What is Pediatric cervical spine surgery: Purpose, Procedure, Results & Costs in India

For parents, few things are as concerning as a serious health issue affecting their child, especially when it involves the spine. The cervical spine, or the neck portion of the spine, is a critical structure that houses the spinal cord, responsible for transmitting signals between the brain and the rest of the body. When issues arise in this delicate area in children, specialized medical intervention is often necessary. This is where pediatric cervical spine surgery comes into play.

Pediatric cervical spine surgery is a highly specialized field dedicated to diagnosing and treating conditions affecting the neck and upper spine in infants, children, and adolescents. These conditions can range from congenital anomalies (problems present at birth) to injuries, tumors, or deformities that develop over time. Given the unique anatomy and ongoing growth of a child's spine, these surgeries require distinct expertise and careful planning, differing significantly from adult spinal procedures.

In India, advancements in medical technology, coupled with the availability of highly skilled pediatric spinal surgeons, have made world-class specialized spinal care increasingly accessible and, notably, more affordable compared to many Western countries. This makes India a leading destination for families seeking expert care for their children's complex spinal conditions.

Why is Pediatric cervical spine surgery Performed?

The primary objective of pediatric cervical spine surgery is to correct problems that threaten the integrity of the spinal cord or nerves, aiming to relieve compression, stabilize the spine, and restore normal function. These issues can stem from a variety of sources, each requiring a tailored surgical approach.

Conditions Requiring Intervention:

• Congenital Anomalies: These are structural abnormalities present from birth, often impacting the development and stability of the cervical spine.

  • Klippel-Feil Syndrome: Characterized by the fusion of two or more cervical vertebrae, leading to a short neck, low hairline, and restricted neck movement. It can also be associated with atlantoaxial instability (instability between the first two cervical vertebrae).
  • Congenital Scoliosis or Kyphosis: Abnormal curvature of the spine (sideways or excessive rounding of the back) present at birth, sometimes specifically affecting the cervical region.
  • Atlantoaxial Instability: Instability between the atlas (C1) and axis (C2) vertebrae, often seen in conditions like Down Syndrome or Klippel-Feil Syndrome, posing a risk to the spinal cord.
  • Os Odontoideum: A congenital non-fusion or abnormal development of the odontoid process (the tooth-like projection of the C2 vertebra), leading to atlantoaxial instability.
  • Craniocervical Junction Anomalies: Malformations at the junction where the skull meets the spine, such as Chiari malformations (where brain tissue extends into the spinal canal), often requiring decompression and stabilization if cervical instability is also present.

• Acquired Conditions: These conditions develop after birth due to various factors.

  • Trauma and Injuries:
    • Spinal Fractures and Dislocations: Injuries from falls, sports accidents, or motor vehicle accidents can cause fractures or displacement of vertebrae, leading to instability or compression.
    • Ligamentous Injuries: Damage to the ligaments supporting the cervical spine, resulting in instability.
  • Tumors: Both benign (non-cancerous) and malignant (cancerous) tumors can develop within or around the cervical spine, leading to bone destruction, compression of nerves or the spinal cord, and instability.
  • Infections:
    • Spinal Tuberculosis (Pott's Disease): A bacterial infection (more prevalent in India) that can destroy vertebral bone and discs, leading to kyphosis, neurological deficits, and instability.
    • Pyogenic Spondylitis: Bacterial infection of the vertebrae.
  • Inflammatory Conditions:
    • Juvenile Idiopathic Arthritis (JIA): In rare cases, chronic inflammation can affect the cervical spine, leading to instability or subluxation (partial dislocation).
  • Degenerative Conditions (Rare in Children): While typically associated with adults, conditions like disc herniation can occasionally occur in adolescents, causing nerve compression.

