Download Spine Surgery Guide Book - Yampa Valley Medical Center

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Table of Contents
Section One: General Information
Welcome
Using the Guidebook
Your Spine Surgery Team
Anatomy and Physiology of the Spine
Common Spinal Problems
Common Spinal Operations
FAQs about Lumbar Laminectomy
FAQs about Lumbar Fusion
FAQs about Cervical Laminectomy
FAQs about Cervical Fusion
Risk Factors
Possible Complications
Section Two: Pre-operative Checklist
Pre-Hospital Assessment
Pre-operative Exercises - Lumbar
Pre-operative Exercises - Cervical
Four to Six Weeks before Surgery
One Week before Surgery
The Day before Surgery
The Night before Surgery
Section Three: Hospital Care
Day of Surgery
- Arrival
- What to Expect
- Post-op Routine through PCU Discharge
- Understanding Pain Management
- Discharge Plans and Expectations
- Physical Therapy Centers
- Home Health and Short Term Rehabilitation Center
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Table of Contents
Section Four: Post-operative Care
Control Your Discomfort
Body Changes
Caring for Your Incision
Dressing Change Procedure
Stockings
Blood Clots in Legs
Pulmonary Embolus
Section Five: Post-operative Activity Guidelines
Cervical
- Spinal Precautions
- Bed Positioning
- Bed Mobility: Getting In/Out of Bed
- Transfers: In/Out of Chair, Bed, Car, Commode, etc.
- Using a Walker
- Using Stairs
- Brace
Lumbar
- Spinal Precautions
- Bed Positioning
- Bed Mobility: Getting In/Out of Bed
- Transfers: In/Out of Chair, Bed, Car, Commode
- Using a Walker
- Using Stairs
- Brace
- Activities of Daily Living, Cervical and Lumbar
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Table of Contents
Section Six: Body Mechanics - Cervical
& Lumbar
General Rules
Standing
Sitting
Bending
Lifting
Turning
Reaching
Push/Pulling
Sleeping
Household Chores
Do’s and Don’ts for the Rest of Your Life
Section Seven: Discharge Instructions
Cervical Laminectomy
Cervical Fusion
Lumbar Laminectomy
Lumbar Fusion
Post-Op Care Instruction
Ice/Cold Therapy
Reasons to Call Your Doctor
Home Set Up
Nutrition
Section Eight - Appendix
Anesthesia for Spine Surgery
Glossary of Terms
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Section One:
General Information
Welcome
Thank you for choosing the Spine Center of Steamboat
Springs, part of the New Mobility Joint and Spine Center at
Yampa Valley Medical Center. The Spine Center was
founded in August 2004 with Henry F. Fabian Jr., M.D., a
fellowship trained orthopaedic spine surgeon, as Director.
Since its inception, the Spine Center has been a leader in
delivering the highest quality of spine surgery services to its patients. Dr. Fabian is an
internationally recognized spine specialist, with an extensive background in developing new
surgical techniques and technologies, including advances in minimally invasive spine
surgery. He has lectured throughout the world and assisted in the training of spine
surgeons from North America, Latin and South America, Asia and Europe. In 2010 Dr.
Fabian was honored with a Patient’s Choice Award as well as being named one of
America’s Top Orthopedists. Along with his colleagues at Orthopaedics of Steamboat
Springs, Dr. Fabian serves as a team physician for the United States Ski Team. At the New
Mobility Joint and Spine Center, Dr. Fabian is supported and assisted by a comprehensive
team of fellow physicians, physical and occupational therapists, nurses and other
professionals trained in the care of patients undergoing spine surgery. A 96.19% patient
satisfaction score and an overall complication rate of less than 1%, as well as benchmark
leading reduced hospital length of stay and infection rates, are testimony to the diligent and
comprehensive care offered at the New Mobility Joint and Spine Center at Yampa Valley
Medical Center.
Back pain, including neck and low back pain, is the second most common reason for seeing
a doctor, besides the common cold. Over 90 million people will see a doctor in the U.S. in
any given year with complaints of “back pain”. In addition, more than 200,000 people
undergo spine surgery in the U.S. each year. Many suffer from debilitating arm, leg, neck
and back pain that they can no longer tolerate. Fortunately, there have been significant
advances in surgical technique, implants and rehabilitation that have allowed surgical spine
patients to return to fully active and productive lives. These days most patients undergoing
spinal surgery recover quickly.
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A significant number are able to undergo outpatient/ambulatory surgery, with even multilevel cervical and lumbar fusion patients discharged in 2-3 days! At the New Mobility Joint
and Spine Center, some patients have returned to sedentary and light duty work after
lumbar discectomy, lumbar laminectomy, cervical fusion, and even lumbar fusion in a week!
Heavy laborers with cervical fusions return to work in 4-6 weeks and in 10-16 weeks after
lumbar fusions.
The Spine Center of Steamboat Springs recently partnered with the New Mobility Joint and
Spine Center at Yampa Valley Medical Center to develop a comprehensive program and
team approach to assure the best outcomes for our patients. We believe that patients play a
key, truly essential, role in ensuring a successful surgical outcome. Our goal is to involve
patients in their treatment along the entire continuum of care, with the patient an active team
member in each step of the program. This guidebook provides the information needed to
maximize your surgical results, ensuring a safe and successful surgical experience.
Features of the New Mobility Joint and Spine Center’s Program Include:
•
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•
•
•
•
•
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A dedicated and experienced surgical team
Nursing and therapists specialized in the postoperative care of spine surgery
patients
Emphasis on individual and patient-specific care
Family and friends participating as “coaches” in the recovery process
A spine care coordinator to facilitate discharge planning
A multi-disciplinary medical physician team to assist in postoperative care
Comprehensive case management care
Attention to consistent and high standards of surgical and postoperative care
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Using the Guidebook
Preparation, education, continuity of care, and a pre-planned discharge are essential for
optimum results in joint surgery. Communication is essential to this process. The Guidebook
is a communication tool for patients, physicians, physical and occupational therapists, and
nurses. It is designed to educate you so that you know:
•
•
•
What to expect every step of the way
What you need to do
How to care for your spine
Remember, this is just a guide. Your physician, physicians assistant, nurses, or therapist
may add to or change any of the recommendations. Always use their recommendations first
and ask questions if you are unsure of any information. Keep your Guidebook as a handy
reference for as long as you need it after your surgery, then please return it so it can be
recycled. The information in the Guidebook covers a lot of details, so it may look
overwhelming. As it will assist you with your surgery, we recommend reading the entire
guide, at a pace that suits you.
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Your Spine Surgery Team
The undertaking and completion of a successful spine surgery and postoperative
rehabilitative course is a multi-faceted and complex process requiring the hard work and
diligence of many highly skilled health care providers. That having been said, the most
important person in the equation and in obtaining the optimal result is You, the
patient! It has often been said by people from little league baseball coaches to CEOs of
Fortune 500 Companies that there is no “I” in “TEAM”, but you, the patient, are the “I” in this
Spine Surgery Team, and you are the most important person. A patient who is actively
engaged in the process, and works alongside all of the various healthcare providers, stands
the best chance of assuring a predictably successful outcome.
Listed below are the members of Yampa Valley Medical Center’s Spine Surgery Team and
the New Mobility Joint and Spine Center. With your help, they will work together to return
you to an active, independent and rewarding lifestyle:
Spine Surgeon: Dr. Fabian and his staff are extremely well trained in the surgical
techniques involved in your specific procedure. They will see you in the pre-operative
period, in the surgical suite, post-operatively in the hospital and after discharge. Dr. Fabian
monitors his cervical and lumbar fusion patients for a minimum of 2 years, with followup
evaluations at 1 and 6-8 weeks postoperatively and then at 3,6,12 and 24 months.
Outpatient laminectomy/discectomy patients are typically followed for 3-4 months. Patient
satisfaction and outcomes are tracked through the continuum of care by Marshall Steele and
Associates, a nationally recognized organization dedicated to developing destination centers
of excellence for spine surgery.
Anesthesiologist: The board certified physicians of Elk River Anesthesiology Associates,
P.C. will provide anesthesia for your spine surgery. They have worked exclusively with Dr.
Fabian and his surgical team since program inception, to develop specific intraoperative and
postoperative protocols for your anesthesia care.
Internists and Local Primary Care Physicians: Every spine surgery patient is required to
have a pre-operative evaluation/history and physical examination by either an
internist/primary care physician or Dr. Fabian and members of his team. Patients
undergoing lumbar fusion, select cervical fusion patients, patients with medical issues and
elderly patients frequently require a more comprehensive preoperative evaluation. Internists
and primary care physicians are specifically trained to complete the general medical pre10
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operative assessment to make sure the patient is medically fit for the specific surgery. For
in-patient spine surgery, they will follow your medical progress and assist in the daily
postoperative care. If your primary care physician is not on the YVMC staff, a YVMC staff
physician will work with you and closely communicate with your doctor so that your care can
be effectively and efficiently managed while you are an in-patient.
Your Spine Care Coordinator
The Spine Care Coordinator will be responsible for your
care needs from the surgeons office, to the hospital, and
home. The Spine Care Coordinator will:
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•
Obtain health database.
Review what you’ll need at home after your
surgery, including support if required.
•
Assess and plan for your specific care needs
such as anesthesia and medical clearance for
surgery.
•
Coordinate your discharge plan to home or a
facility with additional support.
Act as your advocate throughout the course of
treatment from surgery to discharge and home.
•
Answer questions and coordinate your hospital care with New Mobility team
members.
You may call the Spine Care Coordinator at any time to ask questions or discuss concerns
about your surgery. The coordinator will assist you in completing your pre-op patient
outcomes survey.
•
Preoperative Care Nurse : These individuals serve as liaisons among the various
Departments, Surgery and You, the patient. The POC nurse will obtain your health history,
communicate with the primary care physician, schedule pre-admission diagnostic testing,
and physical therapy pre-surgical evaluations.
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Case Management and Discharge Planning
Please call 871-2429 with any questions or concerns you may have prior to surgery.
