Why Medical Clearance Before Spine Surgery?

In advance of spine surgery, your surgeon requires medical clearance, sometimes called pre-operative clearance, from your primary care physician (PCP). Other medical specialists, such as a cardiologist or endocrinology may also be involved. One purpose of medical clearance is to assess your personal risk(s) related to undergoing a surgical spine procedure.
Xray image of the spinal column with an ekg graph running across the photo.Medical or pre-operative clearance is a careful assessment of your personal risk(s) for neck or back surgery. Photo Source: 123RF.com.

Why Medical Clearance Is Important

Medical clearance is a pre-surgical measure aimed to protect you. If you have another medical condition (ie, comorbidity), such as cardiovascular disease, your surgeon may want another doctor familiar with your medical history to offer perspective on whether the procedure is safe for you and ways to reduce risks. That’s because certain comorbidities can increase your risk of serious surgery-related complications, including infection, cardiovascular problems (eg, heart attack), blood clots, respiratory problems, and death during and/or after surgery.

While your PCP or specialist doctor provides valued insight on the risks of the spinal procedure and ways to minimize those risk for you, the ultimate decision of whether to pursue spine surgery rests with you and your spine surgeon.

Comorbidities, Medical Clearance, Estimating Risks

Before, during and after surgery your body’s systems need to work harder to maintain and stabilize vital processes—such as respiration, blood pressure, heart rate, and temperature. Certain comorbidities or conditions may increase risks such as those related to anesthesia, surgical procedures and aftercare (eg, healing).

Some of the most common conditions requiring evaluation during a medical clearance assessment include:

  • Cardiovascular risk (the top reason spine surgeons require medical clearance)
  • Obesity
  • High blood pressure
  • Congestive heart failure
  • Pulmonary embolism
  • Sleep apnea
  • Diabetes
  • Osteoporosis
  • Taking blood thinners (anticoagulants)1,2

A medical clearance often involves a physical examination, chest x-ray, blood and urine testing, and electrocardiogram (EKG). Additional assessments or tests may be necessary depending on a patient’s existing comorbidities or those discovered.

While medical clearance looks different from physician to physician (there’s no set process for how to obtain medical clearance), your surgeon requests it by discussing the following details of your spinal procedure with your PCP or other specialist:

  • Type of procedure (eg, name of procedure, open/traditional versus minimally invasive approach)
  • Goals of the procedure
  • How much time the procedure will take and how long you will be unable to move
  • Type of anesthesia required (eg, general versus local)
  • Recovery details (eg, how long recovery period is expected to last, rehabilitation recommendations)

SpineSage and the American College of Surgeons (ACS) offer two types of online risk calculators your doctor and/or surgeon may use to help evaluate your spine surgery risks. These types of tools can help doctors estimate the risks of an “unfavorable outcome, such as a complication or death,” after a surgical procedure. These tools use the patient’s medical history and compares it to outcomes from a large pool of patients who’ve had a similar surgical procedure.

Keep in mind that the surgical risk calculator tools provide only estimates, not total certainty, of a procedure’s risks for a specific patient. Ultimately, your surgeon and other doctor(s) will work together to best understand the procedure’s risks to you.

Why Is Medical Clearance Necessary for Spine Surgery?

Spine surgery—even when it’s performed minimally invasively—is a major medical operation that poses potential risks and complications. If you have a comorbidity, such as diabetes, that can increase the risks of the procedure.

Medical clearance is important because if your spine surgeon and PCP/other doctor(s) believe the surgery poses a risk for you, they will work together to adjust aspects of anesthesia and/or surgical approach (before, during, and after surgery) to minimize your risk. This could include changes in your medication regimen before and/or after surgery, starting a weight loss or smoking cessation program before surgery, or ensuring you are up and moving shortly after surgery to reduce respiratory complications.

If I Get Medical Clearance, Is My Surgery Risk Free?

No surgery is free of risks or the potential for complications. While being cleared for spine surgery may seem like no risks exist for you, that’s not true.

If you have been cleared for spine surgery, it’s important to still take the time to review the benefits and risks of the procedure with your spine surgeon before undergoing it. Knowing this information can help you make an informed decision.

Medical Clearance: An Important Step in Making Your Spine Surgery a Success

If you’re facing the prospect of spine surgery, you’re likely anxious about your back or neck operation. Will the recovery be long and painful? Will the surgery eliminate my pain? Will my quality of life get better because of this operation? Spinal surgery is a major operation with no guarantees, and your questions and fears going into the procedure are normal.

When your spine surgeon seeks medical clearance before your surgery, don’t view it as an extra hurdle in a long treatment journey; instead, know that it’s a very important safeguard intended to make your surgery safer and more successful. And beyond your surgery, medical clearance may help you make healthier long-term choices, such as weight loss or stopping smoking. Making those lifestyle changes can not only improve your surgical outcomes, it will improve your engagement in your own health for long after your procedure.

Dr. Benjamin Bjerke specializes in cervical (neck) and lumbar (low back) minimally invasive spine surgery. He trained with the combined Neurosurgery and Orthopedic Surgery Fellowship at Mayo Clinic and is a spine surgeon with BoulderCentre for Orthopedics & Spine.

Updated on: 01/10/19
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