Posterior Spine Fusion Surgery: Neuromuscular scoliosis and VEPTR home care

What can be done for pain?

Your child will have some pain and soreness after surgery.  It may be caused by the incision or the way your child was positioned during surgery.  The soreness will go away slowly over several weeks or months.  

During this time, your child may need pain medicine.

• You may get information about medicines to help with your child’s pain, and who to call. If you need a refill please call the team who is caring for your child’s pain. Plan ahead; do not wait until you are out of pain medicine to call.
• There are ways to help with pain besides medicine.  Help your child relax by taking deep breaths or listening to soothing music. Read a book or blow bubbles to distract them from the pain. 
• Ibuprofen is ok for up to 2 weeks after discharge as needed if prescribed.  After the 2 weeks, do not give your child anti-inflammatory medicines for 1 year after surgery. They could prevent the bone from healing. These medicines include, but are not limited to: Aspirin, Ibuprofen, Motrin, Advil, Aleve, Nuprin, and Naprosyn. Please check with your child’s health care provider if your child is on any other medicine.

Diet

• Your child can eat their normal diet. It is important for your child to drink a lot of water.  They should also eat a lot of fruits and vegetables. This reduces the risk of constipation. If your child is g-tube fed, resume home feeding schedule as tolerated.
• Until your child is done taking pain medicine they should take a stool softener or laxative to prevent constipation.  If your child is on bowel program already, you may need to increase the stool softener frequency while on the pain medicine. 
• If your child is not getting enough fluids, they may get dizzy.  To prevent this, have your child drink lots of fluids.
• Once your child stops taking pain medicine and is no longer constipated, they can take a multi-vitamin with iron. This helps with healing.

Bathing and scar care

• Take only a sponge bath until your provider says it is ok to take showers.  Most often, this is after the first follow-up appointment and the wound is healed.
• Keep clothing over the incision for one year after surgery.  This is needed to avoid all exposure to the sun. After one year, use a sunscreen with SPF30 or higher.
• Your child’s scar will change color many times as it heals. The way a scar looks depends on your child’s skin type. Some skin types heal with a thicker scar than others. Most often, a scar will slowly get smaller with time.

School

• While at home as your child is able, they should spend time doing school work.  This will help keep them from falling behind.
• Every child is different and should return to school at their own pace.  Most children go back to school between 2 to 6 weeks after surgery.  It may be better to return to school slowly.  Your child can go half days at first. Increase the time slowly until they are going the full day.
• Heavy lifting should not be done. If your child’s book bag is too heavy, they should ask a friend to carry it. Your child’s doctor can write a prescription for two sets of books. One can be kept at home and one at school. This keeps your child from having to carry books to and from school.  
• Your child cannot go to gym class or school sports after surgery until the surgeon says it is ok. 

Dental Precautions

• Tell your child’s dentist or orthodontist (oral surgeon) about the spinal surgery. It is important that they know about any hardware that was put in your child’s spine.
• For 5 years after surgery, most children will need to take an antibiotic before a dentist or orthodontist visit.  This includes a visit for teeth cleaning or any dental procedures. The antibiotic needs to be taken one hour before the visit. Talk to your child’s health care provider if your child must go to the dentist and an antibiotic is needed.

Tattoos or body piercings

Smoking

Activity Guidelines

These activities and times are guidelines only.  They will vary for each child. Please talk with the health care team before starting an activity.  Your child should not do anything that will cause more than just a little pain.  

Most patients do not need physical therapy.  If your child was in physical therapy before surgery, they can start again after the wound is healed and it is comfortable for them. This will be ok'd at your first post-op wound check appointment.

Bending
Motions that make your child twist, bend at the waist or are jarring may hurt at first.  To avoid bending at the waist, your child should use their knees to stoop. This way, the leg muscles are used and not the back muscles.

Once home from the hospital these things are fine

• Ride in a car if it is comfortable.
• Sit in a reclining chair or wheelchair.
• Visit with friends.
• Walk (if they walked before surgery).
• Use a Hoyer lift.
• Use a stander if one was used before surgery.

3 to 6 weeks after surgery

• When your child is no longer taking narcotic pain medicines, they may return to school when feeling up to it. 
• May return to physical, occupational or speech therapy once the wound is healed. 
  – Do not bend forward (hyperextend) or backward (hyper flex) too far.  In physical therapy sessions, do not use yoga balls for stretching.
  – May have full range of motion of hips.  They may sit at a 90-degree angle and legs may be stretched.
• Continue to slowly return to all activities.

Other
Trampolines should never be used.