Case Manager: This person will provide patient education, is available to answer
questions, and assists in coordinating your care. We will assist in discharge planning,
insurance questions and, along with your health care team, help determine if you can safely
manage at home. You can anticipate to be discharged 1-3days after your surgery. Your
case manager and physician will keep you informed of your discharge status.
A case manager will visit you while you are in the hospital to discuss your plans for
managing at home after surgery . The case manager is there to help you arrange for
assistive devices such as a walker or crutches, arrange home health, or to assist in the
transfer to a transitional care unit.
A case manager can also provide emotional support during your stay. We work as the
patient advocate and will try to address any question or concern that comes up during your
hospital stay.
Nursing Department: This includes Peri-operative and Departmental Floor Nursing.
The Peri-operative nursing staff includes the surgical team nurses and the post anesthesia
care nurses. These nurses prepare you for surgery and then care for you in the acute
phase after surgery in the PACU. They are responsible for starting intravenous fluids and
I.V. lines, initial patient intake questionnaires and then for managing your acute needs,
including pain management, after surgery. For spine surgery in-patients, the departmental
floor nurses assist you in meeting your goals. They are specifically trained to care for
patients who have undergone spine surgery.
Physical Therapy: This individual is critical to your progress in mobility and strength.
Ultimately, you and the effort you put forth, as well as the relationship you develop with your
therapist is responsible for the long-term success of your care. You will meet with a physical
therapist pre-operatively to assess any deficiencies that might hinder your postop rehab and
to begin the education process in postural alignment, core stabilization and strengthening
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exercises you will need to be successful for short and long-term. The therapist will work
with you while you are an in-patient and assist you in accomplishing the standardized goals
of the New Mobility Program, as well as those additional goals that are specific to your
problem.
Occupational Therapist: This therapist will assist you with self-care needs and adaptive
equipment as needed during your hospital stay.
Somatosensory Evoked Potentials (SSEP)/EMG (Electromyogram)
Recording/Monitoring Technician: Select cases involving cervical and lumbar fusion are
done at the Center using SSEP/EMG monitoring. This technique allows for continuous
monitoring of the function of the spinal cord and nerve roots and offers an additional level of
safety in cases where there is risk of neurologic injury secondary to placement of rods and
screws as well as when spinal curvature correction is undertaken. The technician is certified
and services are contracted on an independent contractor/consultant basis.
Dietician: A YVMC dietician will review your dietary requirements and restrictions or special
diets your condition may warrant.
You, the Patient: Your input and full participation along every step of the process is vital to
the team’s success. By preparing yourself prior to surgery and understanding the course of
events before, during and after your hospitalization, you will be contributing to your own care
and to achieving a successful outcome. Please read this entire book in advance of surgery
and seek additional information from Dr. Fabian, his staff and the hospital program
personnel when and where necessary. It cannot be emphasized enough that the success
of your surgery depends significantly on your preparation and hard work! The team
members will help you achieve your goal of a successful surgical outcome and a complete
and fulfilling postoperative rehab.
THE REST OF THIS RESOURCE BOOK WILL GO OVER THE PROCESS DETAILS.
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Durable Medical Equipment
Suppliers of oxygen, walkers, toilet riser and other equipment
Willow Creek Oxygen and Medical Supply
2570 S. Copper Frontage # 6
Steamboat Springs, CO 80487
970-871-0999
PS Homecare
2851 Riverside Plaza #12
Steamboat Springs, CO 80487
970-879-4212
G & G Medical Supply
581 Tucker
Craig, CO 81625
970-824-8347
Sullivan Respiratory Care
246 Market Street
Meeker, CO 81641
970-878-5883
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Anatomy and Pathology of Spine Surgery
By Henry F. Fabian Jr., M.D.
The human spine is an incredibly complex piece of machinery with a remarkable range of
function and motion. If you have ever witnessed the movements of a gymnast or a Cirque
de Soleil performer you have seen the capabilities of the spine at its best. Unfortunately, as
with most things with a lot of moving parts, things can go awry. The aging process, poor
nutrition, poor posture, bad ergonomics and inadequate exercise can lead to debilitating
injuries and complaints of pain, extremity weakness and numbness, and all the loss of
independence and function that go with these problems. You, as a patient who is
undergoing surgery, are at a crucial point where conservative care has failed or been
insufficient in dealing with your problem. A fundamental understanding of the anatomy of
the spine and the pathology and problems that can develop is very important. Educating
yourself about this subject is the most important step in being fully engaged as a team
player in your care. Learning about spine anatomy and pathology will help you to
understand the entire process that follows once you have made the decision to seek
surgical care.
Before you cringe at how complex the spine may seem, thinking back (maybe not so fondly)
on high school biology class, remember that all systems and problems can be broken down
into less complex, smaller parts. Understanding these smaller pieces of the “spine puzzle”
will help you to understand and see the big picture.
The entire spinal column is comprised of 22 vertebrae in total. There are 7 cervical
vertebrae, 12 thoracic vertebrae and 5 lumbar vertebrae. In between the bony vertebrae
(referred to as vertebral bodies) are intervertebral discs. These “discs” are made of
cartilage and serve as the “shock absorbers” of the entire column. Discs are labeled based
on which vertebral bodies they lie between. For example, the disc between the fourth and
fifth lumbar vertebrae would be labeled “L4-5” and the disc between the second and third
lumbar vertebrae would be labeled “L2-3”. The fifth lumbar vertebra, L5, sits on the sacrum,
a part of the spinal column that links the spine to the pelvis.
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This disc level is uniquely labeled “L5-S1”. The sacrum below S1 is no longer really mobile
or segmented, and attaches to the coccyx. The four sections of the spine are highlighted
and reviewed in the drawing below:
The spine is divided into four main sections:
1. The cervical spine is composed of seven
vertebrae and generally control the arms and
hands.
2. The thoracic spine is composed of twelve
vertebrae and control the region of the chest and
abdomen.
3. The lumbar spine is composed of five
vertebrae and controls the region of the legs and
feet.
4. The sacrum is the lowest part of the spine
and serves as the junction between the spine and
Running up and down the left a
Running up and down the left a
pelvis. These nerves control the bowel and
bladder.
Running up and down the left and right sides of the back of the spine are the paired facet
joints, labeled just like the disc levels. As an example, the left sided facet joint between the
fourth and fifth lumbar vertebral bodies is called the “left L4-5 facet joint”. The facet joints
are real functioning joints, just like our knee or hip joints. With two opposing surfaces
covered in hyaline cartilage, the type of smooth, glistening white cartilage found in your
Thanksgiving turkey legs, these joints allow a variety of movements. Our ability to flex,
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extend, twist and bend is because of the function of these joints. There are 44 (yes, 44!)
facet joints along the entire spinal column. The intervertebral cartilage discs are also
considered a type of joint and as a result, we have a total of 66 functioning joints in our
spines! Total joint replacement surgeons are challenged by a single hip, shoulder or knee
joint. Imagine facing the task of addressing 66 joints and you begin to realize the scope of
complexity and the difficulty in isolating a single source of pain!
With all these “pieces and parts” it is best to focus on the basic building block of the spinal
column, the “Functional Spinal Unit” or FSU. Whether we are talking about the cervical,
thoracic or lumbar spine, this “Functional Spinal Unit”, or FSU remains the same. A
functional spinal unit is composed of two adjacent vertebral bodies with a cartilage
intervertebral disc between them, paired left and right facet joints, and the corresponding
ligaments between the vertebrae and attaching muscles. The drawing below shows an
FSU, or functional spinal unit, and its relationship to the spinal cord and branching nerve
root.
The spinal column is composed of these building blocks stacked one on top of the other,
from the base of the skull to the sacrum and pelvis. Each individual functional spinal unit
allows for flexion, extension, rotation and bending from side to side. The intervertebral disc,
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positioned between the vertebral bodies, serves as the fulcrum, or pivot point for motion.
The disc is made of visco-elastic cartilage and can be compressed, stretched, rotated, and
flexed and extended, defined by certain mechanical limits and based on location in the
cervical, thoracic or lumbar spine. The corresponding facet joints, paired left and right move
up and down to allow flexion and extension. Surrounding the facet joints, just like in the hip
socket or knee, are joint capsule fibers and ligaments that serve to control and restrain the
limits of motion.
If you look back to our first drawing, showing the entire spinal column, you see that it is Sshaped. The cervical and lumbar curves match to some extent and the thoracic curve is
directed in the opposite direction. Spine surgeons talk about the cervical and lumbar curves
being “lordotic” and the thoracic curve being “kyphotic”. These curves actually serve
several, very functional purposes. Muscles attaching to the spine and the effect of gravity
generate tremendous forces in, and around the spinal column. The curvature of the spinal
column allows those forces to be dissipated in a very efficient manner. If our spines were
perfectly straight, we would either fall on our faces or every vertebra in the column would be
crushed because of the compressive forces placed on the spine merely from standing and
resisting gravity! Think of the Golden Gate Bridge in San Francisco as you ponder that last
sentence. If the Golden Gate Bridge, or the arches in the Cathedral Notre Dame were not
curved, or cantilevered, they would collapse under the forces placed on them! The
combination of curvatures also places a plumb line dropped from under your chin exactly
one centimeter in front of your sacrum, allowing for a perfectly balanced spine. If we didn’t
have this, the effort in walking and daily living activities like lifting or carrying objects would
be almost impossible!
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The figure to the left shows a functional spinal
unit and then the entire column of FSUs. The
spinal column is usually described as having
three columns, an anterior (front), middle and
posterior (back) column. The anterior column
is defined as the front half of the vertebral
body and disc, along with a thick ligament
that runs along the front from one level to the
next called the anterior longitudinal ligament
(ALL). The middle column is the back half of
the vertebral body and disc, along with a
posterior longitudinal ligament (PLL). The
posterior, or back column, is described as the
pedicle, lamina, facet joint and spinous
process. The facet joints have ligament capsules and running over the tips of the spinous
processes and in between them are the supraspinous and interspinous ligaments. These
posterior ligaments serve as major restraints to hyperflexion and protect the discs from
rotational forces they can’t resist. When you think about the apparently complex interaction
of these columns, think about that toy wooden snake with the interlocking wooden parts. No
matter where you jiggle that toy snake, the individual wooden segments stay aligned to each
other.
