Prior to the day of surgery you will meet with Dr. Osterdock to review all of the plans for surgery as well as the MRI scan. You will have the opportunity to ask any questions that you have. Sometimes it is helpful to come to the appointment with a list of questions that you have regarding surgery so that the important ones are not forgotten.
Typically, after this appointment you will be sent over to the lab to have blood work done which is essential for surgery. Most children will only need a CBC (complete blood count) and possibly urinalysis to look for signs of infection.
The Night Before Surgery
You will be called by the anesthesiologist prior to surgery to discuss any concerns and so they can familiarize themselves with your child’s history. All of the anesthesiologists are Pediatric trained anesthesiologists and there are no other individuals involved in your child’s anesthesia.
Continue your child’s normal routine as much as possible prior to surgery. It is important that you follow the following guidelines for feeding your child prior to surgery:
The Morning of Surgery
You will check in at the main admissions desk at the Rocky Mountain Hospital for Children. They will then direct you to the Pre-op area on the second floor.
Once you have checked in you will meet the nurses who will get your child ready for surgery and the nurses who will take care of your child in the operating room. You will also meet the anesthesiologist who will take care of your child in surgery. Dr. Osterdock will also meet with you again to answer any additional questions and finish the paperwork.
Once your child is taken back to the operating room you will be taken to the waiting room where the nurses will be able to update you throughout the procedure. The anesthesiologist and nurses will be working on starting iv’s and monitors that are necessary for keeping your child safe during the surgery. This can sometimes take a while just to get everything set up properly for surgery.
The nurse will call out to the waiting room to let you know when the surgery actually begins. The typical operating time is around an hour. The surgery will be performed by Dr. Osterrdock herself, there are no residents or students involved in the surgery. Dr. Osterdock will then come out to the waiting room to talk with you as soon as the surgery is complete.
After the surgery your child will go to the recovery room and then to the pediatric floor once he is stable. No ICU stay is required. As soon as your child is awake and stable you will be allowed to be with your child. Once your child is awake he/she can be held, talked to, breast or bottle fed, or whatever is soothing.
Typically your child is kept with the bed flat to keep the head and the body at the same level for the first 24 hours after surgery to prevent spinal fluid leak. It is OK to lie on the back, front or either side, we just want to keep the head down. This reduces the fluid pressure on the sutures that are used to close the spinal canal. After the first 24 hours her activity will be increased gradually depending on the age of the child. It is also important to keep the diaper off the wound to prevent urine and stool from getting into the wound. The nurses will show you how to roll the diaper to create a pocket to protect the incision. There will be a layer of glue over the incision and this will help protect the wound as well. All of the sutures are under the skin and they will not need to be removed.
The usual hospital stay is two days and most children are back to fairly normal behavior after 24-36 hours. Infants tolerate the procedure very well and typically return to normal very quickly. Older children will have a little more pain and may be slower to get back to normal activity. Most infants only require tylenol at the time of discharge. You will be able to bathe your child 2 days after surgery but this will need to be a sponge bath or shower. You will not want to soak the incision under water until the wound is fully healed. Dr. Osterdock will check the wound in clinic prior to allowing the incision to be submerged under water.
Once You Go Home
Once you go home you should pay attention to keeping the wound clean and keeping the diaper off the wound. If the wound becomes soiled, rinse with soapy water and pat dry.
Do not put any ointments or creams on the wound until approved by Dr. Osterdock.
Older children should avoid contact sports for about 3 months after surgery but may otherwise return to normal activities. They may return to school as soon as they feel up to it.
Typically Tylenol is all that is required for pain control but older children may require something a little stronger which will be prescribed prior to your discharge.
You should call the doctor if any of the following occur:
- Fever greater than 101.5
- Any drainage of fluid from the wound
- Your child does not have an appropriate number of wet diapers for their age
- There is significant redness or drainage from the incision
- You have any concerns that your child is not acting right
You will have a follow-up appointment with Dr. Osterdock 2-3 weeks after surgery. Further follow-up will then be 3 months later and typically once a year until your child is potty trained.