Scoliosis surgery may be associated with major blood loss and postoperative voiding difficulties. The magnetically controlled growing rod (MCGR) is the latest innovation developed for early onset scoliosis treatment. Patients with neuromuscular disorders often have an increased risk of pneumonia and decreased lung function, which may further be compromised by scoliosis. Thisthesis examines new surgical methods for scoliosis in paediatric patients, specifically, the effect of adding gelatine matrix with human thrombin to the standard surgical methods of controlling blood loss, and the effectiveness of the MCGR technique in previously operated children. This study also evaluates the effect of scoliosis surgery on the risk of pneumonia in patients with neuromuscular scoliosis (NMS) and on the risk of postoperative voiding difficulties in young patients undergoing posterior spinal fusion (PSF) for idiopathic scoliosis. 

The study consists of four separate parts with different study populations in each part (in total, 263 patients). One study is a randomised clinical trial, one is a prospective cohort study and the other two are retrospective studies. All the patients of the study were children or young adults under the age of 21. Data for one part of the study was collected from various countries; the three other parts used data solely from the Finnish population.

The addition of gelatine matrix with human thrombin to conventional methods of achieving haemostasis reduces both intraoperative blood loss and the decrease in haemoglobin concentration postoperatively in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. Scoliosis can be equally controlled after conversion from traditional growing rods to MCGRs, but spinal growth from baseline is less in conversion patients, compared to that of the primary group. Scoliosis surgery does not decrease the incidence of pneumonia in patients with severe NMS. Postoperative voiding difficulties affect almost half of the patients under 21 years of age undergoing PSF for idiopathic scoliosis. The main risk factors were found to be increased intraoperative blood loss, longer length of surgery and male gender.