The Purpose and Goals of Surgery:

• Relieve Pressure on the Spinal Cord or Nerves: This is often the most urgent reason for surgery. Conditions like tumors, herniated discs, or bone spurs can compress these vital structures, leading to neurological symptoms.
• Stabilize the Spine: When the cervical spine is unstable due to fractures, dislocations, or congenital anomalies, it can move abnormally, risking severe spinal cord damage. Surgery aims to fuse vertebrae or use instrumentation to prevent such movement.
• Correct Deformities: Conditions like severe cervical scoliosis or kyphosis can not only cause pain and functional issues but also lead to progressive neurological deficits if left uncorrected. Surgery aims to restore a more normal spinal alignment.
• Prevent Further Neurological Damage: By addressing the underlying issue, surgery helps prevent the worsening of symptoms such as weakness, numbness, difficulty walking, bladder or bowel dysfunction, and problems with fine motor activities.
• Improve Symptoms and Quality of Life: Successful surgery can significantly alleviate pain, improve motor function, and enhance a child's overall quality of life, allowing them to participate more fully in daily activities.
• Prophylactic Surgery: In certain situations, even asymptomatic patients may undergo surgery if there is clear evidence of significant instability or a very high risk of future neurological compromise. A classic example is complete dislocation of facets or severe atlantoaxial instability, where waiting for symptoms could lead to irreversible damage.

Understanding the specific condition and the goals of surgery is paramount for parents, as it helps in making informed decisions about their child's care.

Preparation for Pediatric cervical spine surgery

Preparing a child for cervical spine surgery is a comprehensive process that involves detailed medical assessments, psychological preparation, and strict adherence to pre-operative instructions. Due to the delicate nature of the surgery and the unique needs of children, a multidisciplinary team often works together to ensure the best possible outcome.

Initial Consultations and Assessments:

• Detailed Medical History and Physical Examination: The surgeon will thoroughly review the child's medical history, including past illnesses, surgeries, allergies, and current medications. A comprehensive physical examination will be performed to assess the child's overall health and neurological status.
• Neurological Assessment: This is crucial for pediatric cervical spine cases. It includes evaluating motor strength, sensation, reflexes, balance, gait, and fine motor coordination to establish a baseline and identify specific neurological deficits.
• Psychological Evaluation: For older children and adolescents, a psychological evaluation might be recommended to assess their understanding of the surgery, address anxieties, and prepare them mentally for the procedure and recovery. Parental support and education are also key components.

Diagnostic Tests:

A series of diagnostic tests are essential to precisely map the spinal anatomy, identify the extent of the condition, and plan the surgical approach.

• X-rays:
  • Static X-rays: Provide basic images of the bone structure, alignment, and presence of deformities.
  • Dynamic X-rays (Flexion-Extension Views): Taken while the child moves their neck to assess spinal stability and identify areas of hypermobility or instability not visible on static images.
• Magnetic Resonance Imaging (MRI): This is the gold standard for visualizing soft tissues, including the spinal cord, nerves, discs, and ligaments. MRI is crucial for detecting spinal cord compression, tumors, infections, or other soft tissue abnormalities.
• Computed Tomography (CT) Scan: Provides detailed cross-sectional images of bone structures. It is excellent for evaluating complex bony deformities, fractures, and the exact anatomy of vertebrae, especially important for surgical planning and screw placement.
• Myelogram (CT Myelography): In cases where an MRI is contraindicated (e.g., due to metal implants) or when more detailed imaging of the spinal cord and nerve roots is needed, a contrast dye is injected into the spinal canal, followed by a CT scan.
• Nerve Conduction Studies (NCS) and Electromyography (EMG): These tests assess nerve function and muscle response, helping to pinpoint the exact nerves affected by compression or injury.
• Blood Tests:
  • Complete Blood Count (CBC): Checks for anemia or infection.
  • Coagulation Profile: Assesses blood clotting ability, crucial to minimize bleeding risks during surgery.
  • Kidney and Liver Function Tests: To ensure these organs are functioning properly, especially if certain medications are to be used.
  • Blood Typing and Cross-Matching: To prepare for potential blood transfusions.
• Cardiac Evaluation: An Electrocardiogram (ECG) and sometimes an echocardiogram may be performed to assess heart health, especially if the child has underlying cardiac conditions or if extensive surgery is planned.
• Pulmonary Function Tests: To evaluate lung capacity, particularly important if the child has respiratory issues or if prolonged anesthesia is anticipated.

Pre-Surgical Stabilization:

In cases of significant spinal instability, a device might be used to immobilize the cervical spine before surgery.

• Cervical Collar: A rigid or semi-rigid collar helps restrict neck movement.
• Halo Vest: For more severe instability, a halo vest may be applied. This involves a metal ring (halo) attached to the skull with pins, which is then connected to a vest worn on the torso. It provides rigid immobilization and may be used for a period before surgery or as part of post-operative care.

Medication Review:

Parents must provide a complete list of all medications, including over-the-counter drugs, herbal remedies, and dietary supplements, the child is currently taking.

