What is the postoperative care following surgery for idiopathic scoliosis?

Updated: Dec 02, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Postoperative patient management involves close monitoring, which often occurs initially in an intensive care unit setting. Patients have monitoring devices, such as arterial lines, and closed suction devices, such as chest tubes, that also require special nursing attention. The use of certain special spine-specific hospital beds, such as the Stryker frame, may also aid in patient care and comfort (change from supine to prone position) during the initial postoperative period.

The use of postoperative bracing varies from surgeon to surgeon. As noted (see Overview, Background), the roots of scoliosis surgery involved immobilization in a body cast. After the development of initial instrumentation systems (eg, Harrington instrumentation), external immobilization was still used routinely.

With the advent of large-rod multiple-hook constructs, such as the Cotrel-Dubousset system and its direct decendents, bracing has been deemphasized a bit. Thus, a patient now is almost as likely not to receive a postoperative brace as to receive one, whereas previously, bracing was much more widespread. In certain specific circumstances, such as anterior thoracic or thoracolumbar instrumentation procedures or surprisingly weak bone stock, postoperative bracing is still almost always used.

When a brace is used, it is typically to be worn full-time for at least 6 weeks, followed by a period in which the brace may be taken off for bathing, with subsequent progressive weaning. As a rule of thumb, patients may also miss up to 6 weeks of school (if their procedure is done during this part of the year), and up to 6 months may be required before they resume most of their normal activities. Vigorous sports may be restricted for at least a year, or in some instances permanently (depending on the outcomes of on risk-versus-benefit discussions between patients, families, and surgeons).


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