Pre- and Post-Operative Spine Surgery Guide

What do I bring to the hospital?

Please bring:

• Photo identification and insurance card(s).
• A current medication list detailing prescription and over-the-counter medications, including names, doses, and frequencies.
• AICD/pacemaker ID cards or copies.
• Advanced Health Care Directive (Living Will) or a copy, which designates a trusted individual to make healthcare decisions on your behalf if necessary.
• Eyeglasses, contact lenses with a storage container.
• Hearing aids and batteries.
• Non-skid footwear.
• Loose-fitting, comfortable clothing.
• Any prescribed braces previously fitted by your surgeon.
• Personal toiletries, socks, and underwear.
• Cell phone, electronic tablet, and chargers (Wi-Fi accessible).
• If you use a CPAP machine for sleep apnea, bring it along with the tubing and settings for inspection by our clinical engineering department.

We recommend placing a label containing your name and phone number to essential items like your glasses case, hearing aids, or removable dental work.

Please do not bring:

• Valuables such as jewelry (including rings and watches), cash, and credit cards. It’s best to leave these items at home or with your family.

What can I expect when I arrive at the hospital?

Registration

Upon registration, you’ll be asked repeated questions for safety measures. An identification band will be placed on your wrist, and you’ll then proceed to the “holding area” where you’ll change into a hospital gown. One family member may accompany you.

Holding Area

• Dentures, hearing aids, eyeglasses, and contacts will need to be removed.
• A pre-operative nurse will review your medical history and conduct an assessment.
• An intravenous (IV) line will be started.
• You’ll meet with your anesthesiologist for a thorough review of your medical history, anesthesia plan discussion, and addressing inquiries.
• You might receive medications for relaxation.
• Transportation to the operating room (OR) will be on a stretcher.

Operating Room (OR)

• Medications will be administered for comfort before and during surgery.
• General anesthesia will be utilized for spine surgery, inducing a deep sleep via intravenous drugs and anesthetic gases.
• You’ll be secured to the operating table with a special protective strap.
• You and your OR team will wear gowns, masks, and head and foot coverings.
• Monitoring devices will be placed as follows:
• A clip on your finger measures oxygen levels.
• A cuff on your arm monitors blood pressure.
• A breathing tube will be placed to support your breathing while you are under anesthesia.
• A catheter (tube) may be placed in your bladder to monitor your urine output.
• An oxygen mask will be placed over your mouth.

What can my family expect while I am in surgery?

Your family should check into the waiting room immediately after you’ve been taken to the holding area. The duration of the surgery can vary based on the type of procedure.

When leaving or returning to the waiting area, family members should check in with the desk staff.

Your family can track your progress using the Patient Tracking System in the waiting room. To ensure privacy, a special code is assigned to identify you. Color-coded icons on the tracking system will indicate your location from pre-op to intra-op, showing when the procedure has begun, and until your arrival in the PACU (Recovery Room).

Your surgeon will either call or come out to update a family member once the surgery is completed.

What can I expect after my surgery?

After your surgery, you will be transferred to the Post-Anesthesia Care Unit (PACU).

Here’s what you can expect during your time in the PACU:

• Close monitoring of your heartbeat, blood pressure, and breathing using equipment similar to that in the operating room.
• Administration of oxygen through a mask or nasal cannula.
• Frequent checking of the dressing over your incision.
• Potential presence of drainage tubes for urine or blood, which will be removed later.
• Possible mild sore throat if a special breathing tube was used during anesthesia, which will quickly subside.
• Remaining in the PACU until you are fully awake and your vital signs are stable, which may take one to a few hours.
• Regular prompts to move your arms, legs, and feet to check for numbness or tingling.
• Pain management support from the nurse, including medication as needed.

If your surgical team feels that it would be within your best interest to stay overnight in the hospital, it is after you fully wake up in the post-anesthesia care unit that you will be moved to a hospital room. In some cases you will be observed for a few hours and then discharged home on the same day as surgery. In the hospital, you will have a nurse, a nursing assistant and a physical therapist working along with your surgical team to optimize your condition before going home.

