Scoliosis Correction

Definition
  • The insertion of various rods, frames, or other fixation devices that act as internal splints until the vertebrae involved in the curvature fuses, correcting deformity.
Discussion
  • Scoliosis is described as a lateral “S” or “C” deviation of the spine, which may include a rotation or deformity of the vertebrae. Scoliosis can be idiopathic or congenital, and may result from muscular or neurologic disease.
  • Surgical treatment is usually performed when musculoskeletal and respiratory functions become compromised or for cosmetic purposes.
  • Indications may also include an increase in spinal curvature in a growing child or pain from the curvature in adults, uncontrolled by conservative methods.
Positioning
  • Prone, on a Wilsom frame or chest bolsters with arms placed on armboards, angled to wand the head; hands pronated.
Packs/ Drapes
  • Laparotomy pack
  • Sterile adhesive drape
  • Extra drape sheets
  • Towels
  • Minor pack
Instrumentation
  • Laminectomy tray
  • Kerrison and pituitary tray
  • Spinal fixation device tray
  • Steinman pins and protractors
  • Self-retraining retractor
Supplies/ Equipment
  • Special frame; positioning aids
  • Suction
  • Fiberoptic headlight
  • Cell saver
  • Cast cart
  • Basin set
  • Blades
  • Needle counter
  • Bone wax
  • Medications
  • Solutions
  • Closed drainage systems
Procedure
Harrington Rod with Fusion
  1. The appropriate incision is made, and the vertebral levels are identified.
  2. Muscular and ligamentous structures are denuded from the spinous processes laterally to the transverse processes on both sides before placement of the rods.
  3. Distractor hooks are placed on the concave side, and the distraction rod is then placed.
  4. Hooks for the compression rod are also applied.
  5. Large amounts of cortical and cancellous bone placed over the rods and the denuded area.
  6. Suction drains are placed and the wounds are closed.

spinal-fusion1

Perioperaitve Nursing Considerations
  1. The individual is placed in a posterior plaster shell or Rizer jacket for approximately 6 to 12 months or until fusion is solid.
  2. Have X-rays taken in the room.
  3. Check with blood bank for available units.
  4. Measure blood loss accurately.
  5. Have additional suction available if cell saver is not used.
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