Questions to Ask When Choosing Your Child’s Spine Surgeon

Preparing for your child’s spine surgery can feel overwhelming, and you want to make sure they’re in the hands of the best pediatric spine surgeon possible. Nicholas Fletcher, MD, Medical Director of the Spine Program at Children’s breaks down some of the most important questions to ask your child’s spine surgeon.

Preparing for a child’s spinal surgery can be a very anxious and uncertain time for any parent. You want to be sure that your child will be getting the absolute best care possible with a surgeon you trust. Choosing a surgeon and a hospital for your child’s spine surgery can feel like an overwhelming task, so we are here to help you make that process a bit easier.

If your child needs spine surgery, we understand you may have a lot of questions and concerns. Dr. Nicholas Fletcher is the Director of the Spine Program at Children’s and a board-certified orthopedic surgeon who specializes in pediatric orthopedics, and he has broken down some of the most important questions you should ask your spine surgeon.

Dr. Fletcher with spine surgery patient

Question 1: How many spine surgeries do you perform each year?

As with any other skill, we get better the more we do something. Research shows that a surgeon needs to have a minimum threshold under their belt every year to stay proficient.

“The same way pilots need to do simulations and training to make sure they stay safe and comfortable when flying, surgeons need to operate often to be able to manage complex problems as they arise," Dr. Fletcher explains. "If your surgeon is only performing surgery on kids or teens a couple times a month, you may want to consider a consultation with a surgeon who treats pediatric patients more often. Doctors who perform surgery more often are more proficient and may be able to have less time in the operating room, which can lead to lower complication rates and better outcomes."

At Children’s, we are experts in diagnosing, treating and caring for kids and teens with spine issues. More parents trust the experts at Children’s for spine surgery than anywhere else in the U.S.* Each of the surgeons in our Spine Program perform more than 55 spine surgeries per year on average. We perform more spine surgeries than any other pediatric hospital in the nation—with exceptional results, like a shorter stay in the hospital after surgery than average compared to other Children’s hospitals in the country.*

Question 2: What is your program's national ranking in pediatric orthopedics?

“National ranking, in many ways, signifies a hospital’s dedication to quality improvement over time,” says Dr. Fletcher. “The fact that hospitals like Children’s are willing to commit to maintaining a level of proficiency to be nationally ranked suggests a dedication to providing the best care to every patient.”

It is important to know that the hospital team you are trusting with your child’s surgery maintains a standard that is at or above the rest of the country. Children’s has the only nationally ranked orthopedics program for kids and teens in Georgia, and is the first organization in the state to meet the criteria for a Level 1 Children’s Surgery Verification from the American College of Surgeons.** Our program is ranked among the top 10 in the nation on the U.S. News & World Report list of “Best Children’s Hospitals” for 2023-2024.***

Question 3: Will my child’s surgery be performed at a pediatric hospital?

Kids and teens are not just small adults. Making sure they get specialized care by medical professionals who are specially trained in working with young bodies is incredibly important.

“It comes down to understanding the nuances of managing a 16-year-old who weighs 150 lbs vs. an 8-year-old who weighs 40 lbs,” Dr. Fletcher says. “It’s the comprehensive system of pediatric anesthesiologists, surgeons, radiologists, physical therapists and other members of the overall medical team that understand the differences in working with bodies that are still growing and developing.”

In a general hospital, a pediatric patient may not be the norm, where the operating team is more used to and comfortable working with adults. Pediatric specialists are trained to manage children with neuromuscular problems in a way that general providers may not be as familiar with. This continuity of care flows directly into the operating room, from the people who are managing a patient’s blood—and are equipped to handle any age- and size-specific issues that arise, to the surgeons dealing with size-appropriate implants or devices. In addition, pediatric radiologists understand how to manage X-rays, before and after surgery, using a lower dose protocol.

Some facilities can’t guarantee a pediatric anesthesiologist for your child—we do.

While some hospitals may not be staffed to meet this need, at Children’s, every baby, child and teen receives care from a pediatric anesthesiologist who understands best practices for growing bodies.

