General Information About Surgery

The purpose of this section is to provide specific information to our patients about the various surgical procedures that are performed at Precision Spine Care.

Roles And Responsibilities

Step One: Rule Out Non-Surgical Approaches To Healing

Surgery will become an option for pain relief only when all other avenues to resolve the problem have been exhausted. Your surgeon will outline the options to resolve your condition beginning with the least invasive treatment, reserving surgery as the “last resort.”

Maximize Healing

One aspect of this process needs to be emphasized from the start. There is a popular conception that our bodies function like a machine such as a lawnmower, and that when we have a problem, surgery is mainly designed to repair or “fix” the problem. The human body should be compared to other living organisms that possess the power to heal and mend on their own. We like to refer to surgery as a systematic way of creating the best circumstances for the body’s healing power to occur. This is quite important. Major spinal conditions that have existed for years may require surgical procedures that are elaborate and extensive, and it is natural for the healing process to take a considerable length of time. Understanding this in advance is very important, and if you have doubts about this, you should discuss them with your surgeon.

Addressing Fears And Concerns

Surgery is a major event in one’s life, and the decision to undergo surgery may be a difficult one. We hope that fear, anxiety, and stress involved with this decision will be lessened by having detailed information about the proposed surgery. While there is no way to avoid fear entirely, fear of the known is usually less than fear of the unknown.

Team Approach To Healing

As surgery moves up on the list of options, your surgeon will discuss potential advantages and disadvantages with you and your family, forming a “partnership” for healing. You must have information that will allow you to decide which treatment is best for you.

Your Surgical Team

We are strong proponents of a “team approach” to medicine. The team is comprised of surgeons, physician assistant and nurses. Everyone on your team will do their best to help with your care, and will work together to meet your needs. Before surgery, there will be an attempt to explain exactly what our “game plan” is for your surgical procedure. In order for you to have as few surprises as possible, we will discuss all possibilities for your surgery in advance.

The Physician Assistant

The Physician Assistant’s training allows him to assist the doctor in the office and in the hospital, including surgery. They are in constant communication with the surgeons and the staff, and they are able to take responsibility for making sure that patient problems are addressed quickly and competently. PA’s are knowledgeable about problems that can occur before and after surgery, and they may be the first person that would be called if a problem arises.

Nurses

Nurses are often the first link of communication to surgeons and PA’s. They have been trained to recognize problems and to expedite solutions. Gordon Spine Associate nurses are highly skilled in conducting admission histories, obtaining laboratory data and diagnostic test results, explaining surgical and conservative care treatments and diagnostic procedures. They serve as a contact between the patient and the physician to facilitate continuity of care.

The Patient’s Role

The most frequent reason for surgery is pain. Since pain is a personal experience that cannot be shared with other people, even your doctor, we have always felt that the decision to have surgery should ultimately be yours. The surgeon’s job is to teach the patient everything he knows about surgery, and the patient’s job is to understand this and to decide if the impact of his problem on his life is such that surgery seems to be the best option. No surgery can be predicted to be 100% successful, and there is always the possibility of a complication that could produce an undesired outcome. This has to be factored into the decision-making process.

There are many things that our patients are encouraged to do to enhance the probability of a successful outcome from surgery. Some of these are:

  • Strengthen the muscles in your spine before surgery with physical therapy or a home exercise program.
  • Stop smoking.
  • Achieve optimal weight prior to surgery.
  • Evaluate the quality of your bones, and treat conditions such as osteoporosis.
  • Behavioral medicine intervention can help reduce depression and stress which are commonly found in patients who are living with chronic back pain.
  • Significantly cut down on pain medication prior to surgery in order to better tolerate the surgical experience.
  • Discontinue all non-steroidal anti-inflammatory medication a week or more before surgery, or as instructed by your doctor.
  • Give proper medical attention to other health problems such as diabetes, heart trouble, high blood pressure, etc.

At least 50% of the success from surgery is the contribution from the patient. Even the most perfectly performed surgery is not likely to help unless the patient’s attitude is positive and the desire to get well is very strong.

What You Need To Know Before Surgery

Exam Before Surgery

Before surgery, your doctor may ask you to see your primary care physician for a general exam with blood work. If you have a chronic condition such as heart problems, diabetes, or high blood pressure, be sure to advise your doctor. We may suggest seeing a local specialist here in Tyler while you are in the hospital.

2 Weeks Before Surgery

  • You will need to significantly reduce the amount of pain medications, or stop altogether, as your doctor recommends, in order to enhance the effectiveness of pain medications after surgery. If, however, you are taking Oxycontin, continue to take it until the day of surgery. (Do not take it the morning of surgery.)
  • There are a number of medications that are important to monitor before surgery. Your doctor will discuss this with you. The major medicine that needs to be discontinued includes blood thinners such as Coumadin, Heparin, and any kind of aspirin containing product or anti-inflammatory medication which is labeled as a non-steroidal anti-inflammatory medication (NSAID). NSAIDs include aspirin, ibuprophen, Advil, Motrin, Daypro, and Naprosyn. These medications have been associated with an increased incidence for bleeding after surgery, and we recommend that the medication be discontinued for a period of 7 to 14 days prior to surgery. There is a new class of NSAIDS– including Vioxx and Celebrex– that may be taken until 2 days before surgery. (Stop taking these two days before your surgery date.) This will be discussed with the doctor who prescribes those medications.
  • If you take herbs or alternative prescriptions, please advise your doctor. Some of these can cause odd interactions with common drugs.
  • Your doctor will discuss the importance of stopping smoking. It will also be important not to smoke for at least 24 hours before surgery in preparation for anesthesia. This is important.

