What is the Shilla Procedure?

This a technique used that allows for the natural growth of the spine and correction of the spine at the same time.

The Shilla is similar to a track and trolley system. The rods are placed but are partially fixated to the spine. This allows the system to “grow with the spine”. Rod breakage can occur and this is a normal outcome. When this happens revision surgery is indicated. This is a newer technique being applied at leading centers across the country.

Pedicle Screws are inserted at specific points in the spine. Screws in the center are holding the rods in place. Other screws allow for the spine to move and elongate at either end.

What happens if the rods break?

The patient is evaluated at that time for the amount of growth remaining, curve size and physical appearance of the spine, chest and trunk.

Broken Rod

There are several options when the rods break:

  1. The system can be removed.
  2. The system is removed, and the patient has another Shilla placed.
  3. The system is removed, and the patient goes on to a spinal fusion procedure.

What is the average length of surgery?

From 4 to 6 hours

What does the surgical procedure involve?

Typically patients are hospitalized for five days. Patients spend the first night in the Pediatric ICU for one on one nursing care. The patients then usually go to the orthopedic floor. (10th floor)

What is the typical Post operative care?

  • Patients work with physical therapy in the hospital only
  • Patients will take it easy for four to six weeks following the surgery
  • Patient’s incision will be covered by a dressing. This dressing is removed day 3 by the orthopedic resident physician.
  • Patients will go home with steri strips on the incision. These should remain on until they are peeling off.

Will the patient be on pain medication post operatively?

Yes, Children are followed by the pain service team while in the hospital. At first the patient will be on Intravenous (IV) pain medication. Then once the child is eating or tolerating feedings they are switched to oral medications.

The oral medications will be the same medications that the child is sent home on.

Typically at home most families report that the children take the pain medication for the first few weeks. We have even had children that have not taken any medication at all once they went home. This is all dependent on the child!

What does the incision look like?

Single line down the back and the length depends on the levels that need to be treated.

Will the patient have spinal cord monitoring?

This is decided on a patient by patient basis. If the patient has normal neurological functioning prior to the procedure, then there will be spinal cord monitoring.

How long are patients out of school?

Patients tend to be out of school for about 4 to 6 weeks.

Walking Through the Surgery Steps…

Pre Op care: Patients are given a prescription and asked to bath/shower with Hibiclens solutions for the 3 consecutive days prior to surgery

Checklist prior to Surgery:

  • Pre op Visit
  • Meet with Physical therapy if available during pre-op visit
  • Anesthesia consult if needed
  • Primary care doctor/ Pediatrician Clearance
  • Clearance from other services seen
  • Blood Donation to Red Cross (If you want direct donor blood)
  • Pulmonary Function Tests
  • Lab work

What do you need to do pre operatively?

  • Pick up pre operative Hibiclens and Bactroban if needed
  • Send in school homebound education forms and FMLA paper work if necessary
  • STOP SMOKING… it decreases healing time! Dr. Luhmann usually does not do spine fusion if you smoke or use smokeless tobacco.
  • STOP ibuprofen or products because can lead to increase risk of bleeding

What do we do the night before surgery?

  • If you live far…you may want to stay at a local hotel because you will be required to be here early. ( about 6 am)
  • The patient may not have anything to eat or drink after Midnight
  • Please shower thoroughly shampooing your hair the night prior to surgery and be sure to use the Hibiclens back wash for the last night
  • Please remove any nail polish, and be sure your nail beds are clean for surgery

What do I need to bring to the hospital? You may bring:

  • Current List of Medications, dosages and frequency
  • T-shirt/undershirt for under brace, if necessary
  • Robe
  • Slippers
  • Personal Items of comfort (blanket, stuffed animal, books, movies)
  • Toiletry items you feel you will need during your stay
  • Comfortable clothes for day of going home

Can my mom, dad or caregiver stay at the bedside?

  • In the Pediatric Intensive Care Unit (PICU) two people can visit at a time, but they can not sleep in the room with the patient.
  • Parents can sleep in the PICU lounge.
  • On the Floor- One parent can sleep at the bedside. The other parent can sleep in the parent lounge. Typically there is not a roommate. If there is not a roommate… both parents are welcome to stay the night.

Dr. Luhmann: will see you at the preoperative visit. He does not typically see patients prior to surgery. If there are any questions or concerns prior to surgery, please call Debbie or Kim before the day of surgery.

Same Day Surgery:

The 6th Floor Same Day Surgery Unit is where you and your family will begin your journey. The day of surgery you will be able to meet with the, anesthesiologist, child life therapist and nurses. Your weight, height and vitals signs will be obtained. You may be given medication prior to surgery by the nurse.

Operating Room:

You will be able to pick a flavor for the mask that will help us put you to sleep. While you are a sleep we will place an IV (intravenous catheter) and Foley catheter (bladder) if needed.

Your back and or abdomen/chest will be cleaned prior to surgery with special soap. Gel pads and pillows will be used to have you placed in a comfortable position for surgery.