During your time in the hospital, your nurse will be in charge of administering your medications. Your daily medications will be distributed from the pharmacy and given to you on a regular schedule. Pain medications will be administered by the nurse based on the level of discomfort you are experiencing. If you are having more pain than anticipated, please let your nurse know so this can be treated and monitored. In addition, it should be understood that your nurse will not be giving you pain medication more frequently than the doctor has recommended. Please notify your nurse if any of the following occur:

• You are feeling nauseous
• You are feeling drowsy or lethargic
• Your medication is not controlling your pain

It is possible that you may have a urinary catheter in your bladder after surgery. If this is the case, it is important to understand that the urine is being drained from your bladder through the catheter and should not be pulled on or manipulated. When the catheter is removed by the nurse, you may initially feel some discomfort with voiding, but this should resolve soon after. If you feel that your bladder is full, but you are unable to urinate, bring this to the attention of the nurse.

It is also possible that after your surgery you will have a drain in your incision. The drain is placed to prevent blood from accumulating in the surgical space. The drain will exit from a site next to your surgical incision and be connected to a long piece of tubing. The drain can be safety-pinned to your clothing or sit in your hospital gown pocket while you walk around. This drain will be emptied and monitored by your nurse.

Physical activity will be encouraged while you are in the hospital. If you are staying overnight in the hospital, it is encouraged that you get out of bed at least every 2-3 hours during the day and walk around within your room or in the hallway for a minimum of 15 minutes. If you are sitting in a chair, be sure to shift your weight or march your legs every 30 minutes to prevent complications. Ambulating on a regular basis has been clinically proven to reduce the risk of complications and lessen the risk of infection. If you are feeling unsteady, ask your nurse or the nursing assistant to walk with you. During your hospitalization, you may also be evaluated by a physical therapist. The therapist will evaluate your strength, coordination and ability to perform simple activities. Based on their assessment, you may be recommended for additional physical therapy once you leave the hospital to optimize your functioning at home.

In addition to physical therapy, you may also be seen by an occupational therapist while you are in the hospital. If you were having difficulty with the fine motor skills in your hands or fingers, an occupational therapist will be beneficial in assessing your level of functioning and make recommendations for your rehabilitation when you leave the hospital.

If you are admitted, you can expect to be discharged the day following surgery. In rare cases patients may stay in the hospital for a couple of days. If a drain is present or a urinary catheter is present, it will likely be removed on the first postoperative day.

You can also expect to have a sore throat for a couple of days following your surgery. You might also note that your voice sounds “hoarse.” This is a normal experience that occurs as a result of the manipulation of the neck during surgery. Soft foods and warm liquids can be substituted during this time for comfort. If it is necessary, dietary modifications will be made to ensure appropriate food is provided for each meal.

Upon discharge from the hospital, a care manager or social worker will collaborate with you to develop a plan for your post-hospital care.

• Most patients will be discharged to their homes.
• Some individuals may require assistance from a licensed home care agency.
• For others, the optimal course of action may involve admission to a specialized inpatient rehabilitation hospital or nursing facility offering rehabilitation services.

You will receive detailed written home care instructions and prescriptions from your surgeon, including guidance on pain medication. It’s important to carefully review your medications as they may differ from those you were taking before surgery.

A nurse will go over the discharge plan with you and your family, covering aspects such as medication review, permitted activities, wound care, and follow-up care.

Your successful recovery is our priority. Generally, each day you should notice improvements in how you feel, the appearance of your incision, and your ability to move.

During your hospital stay, physical and/or occupational therapists will assist you. If the therapy team determines that you’re not safe to return home and would benefit from additional inpatient rehabilitation, our social worker (SW) will meet with you to discuss rehabilitation facility options.

Discharge Planning

Your care manager, case manager, and/or social worker will collaborate with you and your family to determine any recommended services following discharge, which may include:

• Visiting Nurse
• Subacute Care
• Inpatient Rehabilitation

The physical and/or occupational therapist will evaluate and suggest post-acute services accordingly.

How will I get home?

Same-Day Surgery
If you will not be spending a night in the facility, it is your responsibility to have someone accompany you at the time of discharge. You will not be allowed to drive yourself or take a taxi home from the facility following your surgery.

Overnight Stay
If you are staying overnight at the hospital, please make arrangements to have someone at the hospital before your scheduled discharge time. The discharge planning team will work with you to coordinate the ideal time to be discharged to home.

