Dr. Luhmann's Spine Education Booklet

 Download a PDF of this booklet

Spinal Fusion Surgery

What is spinal fusion surgery?
This is a surgical procedure that is completed to fuse the vertebrae of the spine by using bone graft, screws, and rods. These fused segments will be motionless after surgery.

What is the goal of spinal fusion surgery?
The goal of surgery is to prevent further progression of the scoliosis and to correct the spine as much as possible in a safe manner.

How does Dr. Luhmann make a “surgical plan” for my child?
Dr. Luhmann reviews the patient’s age, diagnosis, history, labs, x-rays, diers scan, EOS, MRI or CT (if needed), physical exam and clinical photos to determine the exact surgical plan for each patient.

You, your family, and Dr. Luhmann have made the decision to move forward with the spine fusion. What next?

  1. Date of surgery scheduled
  2. Date of pre-operative appointments scheduled (Dr. Luhmann, anesthesia, pulmonary function tests, and other provider appointments made if needed.)

Please bring a list of your child’s medications to your pre-operative appointments.

Common questions for Spinal Fusion Surgery

PLEASE STOP:
  • ALL NON-STEROIDAL ANTI-INFLAMMATORY medications/arthritis medicines (such as Advil, Aleve, Ibuprofen, Motrin, Clinoril, Indocin, Daypro, Naprosyn, Celebrex, Vioxx, etc.) two weeks before surgery. Tylenol products are suggested for pain. 
  • STOP SMOKING and family members should NOT smoke in the household… it increases healing time! Dr. Luhmann usually does not do spine fusion if you smoke or use smokeless tobacco.
  • Anesthesia staff will let you know during your preoperative visit which of your current medications should be stopped prior to surgery.

    - Some antidepressants will need to be stopped a few days to 1 week prior to surgery. Please do
      not stop medications without consulting doctor.

    - Some medications such as Insulin and Prednisone have specific instructions that may need to
      adjust prior to surgery.

    - ASPIRIN products and BLOOD THINNERS (Coumadin, Persantine) need to be stopped 2 weeks
      prior to surgery. Please do not stop these medications without discussion with your doctor.
I have other implants in my body, what should I do?
  • Notify Dr. Luhmann and the anesthesiologist.
  • Patients with pacemakers will need to check with their cardiologists to see if the pacemaker settings need to be reset 1-2 days prior to surgery. The electrical currents in the operating room could alter pacemaker rhythm if the settings are not adjusted.
How do I prepare my home?
  • You cannot sleep on a waterbed, couch, or on a mattress on the floor.
  • Have a chair with armrests and a firm seat available that appropriate for your height.
  • Stock up on liquids (water, Gatorade, juice) and light snacks you enjoy.
  • Sleep on clean sheets and in clean pajamas the night prior to surgery.
Can my mom, dad or caregiver stay at the bedside?
YES, we strongly recommend parents to be an active partner in your child’s post-operative care.

What do I need to do the week prior to surgery?
Three consecutive days prior to surgery, wash your entire body below your neck with Hibiclens. This can be found at your local pharmacy, Walgreens, CVS, Target Wal-Mart, etc. and is non-prescription.
 
What do I need to bring to the hospital? 
  • Personal items of comfort (blanket, pillow, books, tablets. There is WiFi at St. Louis Children's Hospital)
  • Toiletry items you feel you will need during your stay (tooth brush, tooth paste, hairbrush, etc).
  • Comfortable clothes for the day of going home.
  • 2 packs of sugarless gum- this can be chewed post operative to help stimulate the GI tract.
What do we do the night before surgery?
  • If you live far away, you may want to stay at a local hotel because you will be required to be here early, approximately 6am. There are discounts for parents and patients of St. Louis Children’s and the current list can be found here. 
  • Please shower thoroughly shampooing your hair and cleaning your entire body the night prior to surgery. Remember to use the Hibiclens back wash on the entire body below the neck for the last night.
  • Please braid hair if it is long enough.
  • Please remove any nail polish, and be sure your nail beds are clean for surgery.
  • The patient may NOT have anything to eat or drink after midnight; this means no candy, gum, mints, etc.
When will I be notified of the time of surgery?
The Same Day Surgery phone nurses contact you the day prior to surgery to notify you of the exact time to be here. Most patients are told to arrive between 5:45am and 6am.