We will have special electrodes placed on your body to check for neuro/sensory movement. There may be a time that we will ask you to move parts of your body. You will not fully be awake. You will have pain medication that will keep you comfortable.

Post Anesthesia Care Unit (PACU):

We will wake you up when the surgery is complete. You will then be wheeled in a bed to the PACU. When you are awake, we will be able to call your parent(s) or caregiver to be with you. In the PACU, you will be closely monitored by the doctors and nurses.

Pain Control - You will have a Patient Controlled Anesthesia (PCA). This is controlled by the Pain Service Team. The pain service team is a special team of doctors (anesthesiologists) and nurses who are trained in monitoring your post operative pain. If the patient is able to comprehend, the patient will be able to press the button for pain medication. The patient may also be delivered medication continuously through the PCA.

The back incision will be covered with steri strips, a bulky back dressing, and one or more Hemovac(s), wound drains, may be present. You will be asked to lay flat for 6 hours.

Pediatric Intensive Care Unit/PICU:

Patients will typically stay at least one night in the PICU. The PICU is set up to allow close patient monitored care. The nurses in the PICU will have 1-2 patients at a time depending on the acuity.

Parents are allowed to visit, but they are not allowed to sleep in the PICU. There is a parent lounge with lockers to hold personal items and chairs that pull out for sleep.

Patients will be turned approximately every 2 hours while in the hospital. Patients will be turned using the log roll method. The nurses and physical therapists will go over with the family how to turn the patient properly. The physical therapist will be available to get the patient out of bed for the first time the morning after surgery. Some patients may have to wait until the brace is available.

Patients will have a bulky back dressing that will remain intact until taken off by the orthopedic resident physician on day 3. Patients may have one or more Hemovac(s). A Hemovac helps to drain out access blood under the incision. The Hemovac is typically emptied every four hours.

Pain medication will be delivered through the PCA until the pain service has made a decision to change to oral medications. Typically the patient needs to be drinking, eating, and tolerating a diet for this to occur.

Generally after surgery the patient will only be allowed ice chips until return of bowel function.

Patients will also be receiving Intravenous Fluids (IV fluids). Some patients may require additional nutritional supplementation of TPN and Intralipids this decision will be made by Dr. Luhmann.

It is important for the patient to use the incentive spirometer to encourage pulmonary toilet. The patients can also do things like blow bubbles or pretend to blow out candles of a birthday cake. The patient with a history of asthma, CP, or neuromuscular issues may have respiratory therapy involved with either breathing treatments and or continuous pulmonary toileting CPT (every four hours).

Surgical Floor/ 10th Floor:

The typical stay for a patient in the hospital is 5-7 days. Patients are typically transferred to the 10th floor which is home to the orthopedic patient. This is a 30 bed unit with both single and double rooms. You may have a roommate.

The 10th floor has a parent lounge and small kitchen with a refrigerator and microwave.

Patients are turned every two hours. Patients need to be up out of bed two to three times a day. For the patient to be up out of bed the patient will need sit in the bedside chair, wheelchair or ambulate in the hall.

Pain medication is adjusted per the Pain Service.

It is important for patients to use the incentive spirometer, blow bubbles and or pretend to blow out candles on a birthday cake. The bedside nurse will be able to assist with this. These are all ways to help expand the lungs. Some patients will require respiratory therapy.

Patients will have a bulky back dressing that will remain intact until taken off by the resident physician on day 4. The Steri-Strips on the back should remain intact until they fall off. Do not pull them off.

The Foley catheter is typically removed day 3. If patient is stool/urine incontinent the lower 1/3 of the back incision will be covered with a dressing. This will be changed per nursing staff every shift as needed.

Diet - Patients may experience some difficulty with nausea and bloating. It is important to take it slow with food. When you have signs of bowel sounds, we can progress from ice chips. We will first start you off with clear liquids and then progress to food. Please let the nurses know if you are experiencing nausea because a medication such as Zofran can be given to help alleviate symptoms. You will be given a stool softener twice a day after you are eating. The stool softener helps moves things along! The pain medication that you will be taking can lead to constipation. It is important to drink plenty. On the fifth day you will be given a suppository to assist you in having a bowel movement.

When to call the doctor?

  • Fever greater than 101.5
  • Redness, Warmth or Drainage from the incision site
  • Increase pain not relieved by pain medication

Follow up in 4-6 weeks after surgery. You can call Debbie when you are at home after surgery.

Try to plan going home with medication timing. The outpatient pharmacy is located on the first floor near the information desk. The ride in the car can often be bumpy! Bring your pink bucket home just in case you get sick to your stomach.

2 weeks after surgery -The patient may shower, bath or swim in a chlorinated or salt water pool. NO swimming in natural body of water for 6 weeks.

Please note that the patient may not have body piercing or tattoos placed until 4 weeks after surgery.

For more information about the shilla procedure call 314.454.5437 or Email Us.

Online Resources:

http://www.stlouischildrens.org/

http://www.ortho.wustl.edu/

http://www.posna.org/

http://www.aaos.org/