Please arrange to have your coach at home with you for at least the first 24 hours following your surgery.

Taking care of yourself after your procedure is critically important. Following is important discharge information that will help you be comfortable and recover quickly.

What do I need to know about my diet?

If you are eating a regular diet when you are discharged from the hospital, continue eating normally when you return home. Your doctor or nurse will let you know if you need a specific regime or food consistency.

It is very important during your recovery period that you fuel your body. Try to eat a diet high in protein and make sure to drink plenty of water throughout the day. If you are taking pain medication, try to eat a diet that is high in fiber or take an over-the-counter stool softener to prevent constipation.

Be sure to drink plenty of fluids – especially water – so you stay hydrated. This enables your body to heal quickly.

What should I do if I’m constipated?

Even if you were having regular bowel movements prior to surgery, you are likely to experience post-operative constipation. Exposure to anesthetics and narcotics, alterations in your diet and fluid intake – as well as reduced physical activity – all contribute to this uncomfortable condition. You can help avoid constipation by eating a balanced diet including fruits, vegetables, whole grain foods and fiber – and increasing your water intake.

If you need supplements to help, consider using:

1. Docusate sodium (Colace), a stool-softener that makes stool easy to pass. You can take 100 mg three times a day. If you do not have a bowel movement in three days, add #2 below.
2. Milk of Magnesia, a laxative that works by pulling water into your intestines, helping your stool move along the intestinal tract. You may take one to two tablespoons every 12 hours. Remember to drink plenty of water following each dose. If you still have not had a bowel movement four days after your surgery, use #3 below.
3. An enema or rectal suppository. When the stool softener + laxative combination does not alleviate your symptoms, use a suppository. This will help eliminate heavy straining, which is not good after surgery.

If you try this regimen twice without any results, please call our office at 973.993.7100.

What do I need to know about showering and taking care of my incision?

If you have staples or sutures over your incision, please wait 72 hours after surgery to shower. If you do not have staples, you may shower when you get home from the hospital. You may use liquid soap over the incision, and pat dry when you are finished. Do not apply any creams or ointments to your incision until the scab has completely resolved. Most individuals have a dermabond glue over their incision; this glue will come off on its own a few weeks after surgery. Avoid pulling or scrubbing the glue off.

It is recommended that you apply ice to your incision for approximately 20 minutes 4-5 times/day to reduce inflammation and pain during the first 2 weeks following your surgery. Heat may be used for comfort on sore muscles, but should not be directly applied to the surgical incision.

How long should I plan to be away from work?

Plan to be away from work for four to six weeks after surgery to allow for your recovery. If you can work from home, you may be able to work at a computer or desk sooner. However, you may find it difficult to sit for long periods of time or concentrate.

When can I drive?

It is advised that you refrain from driving until you receive instructions on driving restrictions at your 2-week follow-up. You may not drive until you have stopped taking any pain medication and muscle relaxers.

Can I smoke?

You should not smoke following surgery. Smoking can jeopardize bone healing as well as the recovery process after surgery.

What about physical activity?

It’s important you get out of bed and move as soon as possible after surgery.

You should keep strenuous activity to a minimum. However, moderate physical activity is an important factor in reducing postoperative complications and promoting healing. Walking on a daily basis is recommended, and walking short distances (about 15 minutes) every few hours is appropriate. It is permissible to go up and down stairs at home if you feel steady enough to do so.

Abstain from driving, sexual activities and strenuous activity until follow-up is complete.

Following lumbar/thoracic surgery

It’s essential to adhere to specific body mechanics guidelines as instructed by your surgeon for a period of four to six weeks.

• Avoid Bending Forward and Twisting from the trunk. Maintain proper posture during all activities, especially when engaging in tasks such as washing dishes, doing laundry, or handling items on low surfaces like pet food trays or the floor.
• Delegate tasks involving items below waist height, such as reaching into low cabinets or drawers, to family or friends. Alternatively, utilize a reacher tool to safely retrieve lower items.
• Refrain from Heavy Lifting exceeding 10 lbs, such as lifting a gallon of milk, to prevent strain on the surgical area.

Following cervical surgery

It’s essential to adhere to specific body mechanics guidelines as instructed by your surgeon for a period of six to ten weeks.