The middle and posterior (back) columns are attached to each other via the bony structures
called the pedicles, shown in the drawing. The back of the vertebral body, the pedicle and
then the arch of bone spanning from left to right define the spinal canal. The spinal canal is
the protective chamber for the spinal cord and nerve roots. Many patients have the
mistaken impression that the spinal cord and nerve roots run through the middle of the bony
vertebral bodies and through the cartilage discs. The truth of the matter is that they run
behind these structures. When we talk about “pinched” nerves or spinal cord, there are
several structures that can cause this problem. The nerves pass behind the disc, around
the pedicle and then underneath the facet joint to exit and then travel down an arm or leg.
Compromise at any of these locations can cause nerve irritation.
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Common Spinal Problems
Degenerative Disc Disease and Facet Arthritis: is a gradual process that eventually
compromises the spine. It is a result of the normal wear and tear of the aging process. The
intervertebral disc loses its elasticity and shock absorbing capabilities and the facet joints
start to lose the smoothness of their cartilage surfaces and begin to form bone spurs, as we
have already talked about in the previous pages. As this process evolves and matures, the
disc and facet joints become stiff and limit movement. Pain usually occurs in the area where
the degeneration occurs but can also be referred up or down the column several levels, or
even into the pelvic area and upper thighs. This is called a “pseudo-sciatica”, or false
sciatica, to differentiate it from true sciatica that describes pain traveling down the entire
thigh and leg. As an example, severe L4-5 facet arthritis, frequently has a pain referral
pattern into the buttocks and upper sides of the thigh, over the hips. Many of these patients
will seek treatment for hip arthritis or bursitis, sometimes for many months without success,
until it is realized that their real problem is in the back.
A Disc Herniation occurs when the central portion of the disc, the nucleus pulposus, bulges
through the outer layer of the disc, called the annulus, and puts pressure on the spinal
nerves. This type of problem is very common in the cervical and lumbar regions of the
spine. The disc herniation can be described as bulging, extruded, or as a sequestered or
free fragment. Bulging discs are still contained by the outer fibers of the disc, called the
annulus, whereas extruded discs have a portion still attached to the inner fibers but have
extended out past the annulus wall. Sequestered, or free fragments have lost all attachment
to the disc and may even track out along a nerve root or the back of the adjacent vertebral
bodies.
Spinal Stenosis, probably the most common spinal problem treated, describes a
progressive narrowing of the spinal canal. The normal spinal canal is 10-15 mm. in front to
back dimension and oval in shape, assuring plenty of room for the dural sac and the
enclosed nerve roots to travel down the canal. The individual nerve roots exit the central
canal at their respective vertebral levels. For example, the Left L3 nerve root branches off
and exits the central canal at the L3 vertebral body through what is known as a foramen.
The foramen is formed by the overlapping surfaces of the facet joints of adjacent vertebral
levels. As the discs degenerate and the facet joints get arthritic, they bulge and generate
osteophytes (bone spurs). In addition, the soft tissue capsules and surrounding ligaments
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Why do discs degenerate or herniate?
This is the most commonly asked question posed to spine surgeons. Intervertbral discs are
composed of fibrocartilage and are visco-elastic, which means they can be compressed,
tensioned and rotated. The central or middle fourth of the disc is much more watery and
viscous, and is referred to as the nucleus pulposus. This is the portion that herniates,
pushing through the outer ringed annulus and irritating the nerves. The previous drawing
showed a paracentral herniated nucleus pulposus. The outer 2/3 of the disc is called the
annulus and is a thicker, stiffer cartilage that is very good at resisting compression. Looking
from the top, down on a disc, the annulus looks like the swirling cross section of an onion.
Each layer is laminated to the next with fibers criss-crossing like the fibers of a steel belted
radial. The result is a structure very good at resisting compression forces. Unfortunately
this design is not good at resisting torsion and shear forces. The result in the human spine
is a tendency to degenerate and herniate. These herniations can be described as
contained, extruded or sequestered. The pictures below show the various forms and
locations of herniated discs:
Discs degenerate over time because as we age the vertebra
and their endplates become less permeable to water and
proteins, so that these key nutrients cannot get to the disc. A
healthy disc has a relative composition of water, made up of
hydrogen and hydroxyl protein linkages, of up to 80-85%. As
we age, this hydration status deteriorates significantly,
resulting in stiffer, less elastic discs eventually resulting in
loss of disc height and bone spur formation. The loss of disc
height affects the FSU, or functional spinal unit, by increasing
the pressure on the facet joints and decreasing the space
available for the nerve roots to exit the spinal canal. This is a
cyclical, bad, positive feedback loop, as the increased facet
joint pressure leads to further deterioration of the disc. The
process can go on and on until the disc space and facet joints
collapse completely.
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Discs herniate because shear and rotational forces are poorly tolerated. Unfortunately a lot
of the bending and twisting we do in daily living activities exert precisely those kinds of
forces on the discs. One potential weak spot is along the lateral, or outside margin of the
posterior longitudinal ligament (PLL) and its contact with the outer rim of the disc, the
annulus. This is the paracentral location that is most common for herniated disc. Acute disc
herniations are most common in the 30-45 year old age group, whereas degenerative discs
and spurs with facet arthritis are more common in the older age groups.
In summary, the functional anatomy and the relationship of the nerves and spinal cord and
sac to the bony structures follows a common thread throughout the spinal column.
Understanding the basic structures and their relationships to each other, i.e. understanding
the “functional spinal unit” or FSU, allows you to understand why certain things happen.
Why does my left arm hurt? Why is my right thumb numb? Why does my low back hurt
when I extend and rotate to the right? All these questions can be answered by
understanding what is going on at specific functional spinal units.
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Modifications © 2010, Yampa Valley Medical Center.
Spondylolisthesis is a slippage of one vertebral level forward on an adjacent level.
Because the spinal canal is simply made up of a stack of vertebra with space behind them,
one level slipping forward can cut off the canal and pinch the nerve roots. This slippage can
be the result of trauma, such as a pars fracture, which damages the linkage point between
successive facet joint levels, or degenerative. The degenerative version is the most
common.
Scoliosis is an abnormal curvature of the spine. There are several subtypes, but one of the
most common is degenerative lumbar scoliosis. Asymmetric disc degeneration or uneven
settling of degenerative facet joints can tilt, or tip, one level to the left or right. Then, like the
leaning Tower of Pisa, the entire column follows suit. Our muscles and ligaments serve as
restraints to this and the typical compensatory curve is noted higher up the spinal column.
Degenerative scoliosis is usually associated with degenerative disc disease, facet arthritis
and spinal stenosis.
Non-surgical treatments are the first and essential steps in managing these problems.
The literature shows us that > 85% of herniated disc patients improve with non-surgical
treatment. Degenerative disc disease and facet arthritis are usually managed with a
comprehensive core strengthening and general fitness program, as well as with over the
counter anti-inflammatory medications like Advil and Aleve. Spondylolisthesis, even if
because of a pars fracture or defect, can be managed conservatively. Dr. Fabian has
managed professional football and hockey players this way, as well as high level athletes in
many other sports, including ski racers and PGA golf professionals. Physical therapy,
chiropractic manipulation, massage therapy, acupuncture and spinal injection therapy, may
all have a role in treating a particular problem.
Unfortunately, in some cases conservative therapy fails to achieve the desired results.
Patients with progressive loss of function, including progression of weakness, numbness
and pain that limits daily activities, may lead the patient and the surgeon to discuss and
agree to surgical options.
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Common Spinal Operations
The following are some of the most common surgeries performed in the spine. Your
particular surgery will be determined by Dr. Fabian and his team depending on your
particular situation and after consultation with you.
Anterior Cervical Discectomy and Fusion
This surgery is very common and is performed
when a disc herniates, or a bone spur develops and
compresses a nerve. Symptoms include neck pain
and referred pain to the shoulder region and down
the arm, including pain, numbness and arm and
hand weakness. The surgery is performed from the
front (anterior) side of the neck. This approach is
considered very safe and results in minimal blood
loss. The disc space in question is confirmed with
an Xray marker and then the disc and/or bone
spurs are removed. The disc space is then filled
with an allograft (banked bone) machined dowel or synthetic spacer filled with bonegraft. At
the Spine Center of Steamboat Springs, a unique hybrid technique is used to assure less
pain to the patient with bone graft. Bone marrow and graft is harvested from the iliac crest
at the pelvis with a small drill and then placed inside the pre-fabricated spacer/dowel. The
bone graft grows into the adjacent vertebral bodies resulting in a fusion. An extremely low
profile plate with screws is used to secure the segments being fused. This is so secure that
for one and two level fusions, no postoperative bracing is required. For three level fusions
or greater, a cervical collar is used for 4-6 weeks postoperatively. In some cases, the spinal
cord compression may be so severe that an entire vertebra and the two adjacent discs have
to be removed. This is called a corpectomy and requires longer term bracing.
Posterior Cervical Fusion and Cervical Laminectomy
This surgery is performed from the back (posterior) side of the neck. The posterior cervical
fusion is often performed in conjunction with an anterior cervical fusion when multiple levels
need to be addressed. This then represents a circumferential fusion. The fusion from the
back can be accomplished using wire or cabling techniques or the use of what is called a
lateral mass/trans-facet fusion with rods and screws. Bone graft is placed along with the
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instrumentation to achieve the fusion. Cervical laminectomies are often performed when
there is severe multi-level spinal stenosis. For a single or two level problem, a laminotomy,
or partial removal of the lamina, can be performed. At a single level, this can be done with
what is referred to as a “key-hole” foraminotomy.