Learn more

Question 4: What kind of physical therapy will my child have after surgery?

As important as it is to be cared for by a pediatric surgical team in a pediatric hospital, it is just as crucial to have postoperative care, including physical therapy, provided by experts trained in working with kids and teens.

“All of our patients see pediatric-trained physical therapists and occupational therapists while in the hospital,” Dr. Fletcher notes. “This ensures that all of the child’s immediate postoperative needs are being met.” Your child will typically also receive physical therapy after their first follow-up visit. Depending on your child’s needs, our expert pediatric physical therapists will determine how much therapy your child will need, and for how long.

Having a network of Children’s pediatric therapists available makes all the difference in your child’s care after surgery. “Instead of being treated by adult providers, who may not be comfortable working with a child who has rods and screws in their back after spine fusion surgery, our physical therapists completely understand and anticipate the specific needs of kids and teens,” Dr. Fletcher explains. “Our postoperative pathway was the first of its kind in the country, and has continued to be the template that other centers use to modernize their postoperative care.”

Question 5: Are you an active member of any pediatric orthopedic research groups or societies?

This question was most likely not even on your radar, but it could be an important factor in choosing your surgeon. “Being an active member of either the Pediatric Orthopedic Society of North America (POSNA) or the Scoliosis Research Society (SRS) suggests that your surgeon is dedicated to being on the forefront of spine and orthopedic care,” Dr. Fletcher says. “Through these organizations, providers can stay up to date on the highest level of information and research on a large scale. You want your surgeon to be equipped with the latest techniques from robotics to custom rods and beyond, in order to make sure your child is receiving the best care available.”

At Children’s, we take our dedication to leading-edge care seriously. Dr. Fletcher has served POSNA and SRS as Chair of the Quality, Safety and Value Spine Committee and is a member of the board of POSNA. All of our spine surgeons and specialists are members of at least one, if not both of these societies, and are committed to providing the most comprehensive, innovative and compassionate care to every child.

Where you take your child for surgery matters. At Children’s, we perform more spine surgeries than any other pediatric hospital in the U.S. "With quantity in healthcare, there is a lot of evidence to support the fact that it breeds quality,” Dr. Fletcher says. “You get repetition, experience and professionals who are comfortable at all levels of care.”

At Children’s, with our high volumes and outstanding outcomes, we have been deliberate in making sure that all aspects of care are catered especially to growing kids and teens. We use the most modern technology to maintain the highest level of safety possible, whether it be in navigation or robotics or pediatric-specific anesthesia.

Our goal is to take some of the stress and confusion out of the process of preparing for your child’s spine surgery. If your child needs spine surgery, our professionals will walk you through every step to prepare you for the road ahead.

Where you take them matters.

Request an appointment with the only nationally ranked orthopedic program for kids and teens in Georgia, and we’ll help you understand your child’s diagnosis and create a comprehensive treatment plan.

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Nicholas D. Fletcher, MD, is the Medical Director of the Spine Program at Children’s Healthcare of Atlanta and a pediatric orthopedic surgeon. He is also a professor of orthopedic surgery at Emory University School of Medicine. Dr. Fletcher’s areas of clinical expertise include spine and hip conditions. For children with scoliosis, kyphosis and spondylolisthesis, he offers a range of nonsurgical and surgical options, including Mehta casting, bracing and posterior spinal fusion, as well as magnetic expandable growing rods (MAGEC) and Vertebral Body Tethering (VBT).

This content is general information and is not specific medical advice. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on the Children’s Healthcare of Atlanta team are independent providers and are not our employees.

*Pediatric Health Information System (2023), as prepared by the Children’s Hospital Association. This report compares clinical data annually for more than 52 pediatric hospitals in the U.S

**American College of Surgeons Children’s Surgery Verification (CSV) Quality Improvement Program (2023).

***No. 10 on the U.S. News & World Report “Best Children’s Hospitals” list for 2023-24