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
- The appropriate incision is made, and the vertebral levels are identified.
- Muscular and ligamentous structures are denuded from the spinous processes laterally to the transverse processes on both sides before placement of the rods.
- Distractor hooks are placed on the concave side, and the distraction rod is then placed.
- Hooks for the compression rod are also applied.
- Large amounts of cortical and cancellous bone placed over the rods and the denuded area.
- Suction drains are placed and the wounds are closed.
Perioperaitve Nursing Considerations
- The individual is placed in a posterior plaster shell or Rizer jacket for approximately 6 to 12 months or until fusion is solid.
- Have X-rays taken in the room.
- Check with blood bank for available units.
- Measure blood loss accurately.
- Have additional suction available if cell saver is not used.