Lumbar Micro-discectomy or Endoscopic Discectomy
This procedure is performed for herniated discs when they compress the spinal nerves and
cause sciatica. Sciatica refers to the classic pain that radiates from the lower lumbar region
down the thigh and leg, along the respective nerve level dermatome. A dermatome
describes the regional distribution of a particular nerve root. The S1 nerve root for example,
branching off at the L5-S1 disc level, supplies the lower, inside buttock, back of the thigh,
the calf, and the heel, sole and 4th and 5th toes. The L5 nerve root supplies the upper
outside buttock, the lateral (outside) thigh, the lateral leg below the knee, and then
classically the instep and top of the big toe.
Microscopic or loop magnification, with or without endoscopic techniques, is used to remove
the portion of the disc that is compressing the nerve. Any associated bone spurs
(osteophytes) are also removed to insure the path of the nerve root is free. At Yampa Valley
Medical Center, over 98% of these procedures are performed on an outpatient basis, with
the procedure typically less than 60 minutes in duration. 60-90 minutes after surgery,
patients are ready to be discharged and walk out of the hospital! Dr. Fabian was one of the
first surgeons in Ohio, as previous Director of the Ohio Spine Institute, to perform a microendoscopic discectomy in 1996. Minimally invasive techniques for this type of procedure
continue to be refined. In these procedures, only a small portion of the overlying bone
needs to be removed. The bony covering of the spinal is called the lamina. Partial removal
of this one side is known as a hemi-laminotomy. Sometimes the outgoing channel for the
nerve root needs to be widened in conjunction with this. This is known as a foraminotomy,
or micro-foraminotomy. A related area of nerve compression is known as the lateral
recess, this is opened by performing a partial facetectomy.
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Lumbar Laminectomy
This is done when the stenosis, or compression of the canal is global, involving both sides,
or when the herniated disc is so large that a bigger exposure is needed to safely remove it.
This is also very commonly an outpatient procedure. When greater than two levels need to
be removed at the same time, patients are kept overnight as short-stay in-patients.
Lumbar Fusion
Lumbar Fusions are performed for several reasons, but
the most common are instability of the segment, such as
in a fracture or spondylolisthesis, and for degenerative
disc disease with stenosis. In the case of the stenosis,
sometimes so much of the lamina and facet joints need to
be removed that this in itself can create instability. There
are several methods to achieve lumbar fusion. Over the
past 10 years there has been increased use of interbody
fusion. Interbody fusion involves removing as much of
the disc as is feasible and then replacing it with a spacer
that allows bone graft to grow through and around the
device. Because 80% of the weightbearing axis of the
spine is through the front column of the vertebra and bone grows better in compression, the
interbody region is the best place to fuse the spine. An interbody fusion can be
accomplished from the front (anterior) or the back (posterior). From the front this is known
as an anterior interbody fusion (ALIF) and from the back as a posterior interbody
fusion (PLIF). The anterior interbody technique involves an approach via the abdomen. A
general surgeon assists in the approach. Both techniques continue to evolve with the use of
minimally invasive surgery (MIS). Dr. Fabian has been a leader in the development of
minimally invasive spinal instrumentation and the Spine Center is on the cutting edge of this
rapidly progressive field. It is hoped that MIS techniques will allow for faster rehab, shorter
hospital stays and less blood loss and incisional pain.
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Although stand-alone ALIF and PLIF procedures can be done, in most cases the interbody
fusions are supplemented with pedicle screw and rod instrumentation or transfacet
screws placed via a posterior approach and this further supplemented with a
posterolateral fusion. The posterolateral fusion is the oldest technique and is still widely
used in multi-level fusions, particularly in elderly patients and those with curvatures. For
most of these cases, bone graft is taken from the iliac crest, a portion of the pelvic bone
near the surgical site. Bone marrow aspirate and mesenchymal stem cells, both new
technologies, are used by Dr. Fabian at the Center. In fact, in the Spring of 2011, The Spine
Center of Steamboat Springs/New Mobility was only the third site in the United States where
the new Pure-Gen™ mesenchymal stem cell technology was used. Along with these
exciting new technologies, osteobiologic bone graft expanders are used, such as
demineralized bone matrix (DBM) and calcium phosphate and calcium sulfate expanders.
Allograft, or banked bone, is also used in selected cases. Dr. Fabian and his team discuss
the use of such products prior to surgery.
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Frequently Asked Questions About Lumbar Laminectomy
Q. What is wrong with my back?
A. You have a “pinched nerve.” This can be produced by one or more herniated discs and/or
areas of arthritis in your back. The discs are rubbery shock absorbers between the
vertebrae, and are close to nerves that originate in the spine and then travel down to the
legs. If the disc is damaged, part of it may bulge (herniate) or even burst free into the spinal
canal, putting pressure on the nerve and causing leg pain, numbness or weakness. Bone
spurs associated with arthritis may do the same thing.
BEFORE
Q. What is required to fix the problem?
A. The discs or bone spurs pressing on your nerve must be
removed. This is done by making an incision (usually two or
three inches long) in the middle of your lower back, moving
the muscles covering your spine to the side, and making a
small window into your spinal canal. The nerve is exposed,
moved aside and protected; and the protruding disc or bone
spur is then removed. This decompresses the nerve and, in
most cases, leads to rapid improvement in nerve pain,
numbness and/or weakness. Sometimes the abnormality
may be more extensive, extending over several disc
segments, requiring a longer incision for decompression.
AFTER
Q. Who is a candidate for lumbar laminectomy and when
is it necessary?
A. The primary reason for this operation is pain that is
intolerable to the patient. Sometimes increasing nerve
dysfunction (particularly weakness) or loss of bowel or bladder control may make the surgery
necessary even if pain is not severe. In most cases, nerve dysfunction is not severe and pain
can be controlled by non-surgical means. If this doesn’t happen, and if the pain and
subsequent disability become intolerable, surgery is a reliable way to solve the problem.
Since the patient is the one feeling the pain, the patient is usually the one who decides when
he or she is ready for surgery.
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Q. Who performs this surgery?
A. Both orthopedists and neurosurgeons are trained in spinal surgery and both specialists may
perform this surgery. It is important that your surgeon specialize in this type of procedure.
Q. Is my entire disc removed?
A. No, only the ruptured part and any other obviously abnormal disc material are removed.
This generally amounts to no more than 10-15 percent of the entire disc.
Q. How long will I be in the hospital?
A. Laminectomy patients are usually out of bed within an hour or two after their operation,
and some can go home on the day of surgery. The remainder almost always goes home the
next morning.
Q. Will I need a blood transfusion?
A. Transfusions are rarely needed after this kind of surgery. We do not recommend preoperative donation of your own blood.
Q. What can I do after surgery?
A. You may get up and move around as soon as you feel like it, and may drive short
distances when you feel able. You should avoid bending, lifting and twisting for six weeks to
allow for healing of the surgical area.
Q. When can I go back to work?
A. That depends on the kind of work you do, and how long you have to drive to get there.
Surgical patients can return to sedentary (desk) jobs that they can reach with a drive of 15
minutes or less whenever they feel comfortable, (usually two or three weeks). You should
not drive long distances (30 minutes or more) for about one month after surgery. If your job
requires physical labor, you should consult Dr. Fabian.
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Q. What is the likelihood that I will be relieved of my pain?
A. 90-95 percent of patients get relief of their leg pain. Some patients (about 15 percent) will
continue to have noticeable back pain in some situations, and may require additional
treatment.
Q. Could I be paralyzed?
A. The chances of neurologic injury with spine surgery are very low; and the possibility of
catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are
highly unlikely. Injury to a nerve root with isolated numbness and/or weakness in the leg is
possible.
Q. What other risks are there?
A. There are general risks with any type of surgery. These include, but are not limited to, the
possibility of wound infection, uncontrollable bleeding, collections of blood clots in the wound
or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the
lungs) or heart attack. The chances of any of these happening, particularly to a healthy
patient, are low. Rarely, death may occur during or after any surgical procedure.
Q. Will my back be normal after surgery?
A. Though you may have excellent relief of pain, a disc is never completely normal after it
has herniated, and if your problem has been caused by arthritis, the arthritis cannot be
cured even if the bone spurs have been removed and the nerves decompressed. You may
have more back pain than a normal person would have, and there is an increased risk of reherniation of the damaged disc. However, most people can resume almost all of their normal
activities after recovering from surgery.
Q. What should I do after surgery?
A. You should resume low-impact activities as soon as possible, starting with walking. Try to
walk a little farther each day, building up to a brisk three-mile walk each day by six weeks
after surgery. Once your sutures are removed you may swim, which is very back-friendly. By
two or three weeks after surgery you may try more vigorous activities such as an exercise
bike or NordicTrack. Talk to Dr. Fabian about aerobics and jogging. Physical activity is good
for you, if done properly.
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Q. What shouldn’t I do after surgery?
A. In general, you should limit heavy lifting, bending, twisting and high impact physical
activities, including contact sports. Consult your surgeon for details.
Q. Could this ever happen to me again?
A. Unfortunately, yes. As mentioned above, only part of the disc is removed and there is no
way to return the disc to normal again, which means recurrent herniations do occasionally
occur. Also, adjacent discs may be abnormal, too, and could rupture in the future.
Q. Should I avoid vigorous physical activity?
A. No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic
exercise at least three times a week. Walking either outside or on a treadmill, using an exercise
bike and swimming are all examples of exercise that is appropriate for spine patients.
Frequently Asked Questions About Lumbar Fusion
Q. What is wrong with my back?
A. You have one or more damaged discs and/or areas of arthritis in your back. This produces
pain, and may produce abnormal motion, or misalignment of your spine. Discs are rubbery
shock absorbers between the vertebrae, and are close to nerves that travel down to the legs.
If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting
pressure on the nerve and causing leg pain, numbness or weakness.
Q. What is required to fix the problem?
A. Your condition requires both a nerve decompression (freeing the
nerves from pressure) and a spinal fusion. In this case, both nerve
decompression and spinal fusion would be done.
Q. What is spinal fusion?
A. A fusion is a bony bridge between at least two other bones; in
this case, two vertebrae in your spine. The vertebrae are the blocks
of bone that make up the bony part of the spine, like a child’s
building blocks stacked on top of each other to make a tower.