  • Dr. Luhmann: will see you at the preoperative visit. He does not typically see patients the morning prior to surgery. If there are any questions or concerns prior to surgery, please call Marie or Jenn before the day of surgery.
The morning of surgery:
The 6th Floor Same Day Surgery Unit is where you and your family will begin your journey. 
  • The day of surgery you will be able to meet with the anesthesiologist, nurses, and child life therapist.
  • Your weight, height and vitals signs will be obtained. 
  • You will change to a hospital gown, pants and socks.
  • Girls will be asked to give a urine sample.
  • You may be given medication prior to surgery by the nurse to decrease anxiety. 
  • You will have an IV catheter placed in a way that is Ouchless as possible. 
  • Your parents or the nurse will wipe your back with antibacterial wipes prior to going to the operating room.
Operating room:
  • First you will go to sleep. You will not wake during surgery. You will wake up after surgery.
  • We will place electrodes placed on your body to monitor spinal cord function. We will place additional IV lines and a urinary catheter after you are asleep.  
  • You will have pain medication that will keep you comfortable at all times during the surgery.
The day of surgery (family): 
Parents will be in the Same Day Surgery waiting room in either a cubicle or a room. Parents are called every couple of hours during the surgical procedure to notify them of where their child is in the process of the surgery. Parents are given a pager if they leave the area that works ONLY in the hospital.

Post Anesthesia Care Unit (PACU) or recovery room:
We will wake you up when the surgery is complete. You will be asked to do a “wake up test”.  You will then be wheeled in a bed to the recovery room (PACU). When you are awake, we will be able to ask your parent(s) or caregiver to come to the PACU with you.

Surgical Floor/10th Floor:

Patients are typically transferred to the 10th floor after the PACU which is home to the orthopedic unit.
There are both single and double rooms. You may have a roommate. 

The 10th floor has a parent lounge and small kitchen with a refrigerator and microwave. Parent involvement in care is KEY to Post-Operative success.

Pain Control
You will have pain. It is our goal to get your pain to a manageable level. The expectation is a five or six out of 10.  


                      
  1. Starting the morning of surgery your pain will be managed by the Pain Team.  This team consists of doctors and nurse practitioners from anesthesia.                                                          
  2. After surgery you will get medications through the IV.  You will be transitioned to oral medication within 24-48 hours. This will be a combination of over the counter medications (ie Tylenol), narcotics and muscle relaxers, if there is a need for this medication. The pain team works to individualize each patient’s pain regimen.
  3. You will be discharged with the same oral medications you are taking in the hospital.  You will be told how to use these medications when you go home, and how to wean off the medications as time progresses from surgery.
NO IBUPROFEN or NSAIDS for six months postoperative.

Incision Site: 
The actual incision will be closed with sutures and glue that does not need to be removed. 
  1. Immediately after the surgery the incision site will be covered with a dressing. This will remain intact until post-operative day three.
  2. The incision site should then remain intact. Do NOT pick at or remove the glue. Do not put lotion on the incision site.
  3. NO Showers for two weeks Post-Operative – sponge bath suggested at that time.
  4. NO swimming in chlorinated pools for two weeks post operatively.
  5. NO swimming in natural body of water for six weeks.
Activity:
  • Patients will be turned approximately every two hours using the log roll method. The nurses and physical therapists will go over with the patient and family how to turn the patient properly. 
  • The physical therapist will be available to get the patient out of bed for the first time the evening of surgery or the am after surgery with the assistance of the family. The goal is to be out of bed three times a day to chair and three times a day to walk.
  • The parents will work together with the nurse and therapist to encourage and assist the patient to MOVE!
  • The goal (if ambulatory prior to surgery) is to be up sitting, walking and to use the stairs prior to leaving the hospital.
Diet:
  • Day of surgery — patients will also be receiving Intravenous Fluids (IV fluids) and only first allowed ice chips/clear liquids.
  • Day one — post-operative patients are started on clear liquids and diet is advanced as tolerated. This can be a slow process after spine surgery. 
  • It is important to encourage frequent fluid intake and small frequent meals. You may have to start with crackers and slowly progress as tolerated.
  • Nausea can occur and we can give medications to alleviate symptoms.
Pulmonary (lungs)
  • It is important for you to use the incentive spirometer or blow bubbles 10 times an hour in order to prevent pneumonias.
  • Many children will get breathing treatments four times per day to help prevent pneumonia.    
When can we go home?
Patients are ready to go home when:
  • Pain is at manageable level by oral medications. Remember pain is expected.
  • Tolerating liquids and a light diet (i.e. crackers).
  • Cleared from physical therapy.
  • The patient may NOT have had a bowel movement, but will be given instructions on management at home.
When is the best time to leave the hospital?
Plan your pain medication timing when leaving the hospital. Ask your nurse for help with this. The ride in the car can often be bumpy! Bring your pink bucket home just in case you get sick to your stomach.