• Certain medications, particularly blood thinners (e.g., aspirin, ibuprofen), may need to be stopped several days or weeks before surgery to reduce the risk of excessive bleeding. Specific instructions will be provided by the surgical team.

Food and Liquid Restrictions:

Strict adherence to food and liquid restrictions before surgery is vital to prevent aspiration (inhaling stomach contents into the lungs) during anesthesia.

• Solid Foods: Generally, children are advised to stop eating solid foods eight hours before arriving for surgery.
• Non-Clear Liquids: This includes formula, milk, orange juice, and other pulpy juices. These should be stopped six hours before arrival.
• Clear Liquids: Water, clear apple juice, or Pedialyte may be allowed up to two hours before surgery, but always confirm with the medical team.

Psychological Preparation and Education:

• Age-Appropriate Explanation: Parents should explain the surgery to their child in a way they can understand, using simple language and addressing their fears.
• Hospital Tours: Some hospitals offer tours to familiarize children with the environment, helping to reduce anxiety.
• Meeting the Team: Meeting the surgeon, anesthesiologist, and nurses beforehand can help build trust and ease apprehension.
• Parental Support: Parents should also prepare themselves, understanding the procedure, recovery process, and potential challenges. Support groups or counseling can be beneficial.

Thorough preparation ensures that the child is medically optimized and psychologically ready for the surgery, contributing significantly to a smoother procedure and recovery.

The Pediatric cervical spine surgery Procedure

Pediatric cervical spine surgery is a complex undertaking, requiring meticulous planning and execution due to the anatomical and biomechanical differences in a child's growing spine. The surgical procedure is tailored to the specific condition, location, and severity of the problem.

Anesthesia and Monitoring:

• General Anesthesia: The child is administered general anesthesia to ensure they are unconscious and pain-free throughout the surgery. An anesthesiologist continuously monitors vital signs, including heart rate, blood pressure, oxygen levels, and body temperature.
• Sedating Medicine: A sedating medicine may be given before the procedure to help the child relax and ease anxiety as they are taken to the operating room.
• Intraoperative Neuromonitoring: This is a crucial safety measure during pediatric cervical spine surgery.
  • Somatosensory Evoked Potentials (SSEPs): Monitor the integrity of the sensory pathways in the spinal cord.
  • Motor Evoked Potentials (MEPs): Monitor the motor pathways.
  • These techniques involve placing electrodes on the child's body to continuously assess nerve function. Any significant changes alert the surgical team, allowing for immediate adjustments to prevent neurological damage.

Surgical Approaches:

The surgeon's approach (from the front or back of the neck) depends entirely on where the compression or instability is located.

• Anterior Approach (From the Front of the Neck):

  • An incision is made on the front of the neck, usually along a skin crease to minimize scarring. The muscles, trachea (windpipe), and esophagus are carefully retracted to access the cervical spine.
  • Anterior Cervical Discectomy and Fusion (ACDF): This is a common procedure for cervical disc herniation or degenerative disc disease causing nerve or spinal cord compression.
    • The damaged disc material is removed (discectomy).
    • A bone graft (autograft from the child's own body, allograft from a donor, or synthetic material) is inserted into the space where the disc was removed.
    • A small metal plate and screws are often used to stabilize the vertebrae, promoting fusion.
  • Anterior Vertebral Corpectomy: In cases of severe spinal cord compression involving the vertebral body (e.g., from a tumor or severe kyphosis), a portion or entire vertebral body may be removed. The resulting gap is then filled with a larger bone graft or cage, often followed by plate and screw fixation.

• Posterior Approach (From the Back of the Neck):

  • An incision is made down the back of the neck, allowing access to the posterior elements of the vertebrae.
  • Laminectomy/Laminoplasty:
    • Laminectomy: Removal of the lamina (the bony arch on the back of the vertebra) to decompress the spinal cord and nerve roots. This is often performed for tumors, infections, or severe stenosis.
    • Laminoplasty: Instead of complete removal, the lamina is hinged open and secured in an expanded position, creating more space for the spinal cord while preserving some posterior bony structures.
  • Posterior Cervical Fusion: This technique is used to stabilize the spine, often in conjunction with decompression. Metal implants like hooks, rods, wires, or screws are precisely placed into the vertebrae and connected to create a rigid construct, which then promotes bone fusion. This is commonly used for congenital deformities, severe instability, or after complex trauma.

