OrthoNeuroSpine & Pain Institute
Questions before you decide to have the surgery
- What type of surgery are you recommending? Why?
- What is the source of the painthat is being addressed? How do you know this? (Exploratory back surgery is not done).
- Please explain the procedure - at a very high level/with some detail/in great detail. The amount of information depends on your personal preference – some want to know everything, some not so much!
- What are my non-surgical options?
- What is the natural course of my condition if it is not surgically addressed?
- What would you recommend if this were your friend/wife/sister/daughter etc…?
- How long will the surgery take?
- What are side effects, potential risks and complications?
- Please explain the risks and how they relate to me personally. For example, chances of having a non fusion if you are overweight, a smoker, risks if have a grade 3 spondy, etc.
- What if you get in there and see something different than you expected?
- Do I need to donate my own blood? If yes, why?
- Do you perform the whole procedure? Will any students/other surgeons be doing any parts of the operation? If yes, who are they and what are their qualifications? Some surgeons only do a small part of the operation, others do the whole thing. If another surgeon is required, e.g. a vascular surgeon, their role is important and it would be good to know their qualifications..
- Who else will assist you in the operation? What is their background and qualifications?
- What are the long-term consequences of the proposed procedure? E.g. will the operation ever need to be re-done? If it is a fusion, will it lead to degeneration at other levels of the spine?)
Questions about the surgeon
- How many times have you done this procedure? In general, when it comes to surgery "practice makes perfect", so more is better. (However, if the doctor is recommending something that is not often done, such as multi-level fusions, more would not necessarily be better.)
- Are you fellowship trained in spine surgery? This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.
- If I want to get a second opinion, who would you recommend? (Someone not in the same practice)
- Statistically the success rate for this type of surgery is _%. What is your personal success rate, and how many of this type of surgery have you done?
- Can I talk to other patients who have had a similar procedure?
- Any defensiveness on the part of the surgeon when you ask these types of questions may be a red flag. A surgeon with good results and appropriate qualifications will not be threatened by these types of questions and will respect your attention to these matters.
- Questions about what to expect after the surgery
- What kind of pain should I expect after the surgery and for how long?
- How long is the hospital stay?
- May a family member spend the night with me in the hospital?
- How do you manage the pain in the hospital?
- Which pain medications will I be sent home with? What are possible side effects of these prescriptions? E.g. Constipation, drowsiness, etc.
- Will you know before the surgery if I will need a backbrace afterwards? If so, will I be fitted for one before the surgery?
- Who can I call if I have questions after the surgery? What is the process for communication?
- How often will I see you after my surgery?
- What symptoms would warrant a call to your office?
- What symptoms would warrant immediate medical attention?
- What limitations will I have after surgery and for how long?
- How long will I be out of work? School? Whatever...
- What kind of help will I need when I return home?
- When can I drive again?
- When can I resume normal (light) household chores?
- What expectations do you have for my recovery?
- When is it safe for my spouse and I to have sexual relations again?
- How soon after the surgery can I start physical therapy?
- Good luck with your decision and your recovery!
Learning that you need spine surgery can be a frightening realization, because all surgery carries risks as well as benefits. You’ve already taken a very important first step in choosing a surgeon and surgical team that you can trust. Our doctors and nurses are well respected and well trained. We specialize in spine surgery, and we pledge to use our skills and training to the best of our abilities. We will also educate you about your condition and the surgical plan, including associated risks, possible complications and expected outcomes.
However, even the most successful and technically prepared surgical team cannot compensate for your important role in getting ready for surgery. Your physical and mental preparedness for the operation can have a major impact on surgical success and recovery. Depending on the amount of time you have before your surgery, there are many things that you can do to maximize your chance of a positive experience.
It is important that your body be as healthy as possible before undergoing the stress of surgery. We will assess your overall health to identify any concerns in your medical history that could create complications or added surgical risk. We will conduct a thorough physical examination, along with blood tests and urinalysis. Depending on your age and health, we may order additional pre-operative tests such as chest x-rays or an EKG. We may also ask you to improve your health prior to surgery by making nutritional improvements, losing weight, exercising, or stopping smoking.
Eating a healthy and nutritionally balanced diet strengthens your immune system, which helps your wounds to heal faster and may help prevent infection. A balanced diet includes lots of fruits and vegetables, whole grains, and protein from dairy and meat. You should avoid added fat, processed foods, and sugar to maintain the healthiest immune system possible. A multi-vitamin supplement may be helpful as well, although it is best to get your vitamins from eating healthy foods rather than supplements. Keep in mind that herbal supplements, although they may be derived from “natural” sources, are still a type of drug and must be discussed with your doctor. Certain supplements can have adverse affects during surgery.
If you are overweight, you may want to take steps to safely lose weight prior to your surgery through healthy eating and exercise. Excess weight causes additional stress to the spine that can make post-operative healing more difficult and can cause more pain in the recovery process. If you have a lot of weight to lose, be sure to consult your doctor for supervision. Drastic weight loss or weight loss using unsafe methods (such as some herbal supplements) can create additional health problems and risks.
Exercise can help you prepare for surgery by building muscle strength and cardiovascular fitness. The more fit you are, the faster your recovery time and your return to an active and healthy life. Exercise also boosts your immune system and contributes to an overall sense of well-being. Almost everyone can safely adopt some form of activity prior to surgery to increase strength and stamina. Depending on your condition and the level of pain you experience, walking, swimming, water aerobics, or light weight-training exercises can be beneficial. A physical therapist or professional trainer may be helpful in designing an activity program that is right for you. However, be sure to consult your doctor as well.