Idiopathic Spine Fusion Discharge Instructions  

Hospital to HOME:

3-4 days

Diet: 
  • High fiber and high protein- encourage small frequent meals with plenty of hydration.
  • Minimum of 6-8 glasses of water daily.
Activity
  • Encourage getting moving.
  • Daily 60 minute walks which can be broken down into 6 ten minute intervals.
  • Physical therapy exercises three times a day.
Medications
  • Refer to the calendar provided by the pain service that references weaning off medications.
  • Continue stool softeners and MiraLAX if you are on narcotics to prevent constipation.
Restrictions: 
  • NO Physical Education for at least six months.
  • NO spine twisting/torsion.
  • Refer to Post op activity spine guide.
  • NO IBUPROFEN or type products for 6 months post operatively.
  • No driving for six weeks then may return if off all narcotics and physically able to slam on breaks.
  • Do Not Carry more than 10 pounds.
  • NO backpacks.
Shower: 
2 weeks if there is no drainage from wound. May shower using gentle soap.

Baths:
Three weeks ONLY if incision is completely healed, and there is no drainage noted.

 Swimming:
  • ONLY when incision completely healed, no drainage.
  • Two weeks in chlorinated pool.
  • No natural bodies of water for six weeks post operatively and no drainage.
NO PIERCING or tattoos: 
Six weeks post operatively

School:
  • Return to full time in two to four weeks, and you may return sooner if you wish.
  • Refer to back to school note: do not carry more than 10 pounds on your back, no back packs, 2nd set of books, 5 minutes in between classes, NO PE for at least six months.
Incision care:
  • No creams, lotions or ointments to incision site.
  • Keep incision site out of sun by covering for two weeks post-operative and limit sun exposure during first year. Use sun block of SPF 50.  
When to call the DOCTOR?
  • Fevers greater than 101.5
  • Vomiting
  • Significant weight loss after two weeks post-op
  • Incision site redness, warmth or drainage
  • Numbness tingling or weakness in your arms or legs
  • Change in bowel or bladder pattern
  • Rash
  • Increased pain not relieved by pain medication
  • Patients MUST call prior to any dental procedures or surgical procedures for two years after surgery. We will give antibiotics prior to procedure to prevent any risk of infection.
When to follow up?
  • Six weeks
  • Six months
  • One year
  • Two years
  • Three years
  • Five years 

Important Contact Information

Dr. Luhmann's Team: 
Amanda Robertson, Medical Assistant: (314) 454-4191
Jenn Ledbetter, Nurse Practitioner: (314) 454-4261
Kirsten Brouillet, Research Coordinator

St. Louis Children's Hospital:
Orthopedics Appointment Desk: (314) 454-2500
Main Number: (314) 454-6000
Same Day Surgery: (314) 454-6174
PICU: (314) 454-6213
10th Floor: (314) 454-6038
After-hours Number: (866) 582-8055

Online Resources

St. Louis Children's Hospital 
Pediatric Orthopaedic Society of North America 
American Academy of Orthopaedic Surgeons
Scoliosis Research Society


 

      

      

 

 

 

 

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