The Night Before Surgery

Eat or drink nothing after midnight – this includes food, water, coffee, chewing gum, etc. If you take a medication regularly, you may take it with a small sip of water.

What You Need To Know About Your Hospital Visit

The Admission Procedure

  • Report to the admission desk at the given time. When you get your wrist band, check for correct name and allergies.
  • You will be escorted to a holding area where you will be given a gown and asked to remove any jewelry, watches, hairpins, etc.
  • The anesthesiologist will visit to discuss the anesthesia that you will be given during surgery. Make certain you provide information about any medication or anything you are allergic to.
  • The nurse will provide you with a consent form to sign. This acknowledges that you understand the procedure you are about to have as well as the risks and potential complications. These were discussed in medical education and in the pre-op videos. If you have any questions that you need to ask your surgeon, be sure to let the nurses know.
  • You will sign the “Texas Directive to Physicians” or advanced directives stating your wishes regarding life support should that need occur, and who you want to make decisions in the event you are unable to do so.
    It is permissible for one or two family members to be with you while you are in the holding area.
  • An IV will be started.
  • Family may wait in the surgical waiting area. The surgical nurses will usually call with updates during the surgical procedure. After the surgery is completed, the surgeon will speak to them. You will go the post-anesthesia area for one to two hours and then you will be taken to your room. Your family will be notified about your room number before you are taken to your room. Family members are permitted in the post-anesthesia area. If you request a private room and one is not available, you will be put on a waiting list.

After Surgery

  • Sometimes patients will have a “PCA pump” (Patient Controlled Anesthesia) which allows you to administer a small amount of narcotic as needed. Pain will be managed for other surgeries with injections and oral medications. When oral medications are sufficient to control pain, and you can take care of basic needs, you may be discharged to go home.
  • You will be encouraged to walk reasonably soon after surgery.
  • You will wake up after surgery with elastic stockings that may be removed once you are sufficiently active. The nurse will advise you when it is ok to remove them.
  • Use the “log roll” method to get out of bed: lie on your side and, keeping your knees bent, swing your legs over the side of the bed as your upper body comes upright in one movement, keeping the back straight.
  • Once you have been instructed to walk, try several short walks throughout the day. Frequency of changing position is the most important key to adjusting to the new movements.
  • If you are given a brace, use it EXACTLY as instructed. If you are not sure about how to use the brace, ask your therapist IMMEDIATELY.
  • Do your allowable exercises as soon as instructed by your therapist. Be sure these have been outlined for you SPECIFICALLY AFTER THE SURGERY. Some people will have certain movement restrictions. Do a few exercises several times a day. Frequency is more important than number of repetitions.
  • Before leaving the hospital, be sure you have spoken to your therapist and have gotten answers to any questions about what you can and cannot do in the next two weeks.
    You want to know about:
    • Using a brace
    • How much walking to do
    • Exactly what is meant by “no lifting, pushing, or pulling”
    • Continuing your allowable exercises on a frequent, low intensity basis.

When You May Leave The Hospital

When oral medications are sufficient to control pain, and you can take care of basic needs, you may be discharged to go home. Sometimes patients will control the amount of pain medication delivered through an IV (Patient Controlled Analgesia). Otherwise, injections and /or oral medication will be used to control post-op pain. Most pain medications are provided by the nurses only on your request.

What You Need To Do After Surgery

On Your Day Of Discharge

  • Be sure you have plans for removing your skin sutures or staples. If you live in the Tyler area, they will probably be removed at Precision Spine Care. If you live further away, you may prefer to have your family doctor or a nurse remove them. Of course, if there is any problem such as redness or drainage, you will want to be sure and let your surgeon’s nurse know.
  • You will be given prescriptions for post-op pain medications before you leave the hospital.
  • The nurses will give you a sheet of post-operative activity instructions. (This is usually referred to as the “Do’s and Don’ts” sheet.)

6-Week Check-Up Appointment

  • You will also need to set up a post-op office visit appointment for four to six weeks after surgery. If you don’t hear from us in a few days, please call and set this up.
  • If you have had a fusion, you will need to go by the hospital and get an x-ray taken before your six-week check-up.

After Neck Surgery

Any time the skin is punctured, infection is a risk. If treated early, infection is easier to control; if not, it can be life threatening. Infection is rare, but it can happen. By being aware of the signs of infection, you can take action quickly if it should happen to you. If in doubt, call your doctor’s nurse. Mention to the switchboard operator that you have recently had surgery and your call will be handled immediately.