• Combined Approach:

  • For very complex deformities, severe instability, or extensive compression that involves both the front and back of the spine (e.g., multi-level kyphosis, global instability), a combined anterior and posterior approach may be necessary. This often involves two separate surgeries, either during the same anesthetic session or in stages, to achieve optimal decompression and stabilization.

Spinal Fusion Techniques:

Spinal fusion is a cornerstone of many pediatric cervical spine surgeries, aiming to permanently join two or more vertebrae into a single, solid bone.

• Bone Grafts:
  • Autograft: Bone taken from the child's own body (e.g., from the hip/iliac crest). It has the highest fusion rate as it contains living bone cells and growth factors, but requires a second surgical site.
  • Allograft: Bone obtained from a donor (cadaveric bone). It eliminates the need for a second incision but carries a slightly lower fusion rate.
  • Synthetic Grafts/Cages: Artificial materials designed to stimulate bone growth and provide structural support.
• Instrumentation: To hold the bone graft in place and provide immediate stability while fusion occurs, various metal implants are used.
  • Hooks, Rods, Wires, Screws, and Plates: These are made of biocompatible materials like titanium and are carefully chosen based on the child's age, bone quality, and the specific surgical plan.
  • Growing Rods: In very young children with progressive deformities (like severe scoliosis or kyphosis) where extensive fusion would severely stunt growth, growing rods may be used. These rods are initially implanted and then lengthened with minor surgical procedures every 6-8 months as the child grows, delaying definitive fusion until a more appropriate age. This approach is less common in the cervical spine but might be considered for combined cervicothoracic deformities.

Special Considerations for Pediatric Patients:

• Growth Potential: Surgeons must consider the child's future growth and development. Extensive fusion in very young children can impact spinal mobility and height.
• Bone Quality: Children's bones are different from adults'. Implants must be chosen and placed carefully to ensure optimal fixation and minimize complications.
• Minimizing Radiation Exposure: During surgery, fluoroscopy (real-time X-ray imaging) is used. In children, efforts are made to minimize radiation dose through advanced imaging techniques.
• Smaller Anatomy: The smaller size of pediatric vertebrae and spinal canals requires highly precise surgical techniques and specialized instruments.

The surgical team, led by an experienced pediatric spinal surgeon, meticulously plans each step, utilizing advanced imaging and intraoperative monitoring to ensure the highest level of safety and efficacy for the child.

Understanding Results

Pediatric cervical spine surgery, while complex, often yields remarkably successful outcomes, particularly when performed to prevent neurological deterioration or correct significant deformities. The results are measured not just by surgical success but also by improvements in the child's neurological function, pain levels, and overall quality of life.

High Success Rates:

India has established itself as a hub for advanced spinal care, with pediatric cervical spine surgery reporting high success rates.

• Overall Success: Studies in India and globally indicate success rates for pediatric cervical spine surgery ranging from 85% to 95%.
• Specific Procedures: For instance, Anterior Cervical Discectomy and Fusion (ACDF) procedures, commonly performed for disc-related issues, show 90-95% success for arm pain relief and 85-90% for neck pain relief. These high rates underscore the effectiveness of these interventions when indicated.

Clinical Improvement and Neurological Recovery:

One of the most critical indicators of success is the improvement in neurological function.

• Neurological Scores: Studies in India on pediatric cervical kyphosis, for example, have demonstrated significant clinical improvement postoperatively. This is often quantified using standardized neurological assessment scales such as the Nurick grade (assesses myelopathy severity) and the modified Japanese Orthopaedic Association (mJOA) scores (evaluates motor, sensory, and sphincter function). Post-surgical improvements in these scores indicate better nerve and spinal cord function.
• Pain Relief: Alleviation of chronic neck pain, radiating arm pain, and headaches associated with cervical spine pathology is a primary goal and a common positive outcome.
• Improved Mobility and Function: Children often experience improved range of motion in the neck, enhanced motor skills, better balance, and resolution of symptoms like difficulty walking or performing fine motor activities.
• Prevention of Further Damage: A key success is preventing the progression of neurological deficits and avoiding potentially irreversible spinal cord injury.

Correction of Deformity:

For conditions involving spinal deformities, surgical correction is a direct measure of success.