Normally each vertebra moves within certain limits in relationship to
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its neighbors. In spinal disease, the movement may become excessive and painful, or the
vertebrae may become unstable and move out of alignment, putting pressure on the spinal
nerves. In cases like this, surgeons try to build bony bridges between the vertebrae using
pieces of bone called bone graft. The bone graft may be obtained from the patient, (usually
from the pelvis), or from a bone bank. There are advantages and disadvantages to either
source. The bone graft is either laid next to the vertebrae or actually placed between the
vertebral bodies (the rubbery disc that normally lies between the vertebrae must be
removed). In either case, the bone graft has to heal and fuse to the adjacent bones before
the fusion becomes solid. Spine surgeons often use screws and rods to protect the bone
graft and stabilize the spine while the fusion heals.
Q. How is the operation performed?
A. A four-to five-inch incision is made in the middle of the lower back. Muscles supporting
the spine are pushed aside temporarily. The spinal nerve is exposed, moved aside and
protected, and the ruptured disc or bone spur is removed to loosen the nerve. The fusion is
performed as described above. The wound is then closed and dressings are applied. The
operation typically takes a minimum of three hours and may be longer, depending on the
complexity of the problem. Sometimes the spinal fusion is performed with an anterior
approach. In this case, the surgeon would make a four-to five-inch incision in the lower
abdomen, gently move the internal organs aside, and proceed with the surgery as described
above.
Q. Who is a candidate for lumbar fusion, and when is it necessary?
A. When the back and nerve problems cannot be corrected in a more simple procedure and
the pain persists at an unacceptable level, it is necessary to do a fusion. Some of the
conditions which require spinal fusion are discussed in the answer to “What is Spinal
Fusion?”
Q. Could I be paralyzed?
A. The chances of neurologic injury with spine surgery are very low; and the possibility of
catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are
highly unlikely. Injury to a nerve root with isolated numbness and/or weakness in the leg is
possible.
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Q. Are there other risks involved?
A. There are general risks with any type of surgery. These include, but are not limited to, the
possibility of wound infection, uncontrollable bleeding, collections of blood clots in the wound
or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the
lungs), or heart attack. The chances of any of these happening, particularly to a healthy
patient, are low. Rarely, death may occur during or after any surgical procedure.
Q. What are my chances of being relieved of my pain?
A. More than 90 percent of patients get relief of their nerve symptoms or leg pain. Relief of
back pain is less predictable, occurring about 75 percent of the time.
Q. Will my back be normal after surgery?
A. No. Even if you have excellent relief of pain, the spine is not completely normal after a
fusion. Stiffening one segment of the spine with the fusion may put additional strain on other
areas. Other discs may have started to wear
out. Even if they aren’t causing you pain now,
they may do so in the future. For these
reasons, you may have more back pain than a
normal person would have. However, most
people can resume almost all of their normal
activities after their fusion has healed.
Q. How long will I be in the hospital?
A. The hospital stay is generally one to three
days.
Q. What shouldn’t I do after surgery?
A. Generally, you should avoid bending, lifting and twisting for six to nine months. Even if
screws or rods are used, 6 to 12 months are required for the fusion to heal completely. You
must protect your spine during this time. Dr. Fabian will usually prescribe a brace for you to
wear for part of this time. If you are a smoker, you definitely should not smoke until your
fusion is completely solid, since smoking interferes with bone healing.
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Q. What can I do after surgery?
A. You should get up and move around frequently as soon as you feel like it. If you are feeling
well enough, you may begin driving in two to three weeks with your back brace on.
Q. When can I return to work?
A. This should be discussed individually with Dr. Fabian. Generally, patients may return to
sedentary jobs whenever they are comfortable, which is usually within three to six weeks. If
you drive more than 30 minutes to get to work, your surgeon may want you to wait longer. It
takes much longer to get back to work that requires strenuous physical activity due to the
increased stress these activities play on the healing bone.
Q. COULD THIS HAPPEN TO ME AGAIN?
A. Unfortunately, yes. A fusion may add stress to the levels above and below the fusion. If
the fusion doesn’t heal solidly, even with plates and screws, your symptoms may recur and
additional surgery may be needed.
Q. Should I avoid vigorous physical activity?
A. No. Exercise is good for you! You should get some
sort of vigorous, low-impact aerobic exercise at least
three times a week. Walking either outside or on a
treadmill, using an exercise bike and swimming are
all examples of exercise that is appropriate for spine
patients. You may start these activities as soon as
you are comfortable.
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Modifications © 2010, Yampa Valley Medical Center.
Frequently Asked Questions About Cervical Laminectomy
Q. What is wrong with my neck?
A. You have a “pinched nerve.” This can be produced by a ruptured disc or by bone spurs.
Discs are rubbery shock absorbers between the vertebrae, and are close to the nerves
which travel down to the arms. If the disc is damaged, part of it may bulge or even burst free
into the spinal canal, putting pressure on the nerve and causing arm pain, numbness, or
weakness. Bone spurs, usually the result of arthritis, can also put pressure on nerves.
Occasionally, pressure from bone spurs or a ruptured disc may affect the spinal cord and
cause abnormalities in the legs or lower parts of the body.
Q. What is required to fix the problem?
A. In most cases, a small (two-three inch) incision is made in the anterior part of the neck.
Muscles supporting the spine are pushed aside temporarily, and a small “window” is made into
the spinal canal. The spinal nerve is protected, and the ruptured part of the disc or the bone
spur is removed. If bone spurs and arthritis are the cause of your problem, you may require a
bigger incision and more bone may have to be removed.
Q. When is this operation necessary?
A. In almost all cases, the major reason for spine surgery is pain which is intolerable to the
patient. Often non-surgical measures can control the pain satisfactorily. However, if the pain
persists at an unacceptable level, if you cannot function because of pain, or if weakness or
other neurologic problems develop, then surgery may be necessary to relieve the problem.
Q. How long will I be in the hospital?
A. Most patients stay 24 hours. Complications may require longer stays.
Q. Will I need a blood transfusion?
A. There is usually very little blood loss with this operation, and transfusions are almost
never necessary.
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Q. What can I do after surgery?
A. You should try to get up and move around as much as your symptoms allow. You may
walk as much as you like.
Q. What shouldn’t I do after surgery?
A. For at least 6 weeks, you should avoid overhead lifting, frequent or repetitive neck
movements and vigorous sports until instructed otherwise by Dr. Fabian.
Q. When can I go back to work?
A. That depends on what kind of work you do and how far you have to drive. It can be as
little as one week, but may be longer if your job involves manual labor or if you have to drive
more than 30 minutes to get there.
Q. What are my chances of being relieved of my pain?
A. 90-95 percent of patients get relief from their nerve symptoms or arm pain. Neck and
shoulder pain are less predictably relieved by disc surgery. Up to 15 percent of patients may
have some neck and shoulder aching after surgery; this percentage may be higher in
patients who have a substantial amount of neck and
shoulder pain before surgery. Other conditions such as
fibromyalgia may also produce continued pain even after
successful disc surgery.
Q. Will my neck be normal after surgery?
A. No. Even if you have excellent relief of pain, the disc has
still been damaged. However, most people can resume
almost all of their normal activities after disc surgery. People
who do heavy work generally take longer to recover and may
not be able to do everything they could do before their injury.
Q. Could I be paralyzed?
A. The chances of neurologic injury with disc surgery are very low, and the possibility of
catastrophic injury such as paralysis, is highly unlikely, though not impossible. Injury to a
nerve root with isolated numbness and/or weakness in the arm is possible.
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Q. What other risks are there?
A. There are general risks with any type of surgery. These include, but are not limited to, the
possibility of wound infection, uncontrollable bleeding, collection of blood clots in the wound
or in the veins of the leg, pulmonary embolism (movement of a blood clot to the lung), heart
attack, stroke and death. The chances of any of these events happening, particularly to a
generally healthy patient, are low.
Q. Could this ever happen to me again?
A. Unfortunately, yes. As mentioned above, only part of the disc is removed and there is no
way of making the remaining disc normal again, which means recurrent herniations do
occasionally occur. Also, adjacent discs may be or may become abnormal too, and could
rupture in the future.
Q. Should I avoid vigorous physical activity?
A. No. Exercise is good for you. You should get
some sort of vigorous, low-impact aerobic
exercise at least 3 times a week. Walking either
outside or on a treadmill and using an exercise
bike are all examples of the type of exercise which
is appropriate for spine patients.
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2010-03v2 Underlying Work © 2010, Marshall Steele & Associates, LLC. All rights Reserved.
Modifications © 2010, Yampa Valley Medical Center.
Frequently Asked Questions About Cervical Fusion
Q. What is wrong with my neck?
A. You have one or more damaged discs in your neck. Discs are rubbery shock absorbers
between the vertebrae, and are close to the nerves which travel out to the arms. If the disc is
damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the
nerves and causing arm pain, numbness, weakness and/or pain in the neck or shoulder
area. Occasionally, this pressure may affect the spinal cord and cause abnormalities in the
legs or lower parts of the body. Bone spurs, usually the result of arthritis, can also put
pressure on nerves or the spinal cord. Loss of the normal “shock absorber” function, or
arthritis around the damaged disc, can also produce mechanical pain around the neck or
shoulders with neck movement or awkward positions.
Q. What is required to fix the problem?
A. The best approach to your problem is to remove the damaged disc and bone spurs from
the front, or anterior part, of the neck and to perform a fusion between the adjacent vertebral
bodies. Certain conditions, however, require the surgeon to
perform the fusion using a posterior approach instead.
Q. What is spinal fusion?
A. A fusion is a bony bridge between at least two other bones,
in this case two vertebrae in your spine. The vertebrae are the
blocks of bone which make up the bony part of the spine, much
like a child’s building blocks stacked on top of each other to
make a tower. Normally each vertebrae moves within certain limits in relationship to its neighbors.
