Spine Surgery: Patient Preparation and Recovery

Pre-Operative Tests
A chest x-ray, blood tests, electrocardiogram (electro-car-dee-oh-gram), and urinalysis (yu-ri-nal-is-sis) are typically included in the patient's pre-operative work-up. If the patient has a co-existing disease such as diabetes, additional tests may be necessary. The primary care physician and/or other treating specialists will be involved to make sure the patient's general health is thoroughly evaluated prior to surgery.

Hospital/Outpatient Pre-Registration
Prior to the surgery day, the hospital or outpatient facility staff will call the patient to schedule an appointment for pre-registration. Pre-registration is a simple process that involves the patient providing information so the treating facility can be paid for services rendered. The type of information needed includes the patient's name, address, social security number, and insurance provider.

Meeting an Anesthesiologist
The patient meets with a member of the anesthesiology department prior to surgery. The anesthesiologist (an-es-thee-z-al-oh-jist) reviews the patient's medical records, discusses the spine surgery and type of sedation to be used during the procedure, and answers the patient's questions. General anesthesia (general an-es-thee-z-ah) is the usual type of sedation chosen for spine surgery. General anesthesia temporarily affects the central nervous system and helps to keep the patient pain-free and comfortable during surgery.

Pre-Operative Instructions
The surgeon's medical assistant or nurse provides the patient with a written list of instructions to follow before surgery. Instructions include how to prepare the home for post-operative care, planning for the patient's transportation needs, special information about taking current medications, to leave valuables at home, a reminder not to eat or drink anything the evening before surgery, and what time to report to the surgical facility.

Surgery Day
At the surgical facility, the patient checks in and is escorted to a pre-surgical area where the patient is prepared for surgery. Here the patient changes into a hospital gown. The patient's pre-surgical nurse verifies the patient's name, type of surgery to be performed, and reviews their medical history including allergies. An intravenous line (IV) is started. Different types of necessary medications are injected through the IV into the patient's bloodstream. Light sedating medication may be given to the patient through the IV. Some patients become so relaxed that they do not remember being taken to the operating room.

Operating Room (OR)
The OR is a sterile environment suited with large adjustable overhead lighting, a surgical table, and other equipment. During the operation the anesthesiologist (an-es-thee-z-al-oh-jist) monitors the patient's vital signs - heart rate, blood pressure, and level of sedation. Surgery is a team effort. The surgeon takes the lead and the surgical assistant and nurses support the surgeon and anesthesiologist.

Recovery Room
After surgery the patient is moved into the Recovery Room. Here the patient's vital signs continue to be closely monitored to help minimize post-operative complications. During this time, the surgeon briefly meets with the patient's family. When the patient is stable, he is moved to a hospital room. A patient who had 'same day surgery' is released home only after their post-operative condition is stable and the patient is awake.

Post-Operative Pain and Patient-Controlled Analgesia (PCA)
Pain following surgery is relative. A patient who has endured pain for years (chronic) may not perceive pain the same way as a patient who has not. Post-operative pain is commonly described as acute pain - it can be severe, but is short-lived. There are several ways to control post-operative pain; oral medications, intramuscular injections, or Patient-Controlled Analgesia (PCA). PCA puts pain control in the patient's hand. A finger-controlled pumping device feeds pain-relieving medication safely through the patient's IV (intravenous line). The patient simply pushes a button for medication. The pump is programmed with a prescribed amount of medication for a specific time period. It is impossible for the patient to over-medicate.

Patient-Controlled Analgesia (PCA) Equipment

Walking
Depending on the type of surgery, the patient may be encouraged to walk the next day. Some patients require assistance. Walking and movement increases circulation and enhances healing. Physical therapy may soon be added to help the patient build strength and flexibility. PT usually continues on an outpatient basis after the patient is released from the hospital.

Going Home
Patients are sent home with written instructions and needed prescriptions. The instructions include information about medications, general care at home and hygiene, acceptable post-operative activities, diet, a name and number to call in case of emergency, and surgical follow-up.

This article is an excerpt from Dr. Stewart G. Eidelson's book, Advanced Technologies to Treat Neck and Back Pain, A Patient's Guide (March 2005).