If you are a smoker, quitting this habit can be the single most important change that you make prior to surgery. Smoking significantly increases your chance of surgical complications. It compromises your immune system, can adversely affect you during the anesthesia process, and can contribute to lung difficulties such as pneumonia during your recovery. In addition, many spine surgeons refuse to perform spine fusions on smokers, because studies show that fusion rates are much less successful among smokers. Stopping smoking three months prior to surgery and during recovery can improve your health and your surgical outcome significantly.
In addition to physically preparing for spine surgery, it is important that you are mentally and emotionally prepared for your operation. We want to make sure that you know what to expect in each step of the process. We also want you to be aware of the many practical and logistical details that you may need to take care of before surgery.
You will need to identify a friend, family member, or support person to drive you to and from the hospital for your surgery. You may also need someone to stay with you at home for at least the first day or two after your surgery to assist you with personal care, meals, cleaning, and necessary errands. Depending on your condition, the type of surgery, and your individual circumstances, you may need to arrange for professional home care for a longer period of time.
Preparing Your Home
It is a good idea to prepare your home for your post-operative recovery needs. You may be temporarily restricted from bending, stooping, or heavy lifting, so place necessary objects such as your telephone, food, toiletries and medicine within easy reach. You may also want to rearrange your furniture so that you don’t need to climb stairs, and remove rugs that might trip you. Depending on your condition, you may need to obtain special equipment for walking and bathing that your doctor, nurse or physical therapist can prescribe.
It is important that you have realistic expectations about your post-operative recovery. If you need to wear a brace after surgery, you may be fitted for it prior to your procedure. Our medical team will also discuss with you how long you may be hospitalized; what temporary or long-term restrictions you may have after surgery, and when you may be able to return to work or other activities.
You will need to sign consent forms showing that you understand the proposed surgical procedure and that you agree to it. We will make sure that you understand your medical history; the type of surgical procedure suggested; the type of anesthesia we will use; the risks, benefits, and potential complications; and the expected plan for your hospitalization, post-operative pain management, rehabilitation and recovery.
Final Pre-surgery Preparation
In the final days leading up to your surgery, you will receive detailed instructions from us about your medication schedule, blood donations, and how to prepare for your admission to the hospital. These instructions vary depending on your individual circumstances, but in general you may want to consider the following issues.
Many patients choose to donate their own blood to be stored for their needs during surgery. Other patients obtain blood donations from family and friends with a compatible blood type. If you donate your own blood, you will need to plan your blood donations to begin two to four weeks prior to surgery.
Food and Medication Instructions
We will give you detailed instructions about your medication schedule prior to surgery, and what you may eat and drink. Often patients are not allowed to eat or drink anything after midnight on the night of surgery. Also, we will give you clear directions regarding certain medications such as blood thinners and anti-inflammatories that you might need to stop taking in the days or weeks leading up to surgery.
When you go the hospital for your surgery, it is a good idea to wear comfortable, loose-fitting clothes and shoes that are easy to take on and off. If you will be staying overnight in the hospital, bring a small bag with underwear, nightwear, slippers or loafers, and personal toiletries. If you will be wearing a brace after surgery, you will need a cotton t-shirt to wear under the brace. Leave your jewelry and watches at home, and remove your rings.
When you arrive at the hospital, you will be asked to change into a hospital gown. Your visitors will be asked to wait in the waiting area. Medical staff will review your vital signs and start an IV prior to taking you into surgery.
Although the prospect of surgery can be daunting, we are experienced in helping our patients through this process. If you have the time to prepare for your surgery physically and mentally, it can greatly enhance your overall sense of well-being and the outcome of your procedure. Be sure to listen to and follow our instructions so that you are ready for surgery, and don’t hesitate to ask us if you have any questions.
Patient Theatre Journey
The Patients experience through our department is very important to us and we aim to make you feel safe in this unfamiliar environment. Many patients feel apprehensive and bewildered about the visit to the operating room, if their need is for elective surgery or as an emergency admission. You can rest assured you will be treated with total dignity in a clean and safe environment.
On the day of your surgery, you will be escorted from the ward on a theatre trolley or your own hospital bed with a porter. Upon arrival in the theatre reception the team will welcome you and carry out a short check in which to identify you as part of our WHO Patient safety check.
When the team have prepared all the equipment for your surgery a member of the team will collect you, and take you into the anaesthetic room where you will be put to sleep if you are to receive a general anaesthetic. Once inside you will meet your anaesthetist who alongside the scrub practitioner and one of the surgeons attending your surgery, we will conduct the Patient Safety Check, where questions about your identity, surgical procedure will be confirmed. Once you and the team are happy to continue with your procedure the anaesthetist will insert a small needle in preparation to put you to sleep, and in no time you will drift off to sleep.
Here the full team will carry out your surgical procedure to a high standard, ensuring your safety, dignity and wellbeing at all times.
Following your operation we will transfer you on your hospital bed to the recovery room. An assigned nurse will work with you on a one - to - one basis making sure your post operative care is continued to the same high standard we work too. Their aim is to ensure you are pain free and comfortable, any wound drains, urinary catheters will be checked.
When you are able to maintain your own airway and pain free you will then be transferred back to the ward with a nurse and porter.If you have a questions prior to your theatre department care, and you wish to discuss with a member of the team then please do not hesitate to contact us.
We are here to deliver our daily vision for your surgical requirements, to a high standard in a safe and controlled manner.