SURGICAL PROCEDURES
What to Expect Before and After
Spine surgery is a long and difficult process requiring preparation. Knowing what to expect can help make your hospital stay more comfortable and your recovery easier.
The Day Before
The surgical department at Long Island Spine will give you personalized instructions regarding preparing for your surgery, but generally most patients are instructed to observe the following directions starting 24 hours before the surgery.
The Day Of Surgery
The day of surgery will be very busy and it's important you arrive on time. The following directions will help your day to run smoothly.
Arrival & Preop Preparations
You will spend time in several areas of the hospital in preparation for your surgery. You may be asked many of the same questions repeatedly; be patient this questioning is done for your safety.
Depending on the rules at the hospital, your family should be allowed to stay with you through the early preop process. Your medical and surgical histories, medications, allergies and preoperative process will be reviewed in detail. Vital signs including weight, blood pressure, oxygen levels, heart rate, and temperature are recorded. If your physician has ordered any other preoperative tests, they will be performed.
An intravenous catheter will be inserted and fluids will be administered including antibiotics and sedatives.
You will meet with the surgical team including the anesthesiologist, the surgeon and nurses, in the preoperative holding area. Risks, complications and questions will be reviewed again and answered. Please bring a list of your questions if need be.
The Operating Room
After you have spoken to both the anesthesiologist and your surgeon, you will be taken to the operating room (OR) and your family will be sent to the waiting area. The hospital staff will communicate with your family during and after the procedure. The surgeon will speak with your family after the surgery as well.
Post Surgery
Now that your surgery is behind you, the recovery process is your main priority. To help you manage your expectations we've outlined the main steps in this process.
Length of stay
The amount of time you spend in the hospital will vary depending on procedure types and individual patient needs. Generally, a cervical surgery and lumbar decompression surgery requires a two day hospital stay. Fusion surgery can require a four to five day stay and minimally invasive lumbar fusions sometimes a one to two day stay. Complex surgeries and other revision and reconstruction surgeries will likely require extended hospital time. The individual patient's general condition and age will greatly influence the length of stay.
Day 1
The first day after surgery is a day of rest. Pain medication will be adjusted and tests will be performed as needed. Therapists may help you to stand up and walk as tolerated with their help. A (PCA) Personal Analgesia Pump is often used to enable you to administer and control your own pain meds.
Day 2
If you have drainage tubes in the incisions they should be removed on the second day. Dressings are changed and the PCA pump is slowly decreased and replaced with oral medication. Physical therapy continues with more walking and sitting up.
Day 3 to 5
The concentration during this time is to get back to a regular diet and void normally. The decision as to when you are ready to go home will be made based on these issues as well as clearance by the Physical Therapists. If more rehab is required, you will be prescribed to outpatient rehab at a PT facility.
Discharge
Discharge day will be very busy. You will be given discharge instructions and any prescriptions you may need. When planning home transportation keep in mind that you should make sure it is in a car or truck that is easy to get in and out of. You will not be allowed to drive yourself home.
The First Weeks At Home
During the first few weeks, you will be very tired. You should be spending half of your time resting and the other half up and moving around. It is good planning to have someone available to help you for the first two weeks. You should be able to go to the bathroom and moving toward manage your surroundings without help. Pain medications should be taken on a routine basis.
Post surgery constipation may occur because of reduced food intake and reduced intestinal motility. A decrese in your ability to ambulate and possible increase in pain medication may also be a cause.
Common treatments for constipation include: ambulation as tolerated, increased fluid intake, eating fresh fruits including prune juice and green leafy vegetables, and increased fiber intake. Laxitive should only be taken when ordered by a physician.
Activities at this point should include a walking program. Do what you feel you can do, but be conservative and safe. In any event, do not lift anything more than 10 pounds and no stooping, twisting, lifting, housework, or yard work are allowed at this time. You can return to sexual activity when you feel ready.
The wound must be kept clean and dry and the dressing should be changed on a daily basis. For showering, you can tape a a cut piece of plastic wrap to over the wound to keep the incision dry. Change this to a dry gauze once again after the shower. Place no lotions, powders, or ointments on the incision unless instructed to do so.
Keep track of your prescription medications by writing down when they should be taken. Narcotic pain medications require the actual written prescription, so don't wait until you are out of medication to call the office for a refill. Please be advised that Long Island Spine requires 48 hours notice for refill requests and prescriptions are only generated during the week (no weekends.)
As the weeks progress, you should gradually increase your amount of activity however, the restrictions are still in effect. Returning to work is based on your type of work, type of surgery, energy level and comfort. Generally, a laminectomy procedure allows a return to a sedentary job within two weeks. A more involved surgery combined with more physical types of work may require months of recovery prior to returning to work.
The First Month After Surgery
Your postop visit to Long Island Spine will occur at about two weeks after surgery. At this time, we might increase your level of activity, which could include progression towards a basic exercise program. The specifics of your particular surgery will influence this decision. For example, fusion surgeries require a longer period of rest than laminectomy surgeries Physical therapy may or may not be prescribed at this point.
Three Months Post Op
Expect to have another office visit at three months after surgery. At this time, a more vigorous physical therapy exercise regimen will be initiated, if necessary. X-rays will be taken as needed to check the healing of the fusion, if performed. If you had a straightforward laminectomy, a full release to all activities will likely be given a green light at this point. Fusion surgery will probably require restrictions for another three months.
Fusion Surgery- Six Month Office Visit
The six month office visit will focus on your rehab plan. More x-rays will be taken to further assess the fusion progress. Most fusions will be mature at this point so many restrictions will be lifted at this time. However, the fusion will take a good one year period before your recovery is totally complete, so some restrictions may remain.
Annual Checkups
A routine office visit is recommended on a annual basis after a major spine surgery. The staff at Long Island Spine is committed to the long-term health of your spine.
Before you return home, you have to be able to perform basic activities including walking up and down stairs, getting in and out of bed, and maneuvering safely. If you cannot perform these basic tasks, you will be be allowed to go home.
At home, you will gradually spend more time out of bed as your energy level increases.Gentle exercise including walking of progressively longer distances, use of a treadmill, or a stationary bike maybe advocated. Housework should be avoided and you should not lift more than 10 pounds or stoop, crawl, or twist.
You can begin to drive whenever you feel you can but if narcotic pain medication has been prescribed, do not drive or operate machinery. You can return to a regular diet but beware of constipation from the anesthesia. You can also return to sexual activities when you feel comfortable.
Your post-op office visit will be approximately two weeks after surgery and until then you should change your surgical dressing once a day with dry gauze and tape. If necessary, physical therapy will be prescribed at this time.
Within six weeks after surgery, most patients are off strong pain medications and many restrictions will be lifted although heavy or impact activities are still to be avoided.
Three months after surgery, you will return to full and unrestricted activities. However, be cautious as it takes approximately six months for your recovery to reach maximum improvement.