In spinal disease, the movement may become excessive and painful, or the vertebrae may
become unstable and misaligned, putting pressure on the spinal nerves. In cases like this,
surgeons try to build bony bridges between the vertebrae using pieces of bone, which we call bone
graft. The bone graft may be obtained either from the patient himself, usually from the pelvis, or
from a bone bank. There are advantages and disadvantages to either source. The bone graft is
laid between the vertebrae. The bone graft has to heal and unite to the adjacent bones before the
fusion becomes solid. Dr. Fabian often uses plates to protect the bone graft and stabilize the spine
during the healing period, attaching them to the spine using screws.
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Q. How is the operation performed?
A. An incision, usually about two inches in length, is made across the front of the neck. The
windpipe, esophagus (food pipe) and other tissues are temporarily pushed aside and the
abnormal disc or discs are removed completely. If your own bone is to be used for the
fusion, another small incision is made over the front of the pelvis and one or more small
bone grafts are removed to replace the disc or discs. In most cases this bone will heal or
“fuse” to the vertebrae above and below it within six to nine months, creating a solid bony
bridge between the two vertebrae and eliminating movement between them. For fusions
involving more than one level, or in the case of unusual spinal instability, internal plates and
screws may be used to improve stability and conditions for bone healing.
Q. When is this operation necessary?
A. In most cases, the major indication for spine surgery is pain. Weakness, numbness,
clumsiness, and gait instability may also be an indication
for surgery. Often nonsurgical
measures can control the pain satisfactorily. If the pain
persists and interferes with daily activities or if other
neurologic problems develop, then surgery may be
necessary to relieve the problem. In most cases, the
patient makes the final decision about surgery because
of pain. If neurologic damage is occurring, Dr. Fabian
may strongly recommend that you proceed with the
operation.
Q. How long will I be in the hospital?
A. Most patients leave in 24 hours; however, anterior/posterior cervical fusion patients will
be in the hospital for 2-3 days.
Q. Will I need a blood transfusion?
A. Rarely do we need to give a transfusion. Only in rare tumor or unusual reconstruction
cases will a transfusion be needed.
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Q. What can I do after surgery?
A. Please refer to the Cervical Fusion Discharge Instructions for details. You should try to
walk and take care of yourself as much as you are able to. You should try to exercise each
day. You may perform other low-impact activities not requiring lifting or neck movement as
allowed by your brace. If a brace is not required, you may drive when allowed by Dr. Fabian.
Q. What shouldn’t I do after surgery?
A. You should avoid lifting heavy objects, and avoid all overhead lifting. Twisting, repetitive
bending and tilting your head back to look overhead are also stressful to the neck. If you are
a smoker, you definitely should not smoke until your fusion is completely solid. Smoking
interferes with bone healing.
Q. Will I need to wear a neck brace?
A. Most patients will wear some type of neck brace after this surgery. The type of brace and
length of time you need to wear the brace will be determined by your surgeon.
Q. When can I go back to work?
A. That depends on the type of work you do. If a brace is required, you will not be able to drive
until you no longer need the brace. For sedentary jobs, work may resume when you feel
comfortable and can get to work. For jobs which require more strenuous physical exertion, a
longer healing time may be required. Dr. Fabian will discuss this with you individually.
Q. What are the chances of being relieved of the pain?
A. 90 percent of the patients obtain relief from their arm pain. Relief of neck pain is less
predictable, usually in the range of 75-80 percent.
Q. Will my neck be normal after surgery?
A. No. While most patients have excellent relief of arm pain after surgery, your neck will not
be completely normal. While most patients with a one or two-level fusion will not notice
significant loss of motion, the stiffened segment of your spine does put additional stresses
on adjacent discs, which may already be abnormal to some extent. These other discs may
cause symptoms. Although most patients can resume most of their normal activities after
healing, you should take care of your neck. Dr. Fabian can discuss this with you in detail.
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Q. Could I be paralyzed?
A. The chance of neurologic injury with spinal surgery is low, but not impossible. Injury to a
nerve root with isolated numbness and/or weakness in the arm is possible. Less than one in
1,000 cases may result in paralysis, either complete or partial.
Q. What other risks are there?
A. The risks of this operation include, but are not limited to, anesthesia, wound infection,
uncontrollable bleeding, collection of blood clots in the wound or in the veins of the leg,
pulmonary embolism (movement of a blood clot to the lungs) and heart attack. The chances
of these complications occurring are 2-3 percent of the cases. Death may rarely occur during
or after any surgical procedure.
Q. Could I have Difficulty Swallowing?
A. Most patients report mild discomfort with swallowing for a few days after surgery.
Occasionally, swallowing difficulties may be more significant and last for longer periods of
time. Rarely, it may be necessary to place a feeding tube while swallowing returns to
normal. If swallowing difficulty persists longer, notify your physician.
Q. Will my voice be affected?
A. Some patients may be hoarse after anterior cervical spine surgery. Usually this goes
away within a few days or weeks. Rarely, the hoarseness may be persistent for a longer
period of time or even be permanent.
Q. Is the entire disk removed?
A. Yes.
Q. Could this happen to me again?
A. Unfortunately, yes. Similar conditions which led to the disc damage being treated now
may have already started in one or more of the other discs, in your neck. A small
percentage of fusions do not heal normally, which may require additional surgery. The
chance of this happening increases if fusion is attempted at more than one level, which is
why spine plates are sometimes used for multi-level fusions. Over 90 percent of patients do
well. Less than 10 percent have some recurring problems.
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Q. Should I avoid physical activity?
A. No. Exercise is good for you. You should get some sort
of vigorous, low-impact aerobic exercise at least three
times a week. Walking either outside or on a treadmill,
using an exercise bike, and swimming are all examples of
the type of exercise which is appropriate for spine
patients. (See post-op recovery sheet).
Q. Who performs this surgery?
A. Both orthopedists and neurosurgeons are trained to do
spinal surgery. It is important that your surgeon specialize
in this type of procedure.
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Risk Factors and Complications
Controlling Risk Factors
With any major surgery there are certain risks. It is important that you understand the risks
involved in having spine surgery, as well as what can be done to minimize those risks and
prevent the incidence of post-surgical complications.
Conditions that increase your risk of having a post-operative complication include:
• Obesity
• Heart and Lung Disease such as Coronary Artery Disease and Emphysema
• Smoking
• Diabetes
• Osteoporosis
• Tooth disease such as periodontal and tooth decay
• Immunosuppressive diseases such as Lupus and Rheumatoid Arthritis
• History of depression, bipolar disorder requiring medication management
• Bleeding abnormalities or Anemia
• Any sign of recent cold, flu or sore throat
By having potential problems identified before surgery, you can work with the healthcare
team to prevent post-surgical complications.
Prior to your admission for surgery, you will be examined by a Primary Care Physician and
have routine laboratory tests, either at your physician’s office or at Yampa Valley Medical
Center. After reviewing the results of your tests, physical exam and medical history, the
physician will be able to identify any particular health risk factors that you may have.
If high risks are identified, your doctor may recommend additional tests or may discuss with
you the need to delay surgery until the risks can be brought under reasonable control. Even
now, before you have preadmission testing, there are things you can begin doing to reduce
the risk of postoperative complications.
Nutrition
Both poor nutrition and obesity increase your risk for infection and/or delayed healing, both
of a fusion and incision. While excessive weight can make your recovery period more
difficult, a crash diet is not the answer. In fact, in the immediate postoperative period your
caloric demands may increase, as your body deals with the additional stress placed on it by
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the surgery and recovery. If you are obese and would seriously like to lose weight
before or after surgery, we recommend that you join a physician supervised weight
loss program. As you lose weight, you may see some improvement in your spine and a
decrease in pain. When your weight is under control and you are preparing for spine
surgery, it is important that your diet be nutritionally sound.
Infection
It is important that you be free of infection before you have surgery and that you
obtain immediate treatment for any infection that may occur after your spine surgery.
Although postoperative spinal infections are rare, particularly at the New Mobility Spine and
Joint Center, they can have severe consequences if not treated promptly and appropriately.
The most common areas that are sources of infection are the teeth and genitourinary tract.
Poor hygiene is the leading factor in developing sources of bacteria in both locations. Any
problems should be corrected before pre-admission testing.
If you have not had a dental check-up within the last 6 months, you should schedule
now prior to preadmission testing.
If you have any problems with urinating- frequency, burning or difficulty passing
urine- you should see your urologist or family doctor for an evaluation.
Let your surgeon know if you have a cold, sores, cuts or inflamed areas anywhere on
your body.
Making sure that you are free of infection may avoid having to delay your surgery.
Smoking
If you are smoking, you should initiate steps to stop smoking immediately! Smoking
increase your chances of lung complications, delays wound healing and in the case
of spinal fusion, delays or prevents successful bone growth of the fused area.
Allergies
If you have any types of metal allergies, or allergies to skin preps such as poviodine or
allergies to specific suture or dressing materials, let Dr. Fabian know.
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Possible Complications of Spinal Surgery
Complications that can occur during or following spine surgery include:
Blood clots
Blood clots, which typically originate in the lower leg venous system, are surprisingly
common after most types of surgery. As many as 50% of patients may develop venous
clotting after surgical procedures. Fortunately, most of these are small and inconsequential.
In some cases however, the results of a deep vein thrombosis (DVT) can be devastating,
with clots that migrate and become emboli that can travel to the lungs, kidneys, heart and
brain. Clots that travel to the lungs, known as pulmonary emboli or “PEs”, are the most
common and can result in sudden shortness of breath, cardiac disturbances and even
death. They can occur several weeks after a procedure. In the case of spinal surgery, the
risks are less than for orthopedic procedures, such as joint replacement or arthroscopy, with
a published risk of approximately 0.6%. At our Spine Center, the risks have been reported
below the nationally published average. To prevent clots from occurring there are several
things that our staff, and you, the patient will do in the post-operative period. These include
the following:
•
•
•
•
Early and aggressive mobilization. Getting up and walking are the most
effective ways of preventing deep vein thrombosis
Performing “ankle pumps” and leg range of motion exercises even when
supine and confined to bed.
