Before your surgery

Before Surgery DMC

Before Your Spine Surgery

The decision to undergo surgical treatment is a personal decision that should be based on objective medical science and a careful benefit risk analysis that is unique to each patient. Once you and doctor Hepler make that decision its very important you make necessary preparations to optimize your chance for a healthy and uneventful recovery. Below you will find a number of steps to help you get ready for your spine surgery.

Pre-approval

Before your surgery can be scheduled, both the insurance company and hospital will need to approve your procedure based on each institution’s guidelines. This process can take several days to several weeks depending on the condition and planned treatment. Once the approval process is completed the office will coordinate with you to schedule your surgery.

Preoperative visit and consent

Prior to your surgery you will have a preoperative evaluation with Dr Hepler to discuss your condition, review your treatment options, and discuss the rationale for surgical management. Dr. Hepler will also discuss the risks and benefits of surgical treatment and have you sign consent forms for surgery. Feel free to ask any questions you have regarding your condition or its planned treatment. The conditions and treatment pages of the website have material to help you familiarize yourself with your diagnosis and its treatment options including surgery before your preop visit.

Medical evaluation

Most patient will require an evaluation with their primary physician or appropriate medical specialist to ensure your health is optimized prior to surgery. This often requires basic labs, chest xray, EKG, or other possible workup. Your medical doctor will make recommendations regarding medications prior to surgery. In general you should discontinue anti-inflammatories and anticoagulants 5-7 days before surgery.

Preparing yourself physically and mentally

Its important to take steps to ensure you are in the best health mentally and physically to optimize your outcome and ensure a healthy recovery. Here are some tips to help you focus on a smooth recovery.

• • Remain as active as possible including your normal exercise regimen. Patients in good cardiovascular health are less likely to develop complications.
  • Watch your weight. Patients who are overweight have more risks and complications with medical and surgical treatment.
  • Stop smoking. Smoking decreases oxygen delivery, impairs healing, decreases outcome and increases risks.
  • educate yourself about your condition and treatment and discuss any questions with your doctor. You should be comfortable, confident, and ready for your surgery.
  • discuss your plans with family and friends, especially those who may be involved with your recovery. Consider bringing them to your preop visit.
  • Case management. Most patients are able to be discharged home following hospitalization. Some patients may require and qualify for home care including visiting nurse or therapy services from a home care agency. Some patients have additional needs and may require an extended care facility before they are optimized for the home environment. Various factors including physical need and insurance coverage determine eligibility and a case manager might be consulted to help with these options.

Days before surgery

Prepare your home to make it safe and comfortable when you return after surgery. Keep a wireless phone with you. Move furniture so you have clear paths for transit to commonly used areas. Remove loose rugs that may make you trip or fall. Stock necessary items so you don’t need to store for groceries and toiletries for the first 2 weeks after surgery.  

Preventing infection is essential for a good outcome. One way to decrease the risk for infection is washing with antimicrobial soap before your hospitalization. Shower once a day for two days before surgery and the morning of your surgery with Chlorhexidine soap. You can obtain this soap in your local pharmacy. Do not use Chlorhexidine if you are allergic to it, and avoid getting soap on your head or face.

Do not eat after midnight the night before your surgery. Absolutely nothing by mouth 4 hours before surgery.

Day of Surgery

Once you arrive at the hospital you will be admitted in the preoperative waiting area by the preop care nurse. Have a list of your preoperative medications and allergies available. You will be changed into a gown, given a ID bracelet, compression stocking placed, and an IV started. The anesthesia team will meet with you, perform a H+P, and answer any questions you have regarding anesthesia for your procedure. Family members or friends can stay with you until you are taken to the operative theater.

After surgery you will be taken to the post-anesthesia care unit (PACU) where you will remain for 2-4 hours. Then you will be discharged home or transferred to the spine surgery stepdown unit.

Hospitalization

The first 24 hrs after surgery is focused on stabilizing your condition and keeping you comfortable.

Pain control: You will be given IV pain medications every 2-4 hrs as needed until you are able to transition to an oral medications. Patients with fusion procedures will usually be given patient controlled pain pump (PCA) until transition to oral medications. You will also be provided orders for medications for sleep at night, nausea, or constipation as needed.

Mobilization and rehabilitation: It’s important to begin mobilization as soon as possible to decrease risk for blood clots, urinary tract infections and pneumonia. Most patients will begin transfers out of bed to chair and weight bearing as tolerated the day after surgery. A physical therapist will evaluate you and assist with progressive mobilization including the use of any ambulatory aids (cane, walker) as needed.  