Be Alert For The Signs Of Infection

  • Fever – even one degree
  • Increased pain at the incision site.
  • Drainage that is pus-like in nature.
  • Redness and swelling at the incision.
  • Heat at the incision.
  • Unpleasant odor at the incision.

Other Symptoms To Report Immediately:

  • If you experience clear, watery fluid draining from your wound, or develop a headache when you are upright, you may have a spinal fluid leak. You should notify your doctor’s nurse or the doctor on call right away.
  • Naturally, your incision area will be sore; however, if you have any drainage, pain, redness, swelling, or fever, please call the office immediately.
  • Do not become alarmed if you experience the same type of pain that you had before your surgery, or even some new weakness or numbness. This usually only lasts a short time. The healing process takes time.
  • You will tire easily after surgery. Plan rest periods for yourself, but start a walking program as soon as your pain allows you to do so. Have someone walk with you at first. Start slowly and increase your distance daily a little bit at a time. Wear sensible shoes and select a flat area on which to walk.
  • DO NOT lift or bend unnecessarily prior to your post-op check-up. Use good body mechanics AT ALL TIMES. If you are unsure of the use of good body mechanics, discuss this with your nurse, or a physical therapist can instruct you properly. Do not bend your spine . The only exercise you should attempt is walking until you receive other instructions from your doctor. Change sitting positions frequently. Keep in mind that you must not lift more than 10 lbs. for at least 6 weeks.
  • Sitting in a low chair of sofa is usually uncomfortable. Avoid unnecessary sitting, such as sitting in a car. You may not drive until you are released by the doctor to do so (usually 6 weeks). Avoid the use of a recliner; use a straight-backed chair to sit. Sleep on a firm mattress.
  • Use your pain medications carefully. Many patients have been on a lot of narcotics prior to their surgery. Use pain medications only as your doctor recommends in order to avoid problems such as increased tolerance to the medication.
  • Let your pain determine your activity level. If something causes increased pain, avoid that activity.
  • Since you will be less active than normal, it is important to have good dietary habits. Excess weight is harmful to your back, and good nutrition promotes healing. If you are a smoker, this is an excellent time to quit. The effects of cigarette smoking (and tobacco use in general) and failed fusions are well documented. If you need assistance with stopping smoking, please discuss it with your doctor or nurse.
  • You may take a shower and at that time gently wash the incision site with soap and water only. It is probably better not to take a bath, but if the only option is a bath, make it quick as the incision should not be soaked in water for prolonged periods. If for some reason you feel the site needs to be cleaned in addition to the shower, cleanse briefly with hydrogen peroxide and sterile water on a gauze pad. DO NOT PUT OILS OR OINTMENTS ON THE INCISION.
  • If you have had a fusion and the graft was taken from your hip you will probably experience pain from this area, which is normal. Be sure to walk regularly as bed rest lengthens your recovery time.

How To Avoid Surgery In The Future

There are many factors that influence whether you will need surgery in the future. The following are some general ways you may participate to enhance your long-term well-being:

  • Discontinue smoking or other tobacco usage.
  • Don’t overdo. The absence of pain does not mean healing is complete.
  • Do not take pain medications in order to do more than you should.
  • Begin exercising slowly. Increase as tolerated. Avoid getting competitive with your exercise–listen to your body.
  • Tune in to physical sensations and listen for messages of “overload.”
  • Form a partnership with your physical therapist and discuss feelings openly. Work together on planning exercise activity and progression.
  • Keep muscles of the spine strong – for the rest of your life.
  • Use proper back mechanics – for the rest of your life.
  • Treat osteoporosis vigorously. Ask your doctor about the condition of your bones if you do not know.

Additional Post-Op Instructions After Neck Surgery

  • Wear your collar as directed by your doctor. In the event you were instrumented with a Syntheses plate (hardware) you may wean your self off the collar by leaving it off only at home while just sitting around for a few hours per day
  • If you experience difficulty swallowing after surgery, go on a soft diet for a few days and if this does not improve, we will order AP and lateral films to rule out vertebral swelling.
  • Be ultra aware of your posture. Your head will tend to move forward on your shoulders. Fight this tendency! Keep your head pulled back, directly over your shoulders with your chin tucked IN (close to your throat).
  • If you have a headache, use an ice pack at the base of the skull.

Enhancing Your Long-Term Well-Being

There are many factors that influence whether you will need surgery in the future. The following are some general ways you may participate to enhance your long-term well-being:

  • Discontinue smoking or other tobacco usage.
  • Don’t overdo. The absence of pain does not mean healing is complete.
  • Do not take pain medications in order to do more than you should.
  • Begin exercising slowly. Increase as tolerated. Avoid getting competitive with your exercise–listen to your body.
  • Tune in to physical sensations and listen for messages of “overload.”
  • Form a partnership with your physical therapist and discuss feelings openly. Work together on planning activity and exercise progression.
  • Keep muscles of the spine strong – for the rest of your life.
  • Use proper back mechanics – for the rest of your life.
  • Treat osteoporosis vigorously. Ask your doctor about the condition of your bones if you do not know.

Precision Spine Care is the only spine center in East Texas to be included in Spine Center Network, an exclusive national listing of credentialed spine centers of excellence. Click here to learn more.


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