Preparing For Spinal Surgery
Dr. Yogesh K. Pithwa, Spine Surgeon in Bangalore, India
Deciding Whether To Undergo Spine Surgery Or Not!
This is the most critical step towards preparing for spine surgery! Most spine surgeries are dictated by two factors, pain and nerve function. Any experienced spine consultant can measure a patient’s temperature, he can measure his blood pressure; but he cannot measure his pain. Pain is a very subjective sensation and hence, the need for surgery on the grounds of pain would be greatly dictated by the patient himself. If pain is severe enough to interfere with the activities of daily living,
if it is becoming a source of constant discomfort, if it is decreasing the patient’s productivity, then it is better to undergo a surgery as per the spine surgeon’s recommendations. If nerve function is affected, then depending on the severity and duration of the problem, as also coexisting disorders such as diabetes mellitus, the spine specialist may recommend surgical intervention. As mentioned elsewhere in this website, only if the risks of doing the surgery outweigh the risks of not doing the surgery; only if the benefits of surgery outweigh the risks of surgery in a significant way, would you be recommended surgery! It is important to realize this as nothing in life comes without an element of risk; even the simple act of walking out on the street is fraught with risk, which we know may sometimes be life threatening too! So, do not confine your life to months and months of futile bed rest for misplaced fears of spine surgery. Discuss the details of your surgery and its attendant risks with your spine consultant to quell any fears and to clear any and every doubt of yours! If you so desire, your spine surgeon or consultant can even arrange to give you references of patients who have undergone similar surgeries.
Taking Second Opinions!
Since medicine is an inexact science, it is always better for the patient to feel convinced about his treatment plan with second opinions. Every conscientious spine surgeon will welcome second opinions.
Preoperative Investigations And Assessment
Once the decision for surgery is made, the patient would have to undergo a battery of investigations related to assessment for “anesthesia fitness”.
These investigations would check the patient’s
- heart function
- lung function
- liver function
- kidney and related functions.
It is better to get these tests done on an outpatient basis so that hitherto undetected problems can be identified and rectified before the patient gets admitted for surgery. Additionally, after these tests, a general physician may be requested to evaluate the patient to reconfirm his fitness to undergo spinal surgery. At this time, it is important to make the doctors either general physician or spine surgeon, aware of any kind of drug allergy that the patient may be having. Painkiller medications such as aspirin and ibuprofen would need to be stopped at least one week prior to the appointed day of surgery, after consulting your surgeon and treating doctor. Smoking too would need to be stopped prior to surgery itself.
Routine microdiscectomy of the lumbar and cervical spine rarely ever requires any blood transfusion. However, as a norm, it would be recommended to arrange for one unit of blood for a microdiscectomy. For surgeries other than microdiscectomy, this requirement for blood may go upto 3-5 or more, in rare cases, depending on the length of the surgery and other such variables. It is better to get this blood arranged on a preoperative basis as far as possible. This would save last minute hassles for the patient and his attendants. Preferably, it is better to get known blood donors. This would have two advantages; one, it would make fresh blood available for the patient; two, it would minimize the risk for transmitting diseases through this route [despite all elaborate tests, there remains a minimal, though definite risk of transmitting fatal diseases through blood transfusion]. In certain spine surgeries such as those for scoliosis, autologous blood transfusion can be a viable option. Here, the patient himself or herself donates blood in the preoperative period. This can be very advantageous since it eliminates many hazards otherwise associated with blood transfusion.
Things to get along to the hospital would include all investigations, all medical reports, insurance-related documents, clothes [preferably loose shirts with pajamas], a pair of light footwear [slippers], some book or magazine for casual reading, etc. It would be advantageous to call up the hospital and confirm room availability. Towards this end, prior booking of a room by paying some advance deposit would save a lot of last minute anxiety related to room availability. Prior insurance approval would also be preferable so that there is no inadvertent delay or inconvenience caused by these administrative issues. Lastly, on reaching the hospital, it would always be recommended to intimate your spine consultant or surgeon or his assistant about the same so that they can coordinate your admission process and help you ease any inconvenience, if any.
Make some necessary modifications at home so as to prepare yourself for homecoming after the spine surgery. Move items that you will need after the surgery so that they are between hip and shoulder level. This keeps you from needing to lift or bend. Particular attention has to be paid to alterations in the bathrooms and washrooms. Necessary modifications related to the toilet commode would need to be made on a prior basis preferably.
The patient would generally be admitted one day prior to the day of surgery. On getting admitted, a duty doctor or the attending nurse would get in touch with the patient and inform him about preoperative starvation status as also the formalities related to signing an official, informed consent for surgery. Most surgeries require the patient to remain starving for a period of about six hours prior to the appointed time for surgery. After giving appropriate preoperative medications, the patient would be shifted to the operation theater. Most spinal surgeries are carried out under general anesthesia [patient will be fully unconscious, in simple terms!]. After the surgery, patient would be kept under observation for some time in the recovery room in operation theater. Thereafter, the patient would be shifted out to the ward. In prolonged surgeries or in older patients or in patients with some significant medical illnesses, the patient may be shifted to intensive care ward for a few days prior to being shifted to the regular ward. After some prolonged spinal surgeries, there may be plastic tubes attached to the body, coming out from the surgery site. These drain out unhealthy blood collections from the surgical site. In addition, there may be a tube to drain out urine as well in some cases. These are generally removed 48-72hours following the surgery. Patients undergoing microsurgery would generally be made to walk the next day itself. For patients undergoing spinal stabilization [insertion of screws and rods into the spine], walking is started not earlier than 2nd or 3rd day following the surgery. In the initial stages, walking is facilitated by a physiotherapist with or without a walking aid with or without a spinal belt/ brace. Surgery stitches are generally removed anywhere from 10th to 21st day. Prior to this, the wound dressing would be changed generally after 2 days and then, after 5 days following the surgery. Daily dressings are not really mandatory.
While getting discharged from the hospital, the patient would receive a discharge summary that would briefly describe his preoperative condition and the surgical procedure. Most importantly, it would give a detailed description of the medicines that would need to be taken after discharge, along with their dosage schedules. It would be beneficial for the patient to travel by an ambulance from hospital to home at the time of discharge. The spine surgeons would also give additional instructions as regards the dos and don’ts after discharge.
Routine activity restrictions following a spine surgery include avoiding the following;
- Bending forwards,
- Lifting heavy weights,
- Traveling in two-wheelers and auto rickshaws,
- Using Indian style of toilet commode,
- Sitting for prolonged times, etc.
On reaching home, till the surgical stitches are removed, the wound dressing should not be allowed to get wet. Follow up visits will be scheduled to make sure your back is healing well. Off-the-schedule meetings can be arranged with the spine surgeon or consultant if the patient has soakage of the wound dressing, fever over 1010 F, increase in numbness or weakness in the legs, difficulty to pass urine.
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