Diet: You will be gradually advanced to a liquid then regular oral diet as tolerated. Pain medications can cause constipation so patients are often given stool softeners and suppositories if needed.   

Incentive Spirometer: Anesthesia and shallow breathing after surgery can cause air spaces in your lungs to close increasing risk for pneumonia. Deep breathing exercises are important to open the lung base and clear your airways. You should take 10 deep long inspirations with the spirometer every 2 hours while awake to optimize your post operative lung function. Early mobilization out of bed will also facilitate these efforts.

Discharge planning: Most patients will be discharged home once they are tolerating a regular diet, tolerating pain with oral medications, and are safe for their home environment. The physical therapist, social worker, and rehab consultant will work together to evaluate your progress and assess your discharge needs and what insurance approves. Post discharge planning may include visiting nurse services at home or transfer to a rehabilitation or nursing facility before home discharge.

After Lumbar discectomy/laminectomy

Most patients with discectomy/laminectomy can be treated with outpatient surgery. Patients are discharged home the day of surgery with instruction for weight bearing tolerated. Avoid bending, lifting, and twisting and avoid activities that aggravate pain. You should be scheduled for a follow up visit 7-10 days after surgery. Healing usually occurs within 4-6 weeks at which time you can begin a structured physical therapy program. Review Laminectomy/discectomy post operative instructions for more information on your postoperative care.  

After Cervical or thoraco-lumbar fusion procedures.

Most patients treated with fusion procedures will require some period of hospitalization before being discharged home. Patients should avoid bending lifting twisting, and gradually increase their ambulation and activities as tolerated. Schedule a follow up visit within 7-14 days of surgery. Once the wound has healed and there has been sufficient bone healing (6-12 weeks) a structured physical therapy program is started for range of motion and strengthening exercises. Most patients return to full unrestricted activities within 2-6 months depending on the specific procedure performed and each patients medical status. Review Cervical fusion post op instructions or Anterior Posterior Spine Fusion post op instructions for more information on your postoperative care.  

Frequently asked questions

How long do I need a bandage?

Your bandage should be changed daily. This helps keep it clean and dry and ensures you the opportunity of identifying any trouble signs of infection (increased redness, drainage, or dehiscence). The incision should be healed within 14 days and dressing can be discontinued within 7-14 days in most cases. Call if you have any questions and follow up within 7-10 days of surgery for routine evaluation.

How long should I use compression stocking and spirometer?

Stockings and spirometer should be used until you are spending most of your time out of bed. This is usually 7-10 days for most fusion patients and 2-4 days for outpatient procedures.

Should I use ice or heat?

Ice is most appropriate for the first few days after injury or surgery. Afterwards you can use ice or heat or whatever combination seems most helpful. Be sure to keep your wound clean and dry.

When can I shower?

Keep your wound clean and dry for 2 weeks after surgery. You may begin to shower with the incision covered 48 hours after surgery. Keep the shower stream away from your incision and pat it dry afterwards. Do not use bath tubs or pools for minimum of 4 weeks and until cleared by your doctor.  

What do I do if I have constipation?

The narcotic medications, anesthesia and inactivity increase constipation in many patients. Wean your narcotic medications as soon as possible. Anti-inflammatories within 5 days if not contra-indicated or Tylenol will help. Increasing your mobility and activity level and returning to a normal schedule are very important. Plan on taking a stool softener (Metamucil or Colace) three times daily and drink plenty of fluids. Suppositories may also be used. If you continue to have constipation contact your medical doctor for further options.

When do my stitches come out?

Your stitches will be placed beneath the skin and do not require removal. You will have steri strips over the incision which should flake off within 2 weeks.

When do I follow up with the surgeon?

You should be seen in the doctor’s office for routine re-evaluation at 2 weeks, 6 weeks, 12 weeks for all post op cases and 6, 12, and 24 months for fusion procedures.

When can I drive and travel?

You should not drive until you are off narcotics and can safely handle your vehicle and an emergent situation. This is usually within 1-4 weeks depending on the specific patient and procedure. You should not travel out of town for at least 4-6 weeks. Check with your surgeon.

When can I return to work?

Your ability to return to work will vary based on your procedure and individual health. Most decompressions (discectomy/laminectomy) return to work within 5-14 days and fusion procedures within 2-4 weeks. Check with your doctor for specific dates and activity restrictions.