Spondylolisthesis; Surgical Procedures, Preparation, and Postoperative Care
II. Intraoperative procedures
During surgery you will be cared for by operating room nurses, anesthesia staff, and your surgical team. A team that works together often doing this type of surgery will provide you with the safest intraoperative experience.
You will be prepared for surgery in the holding area. Normally your family may stay with you until this time. You will meet your anesthesiologist or nurse anesthetist as well as the nurses who will be caring for you during your surgery. At this stage your physician may choose to start intravenous fluids ( I.V 's), and you may also be given some medication to help with the normal nervousness that people have before surgery. When the operating room personnel and your surgeon are ready for you, you will be moved to the room where your surgery will be performed. This room may seem a little noisy, confusing, and cold. Your operating room nurse will be getting all the equipment ready for your surgery, but will be paying special attention to your needs. If you have any questions the operating room nurse will answer them. Your anesthesia team will now begin to put you to sleep.
Physicians, nurses, and hospital staffs are very aware these days of the special needs that children undergoing surgery have at this time. Parents can expect that every effort will be taken to enable them to be with their children for as much time as possible prior to and after the surgery. Additionally, many hospitals will try to further relax children by such methods as allowing them to bring a cuddly toy into the operating room.
After you are asleep your physician will position you on the operating room table to proceed with surgery. You will not be aware of any of this; the next thing you know you will be waking up in the recovery room or intensive care unit after your surgery. During your surgery you will have many people taking care of you to be sure that your surgery goes just right.
III. Immediate postoperative care
When you awaken, you will feel a little cold, very sleepy and confused, and you may have some nausea (from the anesthesia) and will probably have pain. Your nurse will be right there to help you and give you the medications that you need. There will be much activity around you and the nurses will also be checking you frequently for motion and sensation in your arms and legs, blood pressure, pulse, and temperature. You will be drowsy for a while and will remain in the recovery room until you are fully awake.
Depending on the procedure that you have had, many physicians will have you spend your first night after surgery in the intensive care unit. Your physician will decide what is necessary and inform you before your surgery of what to expect after surgery.
On the first postoperative day you may be asked to dangle your feet off the side of your bed and to stand if possible. Within two to three days after surgery you will be walking with assistance to your bedside chair and bathroom. You will need to stay in the hospital for five to six days after your surgery and maybe longer if your procedure is more complex. By the time you leave the hospital you should be walking with standby assistance and be able to get in and out of a chair safely. Until these goals are accomplished it is not safe for you to leave the hospital. Taking a fall after spinal surgery could cause great problems.
You will have some pain after your spine surgery. Some surgeons may decide to give you a pain medicine through your IV for the first two to three days after your surgery. Once you are tolerating eating then you can be changed to pain medication by mouth. In addition to pain medicine your physician may order a muscle relaxant. This will help reduce muscle spasms and is often very helpful after this type of surgery. Your nurse will discuss with you your pain relief and record that in your chart. Reasonable pain relief should be achieved. Every effort will be made to get you the best possible pain relief.
The nurse will help you wash and you will be allowed to shower approximately five to seven days after your surgery. This time frame will be based on your ability to sit up, the size and position of the incision, and your physician's preference for wound care. It is always a good idea to take a shower seated for the first week or two and have someone standing by to help you in case you drop the soap! Once again, a fall could cause you great problems so every care should be taken to avoid one.
IV. If I need a brace after surgery
Many patients having surgery for spondylolisthesis will require a brace postoperatively. As discussed earlier, this may be a ready-made or custom-molded brace. Your physician will choose the type for you. If at all possible it is good to have your brace fitted prior to surgery so that it is ready when you need it. If the alignment of your spine will change after your surgery, then fitting your brace before surgery will not be possible.
The length of time that you will wear your brace will differ according to your physician’s preference and the type of surgery that you have had performed. Generally it will be worn until a good fusion is seen on x-ray. That may take from three to six months. Remember, cutting short the time that you wear the brace does not make sense after having spinal surgery. Be committed to the time necessary to get the best possible result from your spinal surgery. Ask your surgeon or nurse before surgery to get an estimate of the length of time you will need to wear your brace. Remember that this is an estimate and that all decisions will be made with your best interests in mind.
V. When I leave the hospital
You will be discharged from the hospital when you are able to walk safely, have good pain control, and are eating adequately. It will be necessary to have someone with you for the first one to two weeks at home. The length of time necessary for assistance will be based on the type of surgery that you have, how strong you were before surgery, and how quickly you resumed postoperative independent activities safely. If you were very weak coming in for surgery, you will have to wait a longer period of time before you are ready to be left alone after surgery.
You will be discharged from the hospital with specific instructions. You should follow them carefully. A few of the more common ones would be to increase your activity gradually around the house, no lifting anything heavier than a gallon of milk, no driving, and no returning to work or school until your physician releases you to do so. Discuss your specific instructions with your physician or nurse.
VI. Long-term care after surgery
After surgery for spondylolisthesis it may be necessary to change some of your activities. Those work or recreational activities that cause stress to your spine will need to be avoided. Your physician will be able to discuss job and recreational restrictions with you.
Additionally, your physician will be able to recommend ways to help you keep your back healthy in the future. For example, keeping your weight at an acceptable level, gentle, regular exercise, and learning how to pick up items correctly, will all help you reduce the risk of further back problems.
Who Should Treat Spondylolisthesis?
If you are experiencing mild, persistent back pain, or any type of severe back pain, it is recommended that you contact your local physician. He or she may then refer you to a specialist trained in treating spinal disorders.