Preparing for Surgery

When to Have Surgery

Most spine problems improve without surgery. Some people however need surgery to prevent a progressive problem or may find their pain or weakness relieved only after surgery. But surgery does have its limitations. It can't remove all the effects of overuse or aging, and it does have risks.

The reasons to have surgery on your spine may be persistent pain in your neck, arms, or legs, which affects your ability to work or causes weakness in your arm, hand or leg.

Other indications for spine surgery would be a tumor of the spine, instability of the spine or difficulty in walking, caused by pressure on the spinal cord, which could lead to paralysis.

Exercise

It is important for you to be in the best physical and mental health possible before your operation. To assure this, eat a healthy diet and exercise. Dr. Park may recommend a program of physical therapy consisting of stretching, strengthening and general aerobic conditioning. The better shape you are in when you go into surgery the better you will do afterward. Whatever else you can or can't do, WALK as much as possible.

Medications

It is very difficult to achieve good pain control after surgery if a person already has developed a tolerance to the narcotic pain medication. For this reason, we ask that you are weaned off all narcotic pain medications and muscle relaxants well in advance of your surgery, if at all possible.

In general, you should continue all your prescription medications (blood pressure medications are a good example) on the regular schedule, including your normal dose(s) on the day of surgery. Regular medications may be taken safely with a small sip of water on the day of surgery. However, several medications may need to be stopped prior to surgery including blood thinners, aspirin, anti-inflammatory, herbal drugs, and diabetic medications. Please provide us with an accurate list of all medications you currently take. Your surgeon and the anesthesia staff will help determine how your medications will be taken before and after surgery.

If you are taking prescription blood thinning medications, including Coumadin (warfarin) or Plavix (clopidogrel), please inform us, as well as your prescribing physician, so we can determine how they should be managed before and after surgery. Some other drugs affect your blood's ability to clot and may cause bleeding problems during or after surgery. For this reason, we ask that you do not take blood thinners or anti-inflammatories for at least 5-7 days before your surgery.

Do not restart these medications for 3-5 days after your surgery unless directed by your doctor. If these medications are to treat heart related diseases such as heart disease, stroke, or atrial fibrillation, you may restart them 48 hours after surgery. Your doctor will discuss this with you before and after surgery.

Check the labels of all your medications, even those you purchase over-the-counter, to be sure you are not taking any aspirin or anti-inflammatory drugs. Tylenol does not promote bleeding and is generally OK to take in place of aspirin or other anti- inflammatory medications before surgery.

Please inform us if you are taking any medication on the list below, or any medications to treat arthritis. Other medications to avoid include:

Advil
Alcohol
Alka Seltzer
Anacin
Anaprox
Anaproxin
A.P.C.
5 A.S.A.
Ascodeen
Ascriptin
Aspirin
Brufen
Bufferin
Cephalgesic
Cheracol Caps
Childâ€™s Aspirin
Clinoril
Cogesprin
Cope
Coricidin
Coumadin
Darvon
Davon ASA
Dolobid
Dristan
Easpirin
Ecotrin
Empirin
Emprazil
Exedrin
Feldene
Firoinal
Ibuprofen
Indocin
Indomethacin
Meclomen
Medipren
Midol
Motrin
Nalfon
Naprosyn
Norgesic
Nuprin
Percodan
Phenaphen
Quagesic
Robasissal
Rufin
Sine Off
Sine Aid
Trandate
Trental
Trigesic
Trilisate
Vanquish
Voltaren
Warfarin
Zantac
Zoprin
4-Way Cold tabs

If you have any questions, please ask us. If you are taking steroids such as cortisone, or if you are taking birth control pills, please let us know so we can discuss this well in advance of your surgery.

Please provide us with the names and amounts of all dietary supplements, vitamins, and herbal medications you are currently taking. In general, we would ask you to hold herbal medications as well as any vitamins you are taking in large amounts (especially Vitamin E) for two weeks prior to surgery. If you feel this will adversely affect your overall health, your surgeon and/or the anesthesia staff can discuss your concerns further.

Following the above guidelines will help us ensure your outcome and safety is of the highest possible quality.

Smoking Cessation

If you are a smoker, we will ask that you stop prior to scheduling your surgery. Smokers are known to have an increased incidence of neck and low back problems. This may be due to the vascular effects of nicotine. Nicotine may also alter disc metabolism and predispose your back to mechanical problems. Smokers are also a higher surgical risk due to heart and lung compromise. Patients who smoke also have a significantly higher rate of failure of the surgery and especially fusion failure. If you are trying to quit smoking, please note that all nicotine replacement systems (Nicorette gum, The Patch, etc) all have the same effect on your back as smoking – so please do not utilize these smoking cessation methods prior to your surgery or during your rehabilitation period.