• Cobb's Angle Correction: In cases of cervical kyphosis (excessive rounding of the neck), a significant correction of the Cobb's angle (a standard measure of spinal curvature) is observed. For example, one study cited in the research noted a mean Cobb's angle correction from 40.7° to 14.9°, indicating a substantial improvement in spinal alignment. This not only improves appearance but also reduces stress on the spinal cord.
• Height Gain: While not the primary goal, children with severe spinal deformities often gain some height due to the straightening of their spine post-surgery.

Post-Operative Recovery:

The recovery journey is carefully managed to ensure optimal healing and rehabilitation.

• Hospital Stay: Children typically require a hospital stay of about 3-4 days, though this can vary depending on the complexity of the surgery and the child's overall health.
• Pain Management: Post-operative pain is managed effectively with appropriate medication, ensuring the child's comfort during the initial recovery phase.
• Wound Care: Instructions for incision care are provided to prevent infection and promote healing.
• Spinal Alignment: It is crucial to keep the repaired spine aligned during the healing process. Doctors provide specific instructions for home care, including limitations on activity and, in some cases, the use of a cervical collar or brace.
• Activity Restrictions: Full return to regular activities, including sports, may take 4 to 6 weeks, or even longer for more strenuous activities. The surgeon will provide a personalized timeline.
• Physical Therapy (Physiotherapy): This is often a vital component of recovery. A physical therapist will guide the child through exercises designed to:
  • Strengthen neck and back muscles.
  • Improve range of motion and flexibility.
  • Restore proper posture and body mechanics.
  • Enhance overall strength and endurance.

Long-Term Outcomes:

• Improved Quality of Life: The ultimate goal is to enable the child to lead a full, active life, free from pain and neurological limitations.
• Continued Growth and Development: For children, the impact of surgery on future growth is a key consideration. Surgeons aim to preserve as much spinal mobility as possible while achieving stability.
• Follow-up Care: Regular follow-up appointments are essential to monitor the fusion process, assess spinal alignment, and evaluate the child's long-term neurological status and overall progress. This includes periodic X-rays to check for solid fusion and hardware integrity.
• Potential for Adjacent Segment Disease: While rare in children, in the very long term, fusion can sometimes place increased stress on the segments above and below the fused area, potentially leading to problems there. This is carefully monitored during follow-up.

Overall, the results of pediatric cervical spine surgery in India are highly encouraging, offering children a chance at improved health, function, and a better future.

Costs in India

One of the most compelling aspects of seeking pediatric cervical spine surgery in India is the significant cost advantage without compromising on quality of care. India has emerged as a global leader in medical tourism, particularly for complex procedures like spinal surgery, due to its combination of advanced technology, expert surgeons, and highly competitive pricing.

Unmatched Affordability:

• Significant Savings: The cost of cervical spine surgery in India is dramatically lower than in Western countries like the United States or the United Kingdom, offering savings of approximately 60% to 85%. This makes specialized spinal care accessible to a much broader population, both domestically and internationally.
• Average Cost: The average cost of cervical spine surgery in India is approximately INR 3,60,000. However, it's crucial to understand that this is an average, and the actual cost can vary widely.

Factors Influencing Cost Variation:

Several factors contribute to the variability in the total cost of pediatric cervical spine surgery:

• Type and Complexity of the Procedure:
  • A simple single-level Anterior Cervical Discectomy and Fusion (ACDF) will typically be less expensive than a multi-level fusion, a vertebral corpectomy, or a complex revision surgery.
  • Procedures involving significant deformity correction or requiring both anterior and posterior approaches will naturally incur higher costs.
• Hospital Choice and Facilities:
  • Tier of Hospital: Costs are generally higher in highly equipped private super-specialty hospitals in metropolitan cities compared to government hospitals or smaller facilities in non-metro areas. These top-tier hospitals offer state-of-the-art infrastructure, advanced technology, and a wider range of services.
  • Location: Costs can vary by city. For instance, in Hyderabad, the cost can range from INR 2,85,000 to INR 4,60,000. Similarly, in other major cities like Delhi, Mumbai, Chennai, or Bangalore, the costs might fall within a comparable range, or be slightly higher depending on the specific hospital.
• Surgeon's Expertise and Experience:
  • Highly experienced and renowned pediatric spinal surgeons, especially those with international affiliations or extensive track records, may charge higher consultation and surgical fees. However, their expertise often translates into better outcomes.
• Patient's Medical Condition and Comorbidities:
  • Children with underlying health issues (comorbidities), complex congenital syndromes, or severe spinal deformities may require more extensive pre-operative evaluations, longer hospital stays, or specialized perioperative care, increasing the overall cost.
• Pre- and Post-Operative Care:
  • Diagnostic Tests: The number and type of diagnostic tests (MRI, CT, dynamic X-rays, nerve studies) required before surgery contribute to the overall bill.
  • Hospital Stay Duration: A longer stay in the intensive care unit (ICU) or general ward will increase costs.
  • Medications: Cost of pre-operative, intra-operative, and post-operative medications.
  • Rehabilitation/Physical Therapy: The extent and duration of post-operative physical therapy can add to the total expenditure.
• Type of Implants and Instrumentation:
  • The cost of spinal implants (screws, rods, plates, bone grafts, cages) can vary significantly based on the material (e.g., titanium), brand, and whether they are imported or domestically manufactured. Advanced or specialized implants for complex cases might be more expensive.