Wearing TED hose (compressive stockings) in conjunction with the use of
sequential compressive stockings (SCDs)
The administration of medication to prevent abnormal clotting while you are an
in-patient. This is typically a Warfarin or Lovenox™ type drug.
Nerve Damage
Nerve damage is the one of the most dreaded complications of spinal surgery and patients
undergoing any of the various types of surgery, whether cervical, thoracic or lumbar are at
risk. Damage can be caused by direct or indirect injury to the nerve roots or spinal cord. In
addition, postoperative swelling around the spine and soft tissue can cause increased
pressure on the nerve, causing tingling, numbness, or weakness in the legs or arms.
Patients undergoing cervical or thoracic spinal surgery are at risk for spinal cord injury with
possible paralysis. The incidence of catastrophic injury resulting in quadriplegia or
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paraplegia is about 1/3,000 cases per year in the United States. Most of these cases are
due to a lack of perfusion, or blood flow to the spinal cord, rather than to direct injury from a
scalpel or other instrument. It is for this reason that our Spine Center is so vigilant in
monitoring blood pressure and other indexes of hemodynamics. We are using
Somatosensory Evoked Potential Monitoring (SSEP) which is the current standard of care
for monitoring spinal cord function. This is used during those select cases in which we think
the risks are higher for nerve injury. This includes cervical, thoracic and instrumented
lumbar cases. Included with SSEP monitoring is Electromyographic monitoring (EMG),
which allows recordings from specific, individual nerve roots. When screws are placed,
EMG monitoring is often used to verify placement and positioning of a screw relative to the
nerve root. SSEP/EMG monitoring was pioneered by Clyde L. Nash, M.D. of University
Hospitals/St. Luke’s, Cleveland, Ohio and was one of Dr. Fabian’s early mentors. As a
result, Dr. Fabian has over 20 years experience with spinal cord monitoring. He wrote his
first paper on EMG Spectral Frequency Analysis in 1985. SSEP/EMG monitoring provides
yet another technique we have implemented at our Center to insure our patients the best
possible outcomes.
Despite all efforts by the Team, nerve injuries can occur. Some are due to the unique
characteristics of patients and their nerves. Patients with long-standing diabetes for
example, are at increased risk of nerve irritation with surgery and nerve manipulation and
also recover more slowly. Patients with long standing nerve complaints may not fully
recover. The sooner we relieve the pressure on a nerve, the sooner it will function normally
again. A nerve recovers very slowly, but with time usually recovers to an acceptable
functional level. Research in Japan by spinal surgeons has reported recovery up to four
years after surgery, and Dr. Fabian reports a typical plateau of nerve recovery at 18-24
months postoperatively. If a nerve postoperatively is still causing problems with numbness,
hypersensitivity or weakness, further imaging studies are carried out and postop EMG
analysis may be used. There are several medications that can assist in management if
problems occur. In addition, selective out-patient nerve root blocks can be used.
Fortunately, the incidence of postoperative nerve issues is very low, and most of the time no
additional treatments are required.
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During the postoperative period, members of the team will:
• Check the muscle strength and sensation in your extremities
• Remind you to begin active range of motion of the limbs
It is important that you tell the nursing or physical therapy staff immediately;
• If you sense muscle weakness of new onset
• If you feel any tingling, numbness or burning pain in the limbs, as these may
be signs of pressure on the nerve(s).
In some cases, there will be a relative increase in numbness to a nerve distribution after
surgery as a result of manipulation of the nerve during surgery to remove bone spurs and/or
herniated disc. These symptoms are usually transient, and quickly resolve. The Team will
evaluate this in every case and give you immediate feedback as to the status of your nerve
function.
Dural Leak
The dura is a water tight sac of tissue that covers the spinal cord and nerves. Below the
level of T12-L1, there is no longer a spinal cord, but rather a bundle of nerves traveling
inside the dura, with nerve roots branching off at their respective levels. This section of the
spinal column could be best described as resembling a coaxial cable or fiberoptics cable,
with an outer sheath and then multiple fibers running inside. A tear in the dura, this outer
sheath can occur during surgery. It is not uncommon to have a dural tear during spinal
surgery, although the incidence at our Center is less than 1% annually. Sometimes the dura
needs to be cut intentionally to free up adhesions from bone spurs and scar tissue. This is
called a durotomy. A tear of the dura or a durotomy needs to be repaired to achieve a
watertight closure, otherwise, cerebral spinal fluid will leak out. These types of leaks cause
severe postural headaches. This means that lying down the patient has no headache but as
soon as they sit up or stand up they get a severe frontal or top of the head pain. After
repair, the patients are instructed to lie flat, with the head of the bed no higher than 15
degrees for a period of 24-48 hours, depending on the size and location of the leak. In
some rare cases, the dural leak is delayed or not detected and symptoms may not present
until several days to weeks after surgery. You need to inform your surgeon and the team as
soon as you sense any postural headache, so that prompt evaluation can be carried out.
Fortunately, in the vast majority of cases, a dural tear and repair has little to no impact on
the overall outcome of a spinal surgery.
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Infection
Although it occurs infrequently, infection in a spinal surgery is one of our greatest concerns.
It may necessitate returning to surgery for what is known as an “I and D” (Irrigation and
Debridement) and in some cases greater than six weeks out from surgery, removal of
hardware. Intravenous antibiotics for six weeks followed by oral antibiotics are frequently
required and a home antibiotic therapy regimen needs to be arranged with frequent lab
checks. Infections from “Flesh-eating Strep and Staph”, as well as “Hospital-acquired”
infections, have been well publicized in the news media. These reports have highlighted
that most infections are in fact carried into the hospital by patients, and therefore represent
community acquired infections. Methicillin-resistant Staph Aureus (MRSA) is one of the
most dreaded of these bacteria and unfortunately many potential patients can be carriers of
this bug. For this reason, in-patient spine surgery candidates are pre-screened for MRSA
colonization. If they are found positive, they are treated with special antibiotics and decolonized before entering the hospital.
Despite all the efforts of both surgeon, team and patient, infections can still occur. Patients
who have poor hygiene, diabetes, vascular disease or immunosuppression, as well as
smokers, are at increased risk of infection no matter what is done to prevent infection. In
addition to considerable expense, postoperative infection can cause additional pain,
increase disability and prolong recovery.
Your role is to safeguard yourself against infection and obtain immediate treatment if a
problem does occur. In addition you must be aware that certain routine procedures (e.g.
dental cleaning, cystoscopy, colonscopy) can stir up bacteria and present a risk to your
spine. Unlike total joint replacement, where antibiotics are recommended routinely before
dental cleaning and other procedures, there are no guidelines for this type of treatment in
spine surgery patients.
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Mechanical/Hardware-Instrumentation Problems
Although rare, problems of this type can occur. Some of these cases are:
•
•
Hardware loosening, migration or breakage: this may require revision surgery
to correct the problem
Non-union or “pseudarthrosis” of the fusion: This is when the bone grafting
does not consolidate and the fusion is not achieved. This may require revision
surgery if the patient is symptomatic.
A final word…
You, the patient, need to be aware of the potential issues of intraoperative and
postoperative complications of your proposed spinal surgery. Dr. Fabian and his team are
very thorough during the informed consent process to explain these issues with you prior to
your surgery. The surgical techniques and implants used are routinely discussed prior to
surgery. Despite this, you may feel that some of your specific questions were not covered.
Never hesitate to discuss any additional questions or concerns you have with any member
of the team. Most, if not all of these issues should be directed and responded to by Dr.
Fabian and his direct staff. New Mobility Joint and Spine Center prides itself on
comprehensive care and a well established and consistently low rate of complications. We
work diligently to continually improve the process. Your active participation is key to this
standard of care being maintained.
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Section Two:
Pre Operative Checklist
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Pre-Hospital Assessment
Our goal is to make this experience as smooth as possible for you and your family. You will
likely have concerns and questions regarding your surgical procedure. At YVMC, our
professional staff provides pre- and post-surgical counseling. Please let us know how we
can assist you!
STEP ONE: Pre-operative history and physical by a primary care physician:
You will be required to have a complete history and physical prior to your surgery. This will
need to occur within thirty days before your surgery. If your primary care physician is a
member of our YVMC medical staff, you may make arrange-ments for him/her to do this for
you. If your primary care physician is not on our medical staff, the Pre-Op Care Nurse or
your surgeon’s office will assist in obtaining the necessary information from your doctor’s
office.
STEP TWO: Pre-registration
This is the financial component of your procedure. It is important that you pre-register for
your surgery as soon as possible.
Please be prepared to:
Answer registration questions
Provide a copy of your insurance card and driver’s license
Finalize financial arrangements
Sign paperwork
The Admitting Staff will call the POC Nurse for step three, your pre-op assessment
appointment.
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STEP THREE: Pre-Operative Assessment
A pre-operative assessment is necessary to help provide the highest quality of patient care
for you. This assessment is conducted by a Registered Nurse and includes a review of your
medical history. It is best done in person by you, the surgical patient. Please call the POC
Department at 970-871-2341 to schedule an appointment.
In addition to meeting with the Nurse, you will meet with the Physical Therapy members of
the spine surgery program. We will work together to ensure the best outcome for you during
your stay at YVMC and your follow-up treatment after discharge.
STEP FOUR: Day of Surgery
The day of your surgery will be a busy one. You will stop briefly at Admissions before being
escorted to the Day Surgery area. Once there, you will be asked additional questions by
your day surgery nurse, and some of the information already provided will be reviewed and
confirmed. Any additional blood testing is done at this time.
Your surgeon will visit you and confirm the area to be operated on. He will then mark the
surgical site with an indelible pen. You will have an IV inserted to allow the anesthesiologist
to administer necessary medications. During this time, the Anesthesia staff will interview
you. When everything has been completed, you will be taken into the operating room where
you will be attended by the anesthesiologist, your surgeon and the rest of the operating
room team. The amount of time that you are in the operating room will depend upon the
complexity of your procedure.
We will do our best to keep you and your family/friends informed of any changes to the
schedule that result in a delayed start or the procedure taking longer than planned.
