Spinal surgery pre-op assessment

What happens before surgery?

A few weeks before your surgery you will be asked to come into hospital just for a day for a pre-operation assessment. This is to check that you are fit for the operation and to make sure you know what will happen and why.

Some investigations will be carried out and you will have the opportunity to speak to different professionals about all aspects of your surgery. By the end of the day you will have had chance to ask lots of questions and this can help you to be less worried about your surgery.

Where shall I go and what should I bring?

When you come to the hospital make your way to the Main Reception in Outpatients.

It is important to also bring something to wear whilst having your photograph taken which hides your spine as little as possible, such as swimwear.

What investigations will I need?

You will probably need to have:

• X-rays of your spine and chest
• A throat and nose swab
• A urine sample
• A blood test
• An ECG (electrocardiogram) which is a tracing of your heart
• Photographs of your back
• breathing tests
• A back surface scan
• Measurements of your height, weight and temperature

Who will I see?

• The Spinal Nursing Team who will co-ordinate your care, answer your questions and liaise between the different professionals on your behalf.
• The ward doctor who will request your investigations and check that you are fit and well.
• The physiotherapist who will assess your needs in relation to moving around after the surgery.
• The pain management nurse who will discuss how your pain will be controlled after the surgery.
• The respiratory nurse who will check your breathing and lung function.
• The anaesthetist who will discuss your anaesthetic in detail.

You may also see:

• The occupational therapist who would establish the need for help with aids and alterations to existing equipment.
• A technician who will scan the surface of your back (formetric) and take photographs.

Are there any risks associated with spinal surgery?

Any anaesthetic and surgery carries risks and it is important that you are aware of these before you agree to surgery. The risks are small but nevertheless you need to be fully aware to allow you to make an informed decision.

Please bear in mind that your consultant will have balanced all these risks with the benefits of surgery in their decision to operate.

The main risks of spinal surgery are as follows:

• Spinal cord damage. The risk of this is 6 in 1000. This can cause problems ranging from a slight weakness to paralysis. This could affect limbs, bladder, and bowel control. To lessen the risk of this the spinal cord is monitored throughout the operation.
• Early infection. The risk of this is 2 percent. It could happen initially or early in the post-op period. An early infection would result in further surgery to wash the wound out and you would be given antibiotics.
• Late infection. The risk of this is 2 percent. A late infection is often low grade and can be a cause of persistent back pain. The metalwork may need to be removed.
• Bleeding. During the operation your own blood loss is salvaged and cleaned and then given back to you. Transfusions are also used when necessary.
• Failure of metalwork. The risk of this is 1% and can occur up to a few years after surgery.  Further treatment would depend on symptoms.
• Failure of fusion (the bones knitting together). The risk of this is 1 to 2 percent and again treatment would depend on symptoms.

Usually at another appointment, your consultant will talk to you about these risks and your operation again (this will have already happened once in clinic). When you fully understand they will ask you to sign a consent form. Parents are asked to sign for under 16 year olds, but younger patients, if capable of fully understanding the consequences, are also asked to sign.

Finally, if you have decided to go ahead with surgery it is best not to dwell on what could happen. Stay positive. If you would like to speak to another child or young person who has already had spinal surgery (either personally or by telephone) we could try to arrange this.

It may be a good idea to write down any questions you may have and bring them along on your pre-assessment day.

You may find the following information useful:

• Scoliosis
• Spinal surgery and discharge