Weight Reduction

Excess weight places mechanical stress on the back and can make surgery more difficult. A weight reduction program may be advised in advance of surgery. Avoid crash diets, which weaken your body and deplete the nutrients needed to recover from surgery.

Pre-operative Clearance

Depending upon your age and your general health, your surgeon may request that you obtain clearance from your internist, or see an anesthesiologist prior to scheduling your surgery. If you have other major health problems, it may be necessary for other doctors to be part of the team caring for you while you are in the hospital. Depending upon your specific needs it could also be requested that you see a cardiologist, psychiatrist or a rehabilitation doctor prior to surgery.

Risks of Surgery

Surgery and anesthesia involve stresses to many organs and tissues in the body. Incisions and handling tissues during surgery can result in many problems. The benefits of surgery must be carefully weighed against these risks. Some common or serious problems are listed here.

Spinal Cord or Nerve Root Injury: Permanent injury to the spinal cord or nerve roots is extremely rare. It is not unusual, however, to experience minor temporary tingling, numbness, weakness or pain which resolves over several weeks. All precautions will be taken but rarely, more serious nerve injuries can occur.

Dural Tear: Leakage of spinal fluid can occur due to a tear in the tissue (called the “dura”) holding the spinal fluid and containing the nerves. This may require bedrest and, on rare occasions, surgical repair may be needed. This does not typically compromise the ultimate result.

Infection: Infection is always a post-operative risk and occurs in approximately 1–2% of surgical patients, varying by surgery type. Infections may be superficial or deep into the bone. You are given antibiotics before and after the surgery to help prevent this complication. Please follow the instructions for wound care to help prevent infection.

Pneumonia: The sooner you get out of bed and become mobile the better. People that are in bed and not moving very much due to pain tend to breathe shallowly which can contribute to respiratory problems. The nurses and physical therapists will teach you breathing exercises after surgery, including the use of a device called an “incentive spirometer." – It is important to use this at least ten times per hour while still in the hospital.

Failure of fusion: On rare occasions the bone graft does not heal properly. The likelihood of this is greatly increased by smoking or using nicotine of any kind. This can cause the hardware to fail, and the bone graft may shift. In these cases, additional surgery may be needed. For this reason, we recommend quitting smoking at least one month before surgery and refraining from smoking for at least 3 months after surgery. For high risk patients, we may check urine for nicotine by-products to ensure no tobacco is in the system prior to surgery. Smoking also causes more rapid degeneration of the spine, and continuing to smoke increases the likelihood of requiring treatment at another level of the spine. If you are trying to quit smoking, please note that all nicotine replacement systems (Nicorette gum, The Patch, etc.) all have the same effect on your back as smoking – so please do not utilize these smoking cessation methods prior to your surgery or during your rehabilitation period.

Hardware Failure: There is the possibility of hardware failure. It is unusual for the instrumentation in your back to become loose or break. If this does happen, and your bones are fused, it may not be a problem. However, if this happens before the bones are fused, or if there is instability, then you may need to return to surgery for revision of the hardware.

Other complications: Other possible complications include heart attack, stroke, blood clots in the leg or lungs, and complications related to the general anesthesia. Persistent hoarseness and/or swallowing problems may last for several weeks. Please call us if this persists.

Before Surgery

Spine Clinic

You will be scheduled for a pre-operative appointment before your operation with Dr. Park.

The Night Before

You will be asked not to eat or drink anything after midnight preceding your surgery. Please check with the doctor regarding any medications you are taking. You will be advised if you should take the medicine with a small sip of water. If you have any questions or problems, please phone our office.

The Day of Surgery

You should arrive at the Surgery Admission Unit at the time requested. You can bring toiletries with you on the day of surgery. Valuables are best left at home or with a family member.

Your Family

There is an area outside of the operating room where your family can wait. When the surgery is over the doctor will speak with your family. If there are any major problems during the operation, the doctor will be in contact with your family. If the operation is taking longer than expected, this is not a reason to worry.

After Surgery

The Recovery Room

After your surgery, you will be taken to the recovery room where you will wake up. When you are stable, you will be either discharged home or transferred to the orthopaedic ward. Dr. Park will discuss with you if your surgery is outpatient or will require hospitalization.

Your Throat

Your throat may be sore and your voice may be hoarse for a couple of days after surgery. This is particularly likely for patients having cervical spine surgery. You may need to remain on a liquid or soft-solids diet for a week after surgery. Breathing difficulties after neck surgery are extremely rare but can be medical emergencies. If any breathing difficulty symptoms arise, call us and/or call 911 immediately.

