wake up and see a clock or someone tells you….it is just like
taking a nap.
b.
Surgery requires creating an incision on the skin,
which means the area of surgery can develop a bacterial infection.
Surgery requires creating an incision on the skin,
which means the area of surgery can develop a bacterial infection.
i. In
medical terms this is call a SSI or Surgical Site Infection
ii. There
are many things the surgical team will do to minimize the chance of an
infection.
1.
The use of antibiotics is very important. They are given before incision is made,
during the surgical procedure and after surgery to minimize the risk of a SSI. It is also important the correct antibiotic
is give, at the correct dose and at the optimal time.
The use of antibiotics is very important. They are given before incision is made,
during the surgical procedure and after surgery to minimize the risk of a SSI. It is also important the correct antibiotic
is give, at the correct dose and at the optimal time.
2.
Before surgery, usually at the preoperative
visit, a nasal swab will be performed.
This is to try to identify people with MRSA on their bodies,
specifically their noses. MRSA =
Methicillin-Resistant Staphylococcus Aureus, which is a very bad infection to
get due to its being resistant to most antibiotics which can be given to
prevent infection. It is important to
know who carries MRSA before surgery to make sure the correct antibiotic is
given before an incision is being made.
Before surgery, usually at the preoperative
visit, a nasal swab will be performed.
This is to try to identify people with MRSA on their bodies,
specifically their noses. MRSA =
Methicillin-Resistant Staphylococcus Aureus, which is a very bad infection to
get due to its being resistant to most antibiotics which can be given to
prevent infection. It is important to
know who carries MRSA before surgery to make sure the correct antibiotic is
given before an incision is being made.
3.
And there are many things you will not see the
surgical team doing, such as the sterile skin preparation, surgical draping,
sterile surgical technique, etc…. which also help minimize surgical infections.
And there are many things you will not see the
surgical team doing, such as the sterile skin preparation, surgical draping,
sterile surgical technique, etc…. which also help minimize surgical infections.
iii. Due
to the large amount of metal used in spine deformity surgery a deep infection
of SSI (an infection which is on the spinal metal) is a major problem. It can be difficult to get rid of a deep
infection around the metal since many bacteria strongly adhere to the metal. In addition bacteria can put up a protective
wall around itself which prevents antibiotics from reaching the bacteria and killing
it. If a SSI occurs it usually requires
several surgical procedures (called irrigation and débridement) to wash out the
wound in order to remove the bacterial load.
The use of antibiotics is essential, with the initial treatments given
intravenous (through tubing) and then switched over to oral.
iv. The
surgical site infection rate for patients with idiopathic scoliosis (which means
no known cause) is at Washington University is much lower than the average for
pediatric hospitals in the U.S. However
we will not be satisfied until ALL infections are prevented.
The next post will be on risks unique to spinal deformity surgery…..such
as neurologic deficit, failure of fusion, implant breakage or dislodgement,
need for repeat surgery, etc…..
as neurologic deficit, failure of fusion, implant breakage or dislodgement,
need for repeat surgery, etc…..