General Cost Range Across India:

• The average spine surgery cost across India can broadly range from INR 2,50,000 to INR 6,00,000.
• For less complicated procedures, the minimum cost might be around INR 1,20,000.
• For highly complex cases requiring advanced techniques, specialized implants, or prolonged hospital stays in well-facilitated metropolitan hospitals, the cost could potentially exceed INR 8,00,000.

Insurance Coverage:

• Most health insurance policies in India cover spine surgery as it is almost always considered a medical necessity rather than a cosmetic procedure.
• Parents are strongly advised to check the specifics of their insurance policy, including coverage limits, network hospitals, waiting periods, and pre-authorization requirements, well in advance of the surgery.
• Many hospitals have dedicated insurance desks to assist patients with the claims process.

In conclusion, while the cost of pediatric cervical spine surgery in India can vary, it consistently offers a highly affordable option for families seeking high-quality, specialized care for their children, making India a global leader in this niche medical field.

How Ayu Helps

Ayu simplifies your healthcare journey by digitizing medical records, making it easier to manage your child’s pre- and post-surgery information, appointments, and prescriptions securely and efficiently.

FAQ

Q1: How long is the recovery period for pediatric cervical spine surgery? A1: The initial hospital stay is typically 3-4 days. Full return to regular activities, including school, usually takes 4 to 6 weeks. Strenuous activities and sports might be restricted for several months, depending on the specific procedure and the surgeon's recommendations.

Q2: Will my child experience pain after the surgery? How is it managed? A2: Yes, some pain is expected after surgery. However, it is carefully managed using a combination of pain medications (oral or intravenous), which are adjusted to the child's needs. The medical team will ensure your child is as comfortable as possible.

Q3: Will my child need physical therapy after the surgery? A3: In most cases, yes. Physical therapy is often recommended to strengthen neck and back muscles, improve range of motion, and help the child regain optimal function. The duration and intensity of therapy depend on the individual case.

Q4: What are the long-term implications of cervical spine fusion in a growing child? A4: Cervical spine fusion in children aims to stabilize the spine and prevent neurological damage. While it can reduce mobility in the fused segments, the primary goal is functional improvement. Long-term follow-up is crucial to monitor the fusion, adjacent segments, and overall spinal health as the child grows.

Q5: When can my child return to school and sports activities? A5: Most children can return to school within 4-6 weeks, often with some restrictions on physical education or heavy lifting. Return to sports and more strenuous activities is usually permitted after 3-6 months, or once the fusion is solid and approved by the surgeon, depending on the sport's impact level.

Q6: Are there alternatives to surgery for pediatric cervical spine conditions? A6: For some less severe conditions, non-surgical options like physical therapy, bracing, medication, or observation might be considered. However, for conditions causing spinal cord compression, significant instability, or progressive deformity, surgery is often the only effective treatment to prevent irreversible neurological damage.

Q7: What are the signs of a complication after pediatric cervical spine surgery? A7: Parents should be vigilant for signs such as fever, increasing pain not relieved by medication, redness or swelling at the incision site, drainage from the wound, numbness or weakness in the arms or legs, difficulty breathing or swallowing, or changes in bladder/bowel function. Report any of these symptoms to your medical team immediately.

Q8: How often will my child need follow-up appointments after surgery? A8: Follow-up schedules vary but typically involve appointments at regular intervals (e.g., 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter) to monitor healing, assess fusion, and check neurological status. X-rays are usually taken at these visits to track progress.