Your I.V. Line and Urinary Catheter

You will have an intravenous (IV) line in after surgery. The line may be inserted in your arm or you may find that you have a “central line” which is intravenous line inserted in your neck area. Immediately after surgery you will receive IV pain medicine. When you are able to take fluid and food adequately and no longer require intravenous pain medication your IV will be removed. You may also have a urinary catheter in place when you awake after surgery. This catheter is usually removed after 1 day, when you are able to get out of bed to urinate.

Your Diet

You should be able to resume regular meals after surgery. Occasionally, the bowels are sluggish for a time. This can be caused by the anesthetic and narcotic medications. Typically, getting out of bed and walking can help your bowels to resume normal activity.

If the surgery was from the front, this sluggishness may be increased if the bowels are manipulated during surgery. If this is the case, you may be placed on a clear liquid diet with broths, juices, and jello. As your appetite returns, and the doctor and nurse are able to hear bowel sounds with a stethoscope, your diet will be slowly advanced to a regular diet.

Sometimes it is necessary to take some medication to help overcome the constipation, but usually bowel function returns to normal without medicine.

Getting Up and Around

After surgery, the nurse or physical therapist will help you sit on the side of the bed and probably will help you up to a chair. You will be encouraged to walk as much as you can tolerate as soon as possible after surgery. You may need the assistance of a walker for a period of time. Each day you will be asked to do a little more, such as sitting in the chair for your meals and walking further in the hall until it is felt that you are independent enough to go home. Signs of independence are your ability to eat a regular diet, move your bowels, urinate and walk to the bathroom alone.

Pain

The information below is intended to help you understand what to expect and how to respond to the symptoms you experience. If you have questions about any pain you experience during your recovery period, please feel free to call us at any time to discuss your symptoms.

Most patients will experience some incision-related pain after surgery. Sometimes arm or leg pain will return for a short period of time and then go away again. The nerves have been irritated by the condition which necessitated your surgery. In addition, the nerves can become irritated during surgery and then again once you begin to move around. If your pain is relieved after surgery but then returns, rest assured this is not a sign that your surgery has failed. Instead, it is usually a sign that healing is progressing as expected. It is not unusual for the pain to come and go.

Some people will also have spasms in their muscles as healing occurs. This is not unusual. As the nerves heal, and feeling in areas that were numb after surgery begin to come back, you may experience an increase in pain or a change in sensation.

As time progresses after your surgery, you will notice these flare-ups get less severe, less frequent and, when they do occur, hang around for a shorter duration of time. The pain should decrease markedly over the first 3 months following surgery. Then the pain will continue to decrease slowly over the next one to two years.

Bracing

You may require a brace after surgery. Please use the brace on a daily basis until Dr. Park has cleared you from wearing the brace. You may take breaks from the brace for hygiene such as washing and showers. Remember to maintain proper posture and alignment and to avoid large movements while you are out of the brace.

Returning Home

When you are released to home, you may need assistance from your family or friends. It is best to plan this ahead of time. If you are unable to take care for yourself and have no family/friends to assist you, you may need to go to an extended care facility until you have recovered your independence.

You may shower but keep your dressing clean and dry. If you have a waterproof dressing, you can shower 24 hours after surgery. You may then remove the dressing and keep the incision open to air 48 hours after surgery. Resume showering after the dressing is removed. Allow soapy water to gently go over the incision. Do not scrub the incision. Pat the incision dry afterward showering. Do not submerge or soak the incision under water for any period of time until cleared by Dr. Park. Do not place any creams, lotions, or ointments on the incision, including antibiotic ointments.

You are encouraged to walk a little farther every day, eat a healthy diet and drink plenty of fluids. Patients are encouraged to work towards walking 20 minutes, 3 times per day. Most patients can eventually reach this goal over time. You will be discharged with pain medicine and your doctor will tell you when you should begin to taper your medicine.

Depending on the type of surgery, you may not require narcotic pain medicine after 2 - 3 weeks.

It is important to always practice proper body mechanics. The Physical Therapist will show you the proper ways to get in and out of bed, bend and lift. You should always reach for objects on the floor by bending your knees. Your doctor will tell you what your lifting weight limit is and when you can resume activities such as driving, and working.

Please avoid strenuous activity, driving an automobile, returning to work, or operating any power equipment until cleared by Dr. Park. Avoid lifting more than 10 pounds during the first 4 weeks after surgery. If you had a lumbar fusion surgery, avoid deep bending and heavy lifting more than 10 pounds for the first 3 months. Use the appropriate assistive devices such as wheelchairs, crutches, walkers, canes as directed by MD and the physical therapist until you are cleared to stop using them.

Goals

It is important that you and your physician have a thorough discussion of goals before surgery. Is the purpose of your surgery to reduce pain, help you return to gainful employment or to have a physically active lifestyle? These are questions to think about and to discuss with the doctor.