People of all ages - children, adults, and seniors - undergo some type of spinal surgical procedure annually. The majority of these patients have weeks or months to prepare for their surgery. However, whether your spinal procedure is pre-planned or not, you can benefit from learning some general information about the preoperative steps to spinal surgery.

Importance of Preoperative Evaluation
Surgical procedures of any type carry varying amounts of risk. A surgical risk assessment combines this risk percentage with the patient’s physical and emotional health. During the preoperative evaluation, facts about the patient’s health (e.g. pre-existing conditions such as diabetes) are investigated enabling medical staff to take pro-active steps to reduce surgical risk.

This evaluation includes an in-depth review of the patient’s medical history, findings from x-rays, CT scans, MRI studies and/or other diagnostic tests. The patient’s general health is reviewed during a physical and neurological examination.

The preoperative evaluation identifies physical conditions (existing and unknown) that could cause surgical complications (e.g. cardiac or breathing difficulties). In some cases, the patient may be referred to a medical specialist for consultation prior to surgery.

Preoperative Goals
The results of the preoperative evaluation assist the medical staff to provide the patient with appropriate anesthesia, preoperative medical treatment, monitoring during surgery, and postoperative pain management and care. The preoperative process also provides opportunities for the patient, primary care physician, treating specialists, surgeon, and anesthesiologist to communicate concerns before and after surgery.

Medical History and Examination
A detailed medical history gathers information about allergies (e.g. to medication, food, allergens), side effects from medication, medication and/or dietary supplements taken daily, pre-existing medical conditions, family history, tobacco and alcohol use, bleeding history (e.g. unusual bruising), and previous surgical experiences (e.g. problems with anesthesia).

During the physical examination the patient’s blood pressure, pulse, respiratory rate, body temperature, height and weight are recorded. The physician listens to the patient’s heart and breathing, notes any abnormalities of the head, eyes, ears, nose, and throat. The patient’s physical stamina (e.g. walking, climbing stairs) and range of motion (e.g. neck) are observed. During the neurological exam, the patient’s mental status, as well as sensory and motor function is considered.

Any condition effecting the cardiovascular, pulmonary, gastrointestinal, endocrine, and nervous systems can increase surgical risk. Understanding these problems and addressing them before and during surgery can make the spinal procedure safer.

Preoperative Tests

Blood:
A small blood sample can provide a wealth of information about the patient’s general health. A low red blood cell count (hemoglobin) may indicate the presence of anemia. Red blood cells are needed to carry oxygen throughout the body. White blood cells (WBC) are needed to fight infection. Platelets are the smallest cells in the blood and are essential to blood coagulation. A Partial Thromboplastin Time (PTT) test reveals clot formation time. The level of glucose (sugar) in the blood (Blood Glucose Level) is helpful in determining if the patient is diabetic or hypoglycemic (low blood sugar).

Metabolic:
Electrolytes are needed for metabolic function. For example, calcium is necessary for contraction of skeletal muscle as well as relaxation of cardiac muscle. Blood Urea Nitrogen (BUN) indicates metabolic function of the liver and kidney efficiency.

Urinary:
A Urinalysis detects urinary tract infection, kidney function, diabetes, and the body’s state of hydration/dehydration.

Pregnancy:
Female patients of childbearing age may be given a pregnancy test.

Medications:
Other tests may be used to measure the level of medication in the patient’s system. Some medications can affect anesthesia such as antiarrhythmics (drugs used to control cardiac rhythm).

Cardiovascular
Male patients over age 50 and female patients over age 60 may be given a preoperative Electrocardiogram (EKG). Patients with a history of cardiovascular surgery, angina, diabetes, peripheral vascular disease, or smokers are usually EKG candidates, whatever their age. These same patients may also be given a chest x-ray.

Pulmonary
To assess pulmonary (lung) function, the patient may be asked to breath into a spirometer. This instrument measures the volume of air inhaled and exhaled. Arterial Blood Gases (ABG) measure the oxygen and carbon dioxide levels in the blood as well as oxygenation and movement of air in and out of the lungs (ventilation).

Blood Loss
In any type of surgical procedure, loss of blood is a possibility. Your surgeon and/or anesthesiologist will discuss the advantages and disadvantages of donating your own blood (autologous donation) prior to surgery compared to taking someone else’s donated blood.

Stop Smoking (Tobacco Use)
Patients who smoke or use tobacco are advised to stop several weeks before spine surgery. Cigarettes and other tobacco products contain hundreds of toxins, which effect blood’s ability to carry oxygen. Smoking (tobacco use) increases the risk of surgical and anesthesia complications. Smokers suffer from more respiratory ailments than non-smokers; smokers require more supplemental oxygen during surgery and may need assistance breathing following surgery. Patients who smoke also stand a greater risk for failed fusion.

Preoperative Consultations - Consent Forms
Prior to your surgery, you will meet with your surgeon and anesthesiologist either separately or together. During this consultation, you and your surgeon and/or anesthesiologist will review your medical records, the benefits of the proposed surgery, type of anesthesia, the surgical procedure(s), potential risks and complications, pain management, pre and post hospitalization, rehabilitation, and recovery.

The surgical and anesthesiology plan is put into writing - a document termed a Consent Form. By signing this document the patient gives their permission to the surgeon and/or anesthesiologist to perform procedure(s). The surgical and anesthesiology Consent Forms may be separate documents.

Preoperative Check List
If your spine surgery is pre-planned, you will be given many instructions (usually in writing) to follow before your procedure. Keep in mind the following list is not all-inclusive. Be sure to strictly follow the list provided by your spine specialist.

Day of Surgery
If you will be traveling to the hospital or surgery center the day of surgery, plan to leave your home early. Feeling rushed will not help you to relax. Wear loose fitting clothing that is easy to take off and put back on. Shoes that you can slip off and on are suggested. If you will be staying at the hospital overnight, pack night clothes, slippers, and toiletries. Leave watches, earrings, and jewelry at home. Do take hearing aids, glasses, and dentures.

After hospital admission, you will be taken to the preoperative area. Medical staff will review your medical history and other reports. Your vital signs will be checked (and rechecked) and an IV (intravenous line) will be started. Different drugs including some anesthetics may be administered through the IV. Although you may not be awake, at the appropriate time, you will be wheeled into the operating room (OR). In the OR the anesthesiologist will put you to sleep and monitor all vital signs during the entire surgical procedure.

Following surgery, you will wake up in the recovery area where medical staff will continue to monitor your pulse, respiration, blood pressure, and other signs. Postoperative pain will be managed. Once stable and awake, you will be moved into your hospital room. If your procedure allows you to go home the same day, medical staff will provide you with written instructions to follow.

Editorial Board Comment: “Any type of invasive procedure, especially a major operation, may be frightening to patients. This natural response will be exacerbated by lack of information. More thorough understanding of the preoperative evaluation process should alleviate some of these worries. Spinasanta clearly reviews the steps in the preoperative process, including explanation of preoperative radiographic evaluation, history and physical examination, blood tests and anesthesia assessment. The importance of smoking cessation is wisely emphasized, as are possible changes in medication schedules. This article will be of benefit to those preparing for spinal surgery.” Anthony K. Frempong-Boadu, M.D. - Editorial Board, SpineUniverse John K. Ratliff, M.D. - Fellow in Complex and Reconstructive Spinal Surgery

 

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