• If you have been prescribed a collar, wear it consistently unless instructed otherwise by your physician. Ensure the collar fits snugly, and if there is any excess movement, tighten it accordingly.
• Refrain from any Twisting or Bending of the neck forwards, backwards, or sideways to prevent strain on the surgical area.
• Avoid Lifting objects weighing more than 5 lbs, especially refrain from overhead lifting, to promote a smooth recovery process.
• Enlist the help of family or friends to relocate items positioned above shoulder height to lower surfaces for easier access and to adhere to lifting restrictions.

After your 2-week follow-up in the office, you will be given a walking plan with a more detailed exercise regimen. After your 30-day follow-up, your doctor will give you specific instructions regarding activity precautions. Wait until you are cleared by your surgeon to resume activities such as yoga, golfing or swimming.

The doctor may also recommend outpatient physical therapy 2 to 3 times a week depending on your level of functioning.

If you are instructed to wear a brace, do not wean yourself off of the brace until specifically instructed to do so by your doctor. You should wear the brace at all times except when you are sleeping and showering.

What about pain or discomfort?

It is expected that you will have some pain, aching and discomfort after surgery. The goal is to keep the pain at a controlled level that allows for maximum rehabilitation. Your doctor will call in a prescription of appropriate medication to your pharmacy or give you a prescription in the hospital before discharge. If you have a pain management physician, the surgical care team will continue with the established preoperative pain regimen. It is important to take the pain medication as needed and not more frequently than recommended. Do not let the pain get higher than a 7 out of 10 without pain medication. Once the pain begins to diminish, take the pain medication less frequently until it is no longer required.

As you taper yourself off the pain medication, be sure to avoid over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or naproxen. These medications may interfere with healing and should be substituted with acetaminophen, if tolerated. These medications are typically not restarted for at least 3 months after surgery.

It is important to understand the healing process will take time. While your preoperative symptoms may not disappear overnight, the healing process varies for everyone. At the conclusion of your surgery, a long-acting anesthetic is injected into your back muscles. This medication provides about 48-72 hours of prolonged relief. However, once this medication wears off, you may experience an increase in postoperative pain, which is expected and should be managed with your oral medication regimen.

Numbness and tingling can be one of the last symptoms to resolve after surgery. In some cases, the longer the nerve was compressed, the longer it can take to heal and regenerate. Symptoms of nerve damage can resolve immediately after surgery or take as long as 6 months to a year.

What medications should I take?

You will be told which of your current medicines you should resume from home – as well as any new ones you should start. After surgery, you may be prescribed steroids to help reduce swelling. It is very important you take these medications as directed. You do not need to take pain medication unless you need it. If you were taking blood thinners prior to surgery, ask your doctor when you should resume them.

Do not drink alcohol while taking prescription pain medications, anticonvulsants or muscle relaxants.

If you have a sore throat, you may use over-the-counter Cepacol lozenges. Follow the packaging instructions, and do not use them more than directed.

When should I call my doctor?

You should call the office if you are experiencing any of the following:

• A fever greater than 101.5°F
• Pain greater than a 7 out of 10 or if your pain is worse than before surgery
• If you are experiencing numbness or tingling that was not present prior to surgery
• If you are experiencing weakness that was not present before surgery
• If you are having difficulty urinating or feel you are not emptying your bladder completely
• If you have a decrease in appetite, nausea or vomiting
• If your incision is draining, oozing or reddening and hot to touch

What happens next?

If you leave the hospital with a drain in your incision, you will be asked to make a follow-up appointment in the office for within 5 to 7 days so it can be removed.

Otherwise, you will need to make an appointment in the office for 2 weeks after your surgery. At this appointment, you will be seen by a nurse who will inspect your incision, discuss any concerns and review your medications. It is appropriate at this time to bring up any concerns you may have about physical activity, returning to work, driving, etc. You will also be given a walking program to adhere to until your 30-day follow-up visit with the surgeon and/or nurse practitioner, which can be done in the office or virtually.

The 2-week and 30-day follow-up appointments may be scheduled at any time once you have a date for surgery.

Our goal is to help you feel better as quickly as possible. Please do not hesitate to contact us with any questions or concerns you have. It is our privilege to care for you.