Complex Care Spinal Surgery Pathway
This information is designed to help parents and guardians understand what the Complex Care Spinal Surgery Pathway at Children’s Health Ireland (CHI) involves. Our goal is to guide you through every step, making sure you understand what is happening, why it is important, and how we are keeping your child safe and supported along the way. Although each patient will have an individually tailored journey to their treatment, this page outlines the standardised pathway families take when their child is preparing for spinal surgery.
Journey to Complex Care Spinal Surgery
Why the Complex Care Spinal Surgery Pathway takes time
We understand that waiting can be stressful. Every child’s journey is unique, and some steps may take longer - especially when several specialists are involved.
The reason for this is simple: we take every precaution to make surgery as safe as possible. Each test, review, and meeting ensures that your child is fully prepared and that their care plan is the right plan for them. The timing for surgery is also carefully considered.
Your patience and partnership are vital parts of that safety. Together, we will make sure your child receives safe, coordinated care.
* Patients are only included in this pathway if their condition is considered complex (e.g. scoliosis with underlying chronic conditions).
1. Surgical Consultation
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. This does not yet mean that your child has been approved for spinal surgery, but the team will begin the planning process.
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.
2. Pre-Operative Assessment Clinics
Before any potential surgery is confirmed, your child will attend pre-operative assessment clinics (often called pre-assessment). This is a series of tests to ensure they are fit for surgery.
You will need to attend the hospital for appointments to undergo these pre-assessment tests. Some involve day visits, while some will require overnight hospital admissions (like a sleep study, for example).
These checks take time, but they are essential to make sure surgery is safe and successful. If anything needs extra attention for your child, this will also be addressed during the pre-assessment phase.
Your child’s pre-assessment may include some or all of the following:
- Anaesthesiology
- Blood tests
- Cardiology
- Clinical Photography
- Dental Services
- Day Ward
- Haematology
- Infection Prevention
- Laboratory tests
- Measurements
- Neurophysiological monitoring
- Neurosurgery
- Nutrition and Dietetics
- Occupational Therapy
- Orthopaedics
- Paediatric Intensive Care
- Plastic Surgery
- Physiotherapy
- Psychology
- Radiology
- Respiratory
- Sleep study
- Social Work
- St Joseph’s Ward (Crumlin)
- Surgical Flat (Temple Street)
- Urology/Urodynamics
You can find more information about pre-assessment in our Guide to Spinal Surgery in CHI
Once all of the pre-assessment tests are complete, your child’s case returns to the Multi-Disciplinary Team (MDT) for final review. The team meet to confirm that:
- All tests and consultations are complete
- It is safe to proceed with surgery, or not
3. Multidisciplinary Team Review
Spinal surgery for complex patients involves many parts of your child’s health, not just their spine. To make sure everything is safe and well-coordinated, your child’s care is discussed by their Multidisciplinary Team (MDT).
This team may include some or all of the team members involved in their pre-assessment and care to date. Some very complex patients may need extra specialists to be involved in their MDT.
For example, a child with spina bifida may require anesthesiology, neurosurgery, urology, orthopaedics, physiotherapy, occupational therapy, nursing, dietetics, and psychology to be involved in their MDT, at a minimum.
A child with cerebral palsy could need attendance from anesthesiology, neurology, orthopaedics, physiotherapy, respiratory, occupational therapy, speech therapy, nursing, dietetics, psychology and social work at their MDT meeting, at a minimum.
Your child will only be approved for surgery upon agreement of the MDT members. The outcome of the meeting will be communicated to you afterwards.
4. Pre-Admission
When a surgery date is set, our team will help you and your child prepare for hospital.
During pre-admission, final checks are carried out, infection control protocols confirmed, and patient/family education is completed.
You can find more information about what to expect every step of the way in the Scoliosis Information Hub.
5. Surgery, Recovery and Rehabilitation
You can find more information about what to expect every step of the way in the Scoliosis Information Hub.
6. Going Home and Follow-Up
Your team will talk to you about what is necessary in order to get home safely.
You will leave hospital with the contact details for our Spinal Services Clinical Nurse Specialists (CNS), who can answer questions or concerns after discharge.
Questions?
If you have questions or worries, please reach out to your Spinal Clinical Nurse Specialist. Contact details for all members of the Spinal Surgery Management Unit can be found here.
Explainer Video
Explainer Video