Adolescent Idiopathic Scoliosis (AIS) Posterior Spinal Fusion (PSF) Pathway

Posterior Spinal Fusion is the most common operation used to treat AIS.

This is a surgery where the curved part of your spine is permanently fused together. The bones in the curved area are joined using metal rods to hold the spine steady. The aim of surgery is to stop the progression of the curve, and to improve it if it safe to do so.

Once your child’s doctor refers them to CHI’s Spinal Services team, the referral is reviewed by a spinal surgeon and triaged based on the urgency of your child’s condition.

You will then be invited to an outpatient appointment at CHI.

At this visit:

• You will meet the spinal surgeon and their team.
• We will talk about your child’s condition, possible treatments (non-surgical and surgical), and what surgery could involve. We will weigh up the risks of having surgery, vs the risks of not having surgery.
• This is also your chance to ask questions. The aim is for you to feel informed and supported.
• If surgery is recommended, your child will be placed on the Spinal Surgery Waiting List.
• You will also be linked with the Spinal Clinical Nurse Specialist (CNS), who supports families throughout the pathway.

You can find updates about surgical waiting lists and waiting times for outpatient appointments on www.childrenshealthireland.ie/spinal.

You can find more information about scoliosis and treatments in our Guide to Scoliosis:

All young people listed for spinal surgery attend the Pre-Assessment Clinic before surgery. This is an important visit(s) that helps ensure your child is ready and safe for their operation.

Tests may include:

• EOS spine X-ray
• Bending X-rays (if needed)
• Blood tests, including vitamin levels
• MRSA/MSSA screening
• Pregnancy test (for teenage girls)
• Lung function testing

You can find more information about pre-assessment in our Guide to Spinal Surgery in CHI:

You will meet members of the spinal team, including:

• Spinal Clinical Nurse Specialist (CNS) who will give you an overview of what to expect.
• Physiotherapist will recommend breathing exercises and early mobility.
• Dietitian (if needed) will provide nutrition advice.
• Your child will receive an incentive spirometer (a device that helps to practice deep breathing to keep lungs clear and healthy after surgery) to practice at home.
• Most young people are also advised to start daily multivitamins three months before surgery.
• You will be provided details of our Scoliosis Information Hub to find more information.

When all pre-assessment tests are complete, you will meet an Anaesthesiologist.

They will:

• Review your child’s medical history
• Discuss the plan for anaesthesia
• Talk about pain control after surgery
• Make sure your child is medically ready for their procedure

You can find more information about anaesthesia in Your Child’s General Anaesthetic

Your child’s recovery in hospital follows a structured plan. Daily goals help with movement, breathing, pain control and getting back to normal activities. Meeting these goals each days means getting closer to going home.

After the operation, your child will go to recovery, then return to the ward.

Today’s goals:

• Gentle movement with staff such as rolling and sitting on the side of the bed
• Begin sipping water once fully awake
• Start using the incentive spirometer
• Pain managed by the Pain Team
• Regular checks of nerves and circulation in the legs

Your child may have a urinary catheter and IV lines, which will be removed as soon as appropriate.

Today’s goals:

• Sit out of bed in a chair
• Stand and take a few steps with the physiotherapist
• Have lines and pumps removed where possible
• Eat a light diet
• Continue breathing exercises

Your child will have:

• Four-hourly vital signs and spinal checks
• A morning blood test
• Two physiotherapy sessions (morning and afternoon)
• The urinary catheter is usually removed today.

Today’s goals:

• Walk part of the ward corridor
• Increase time out of bed
• Eat normally
• Continue pain control
• Prepare for going home

Other planned care includes:

• Daily physiotherapy
• Regular wound dressing checks
• Whole-spine EOS X-ray
• Support with showering if needed

Most young people are ready for discharge around Day 3.

Today’s goals:

• Comfortable pain levels on oral medication
• Confident walking with or without support
• Understanding the home care plan
• Eating and drinking normally

Before leaving hospital, you will receive:

• A discharge information pack
• Pain medication prescription
• Wound care instructions
• Activity and movement guidance
• A follow-up appointment (usually 6 weeks after surgery)
• A plan for clip/suture removal 14 days after surgery

Your child will return to the Outpatient Department six weeks after surgery for review and repeat X-rays. The spinal team will continue to monitor their progress and answer any questions.

Many young people have gone through this pathway and come out stronger. In the Scoliosis Information Hub, you can find stories from other AIS patients about their journeys, recovery and the things they found most helpful along the way.