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Start Pre-operative Exercises
Just as exercise is important in the rehabilitation process following spine surgery, it is
imperative that you participate in a pre-operative exercise program as well. Exercising
before surgery can help you build up the necessary strength and endurance for a more
optimal recovery from spine surgery. The exercises found below help to strengthen and
condition your muscles in preparation for surgery and the post-rehabilitation phase. To
enhance your recovery from this surgery, try to incorporate these exercises, as well as some
aerobic exercise (walking, water aerobics and recumbent bicycle) into your daily routine.
Our past patients have mentioned just how helpful it was to take the time to "strengthen" the
muscles in their arms and legs prior to coming in for surgery.
NOTE: All of these exercises should be pain-free. If any exercise causes pain, you should
consult your physician before continuing the program.
1. Chair Push–up
Sit in Chair. Use arms to push body up from chair. Keep elbows slightly bent and feet on
the floor. Return to the chair slowly. Focus using your arms instead of your legs.
Sets: 1-2 — Reps: 10 — Hold: 5 - 10 sec. — Frequency: 1-2x day
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Pre-operative Exercises
NOTE: This exercise is just the beginning a lifelong challenge of being able to keep your abdominal
muscles tightened all day long. The strengthened muscles provide continuous support for your
spine.
4. Shoulder Circles
Raise and lower shoulders using a circular motion.
Sets: 1
Reps: 20
Hold: 10 - 15 sec.
Frequency: 2x day
5. Scapular Retraction - Initial Phase
Pinch your shoulder blades together.
Do not shrug your shoulders.
Sets: 1
Reps: 20
Hold: 10 - 15 sec.
Frequency: 2x day
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Four - Six Weeks before Surgery
Contact Your Insurance Company
Before surgery, you will need to contact your insurance company. From them, you will need
to find out if pre-authorization, pre-certification, a second opinion or a referral form is
required. It is very important to make this call, as failure to clarify these questions may
result in a reduction of benefits or delay of surgery. This is especially important if your spine
problem is due to an injury at work.
If you are a member of a health maintenance organization (HMO), you will go through the
same registration procedure. However, you will need to call your HMO once your procedure
has been scheduled to arrange for pre-admission lab studies that must be completed.
Billing for Service
After your procedure, you will receive separate bills from the anesthesiologist, the hospital
and if applicable the surgical assistant, the radiology and pathology departments. If your
insurance carrier has specific requirements regarding participation status, please contact
your carrier.
Pre-register
After your surgery has been scheduled, a representative from pre-admission screening will
call you to gather your pre-registration information by phone. You will need to have the
following information ready when you are contacted:
• Patient’s full legal name and address, including county
•
•
Home phone number
Religion
•
•
Marital status
Social Security number
•
Name of insurance holder, his or her address and phone number and his or her work
address and work phone number
•
•
Name of insurance company, mailing address, policy and group number
Patient’s employer, address, phone number and occupation
•
Name, address and phone number of nearest relative
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•
Name, address and phone number of someone to notify in case of emergency. This
can be the same as the nearest relative.
Review “Exercise Your Right”
The law requires that everyone being admitted to a medical facility have the opportunity to
complete advance directives forms concerning future decisions regarding your medical care.
Although Advance Directives are not required for hospital admission, we encourage you to
consider completing the forms for the directives you desire. If you do have advance
directives, please bring copies to the hospital on the day of surgery.
Become Smoke Free
If you are a smoker, you should stop using tobacco products. The tar, nicotine and carbon
monoxide found in tobacco products have serious adverse effects on your blood vessels
and thus impair the healing of wounds and bone grafts. In addition, continued tobacco use
damages the other discs in your spine, leading to disease at other levels. Finally, we have
found that smokers experience a greater degree of pain than do non-smokers. Please read
information about our Nicotine Dependence Program in the Appendix.
Spine Outcomes Program
We are pleased to introduce the Spine Outcomes Program. We have instituted a process for
collection of data that will help us measure our patients’ satisfaction with their surgical outcome.
The program has two parts. The first data collection process occurs during the pre op process.
The second data collection process occurs six months after surgery. You will receive a short
questionnaire that includes selected questions taken from the pre-op collection survey. This
format allows us to form a comparison of a patients’ pre-op and post-op status. Collected
information is kept strictly confidential throughout the data analysis process. We greatly
appreciate your participation with our hospital-based study. Your input will assist us in our
efforts to perform a thorough assessment of the New Mobility Joint and Spine Center.
Read “Anesthesia and You” (Appendix)
Spinal surgery does require the use of general anesthesia. Please review “Anesthesia and
You” (see Appendix) provided by our anesthesia department. If you have questions or want
to request a particular anesthesiologist, please call your surgeon’s office.
•
Call pre-operative nurse for appointment
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One Week before Surgery
Stop Medications that Increase Bleeding
•
Seven days before surgery stop all medications containing aspirin and antiinflammatories, such as aspirin, Motrin, Naproxen, etc. These medications may cause
increased bleeding. Your pre-operative Nurse and physician will tell you which ones.
•
If you are on Coumadin you will need special instructions on stopping this medication.
Please contact the prescribing physician for these instructions.
Planning Ahead to Ease Transition Back Home
Home
•
•
De-clutter your home. Temporarily put away area rugs that may be a tripping hazard.
Shop ahead! Have frozen dinners available to pop into the microwave and paper
plates to limit washing. Also have plenty of liquids available. Pain medications can
give you a very dry mouth.
•
Complete needed yard work and mowing or arrange to have this done for you.
•
•
Arrange for neighbors/family to collect mail and newspapers for a few days.
Change your bed and have fresh linens prepared.
•
Strategically place nightlights in bedrooms, hallways and bathrooms you may need to
access at night.
•
Place essential and frequently used items at counter level in the kitchen. This may
mean taking out the items from the lower or very upper cabinets out and storing them
on the counter temporarily.
•
Have current bills paid so you do not have to worry
about these immediately after the surgery.
•
Have support lined up, especially if you live alone.
Arrange for friends to call on certain days or stop by
and make sure you don't need any extra assistance.
•
No special chair is needed, but you want one that
offers you support and comfort.
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Pets
•
•
Have help for the first few days to keep food and water available for pets.
Have a dog walker planned for the first week at least. You will not want to chance
losing your balance or being jerked by your excited canine friend!
•
If you have cats, have the litter box up on a high table or counter so you don't have to
bend down to clean it.
Points of Comfort
• You may want to bring extra pillows for the ride home to maximize your comfort.
The Day before Surgery
Find Out Your Arrival Time at the Hospital
You will be asked to come to the hospital 1 ½ hours before the scheduled surgery to give
the nursing staff sufficient time to start IVs, prepare the surgical site and answer questions.
It is important to arrive on time because sometimes the surgical time is moved up at the last
minute and your surgery could start earlier. If you are late, your surgery could be moved to a
much later time.
The Night before Surgery
Chlorhexidene Shower
You will receive Clorhexidene soap, please follow the instructions for use as provided.
Please shower again with Clorhexidene soap the morning of your surgery.
NPO - Do Not Eat or Drink
•
Do not eat after midnight unless otherwise instructed to do so.
•
•
You may have clear liquids until 4 hours before surgery.
If you must take medication the morning of surgery, do so with a small sip of water.
SPECIAL INSTRUCTIONS:
You will be instructed by your physician or the pre-operative nurse on which of your daily
medications to take or omit the morning of surgery.
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What to Bring to the Hospital
•
•
Patient Guidebook
Advance directives and living will
•
•
Insurance card and co-pay (if applicable)
Personal hygiene items (toothbrush, powder, deodorant, razor, etc.)
•
•
Shorts, tops, culottes, well-fitting flat shoes
Loose-fitting warm-up suit for the ride home
•
•
Battery-operated items
For safety reasons do NOT bring electrical items
•
A favorite pillow with a pillowcase in a pattern or color so it will not end up in the
hospital laundry
• Any braces for your back or for walking
Cane or walker if you already have one - have a family member bring equipment to the
hospital room the day after surgery for proper adjustment, if needed
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Section Three:
Hospital Care
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Day of Surgery
Arrival
Enter through the main entrance to the hospital. Sign in at counter. Have a seat until you
are called to a desk to be registered. You will be escorted back to the Day Surgery Area.
What to Expect
In the Day Surgery area you will be prepared for surgery. This includes starting an IV and
fitting you with T.E.D. stockings. The operating room nurse and your anesthesiologist will
interview you in the prep room. They will escort you to the operating room where you will
see your surgeon. Following surgery you will be taken to a recovery area where you will
remain for approximately one hour. During this time, pain control will be established and
your vital signs will be monitored. You will then be taken to the New Mobility Center where
our specialized staff will care for you. Friends and family can see you at this time.
For the rest of this day, you may walk around in the room or try a short walk in the hallway,
eat soft foods and drink what you like. We will instruct you on breathing exercises, ankle
pumps, T.E.D. stockings and the benefits of ambulation. Initially, your pain will be managed
with IV medication. When able, the nurse will transition you to oral medication. There will be
a dressing over your neck incision. If you require evaluation and treatment by a member of
physical or occupational therapy, these services will begin the day after surgery.
Post-op Routine through Discharge
Each day starts with blood work obtained early in the
morning with the 6 a.m. vital signs. A post-op xray of your
cervical spine is needed by 6 a.m. so your doctor may see
the surgical area before you are discharged. The staff will
assist you to a wheelchair for transport to the radiology
department. After the X rays, our staff will help you to a
chair for breakfast.
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Day of Surgery
Please read the following information about the day of surgery very carefully. Ask
any questions about these instructions in advance of your surgery day.
Do not eat solid food after midnight the night before you are scheduled for surgery. If you
surgery is after 2 p.m., a pre-operative nurse will provide specific instructions.
You may have clear liquids up to 4 hours before surgery. Then nothing to drink.
If you do, we will have to cancel your surgery!
Do not smoke, chew gum, or take hard candy or breath mints on the day of your surgery.
Do not take any medications before surgery that your Physician or the POC Nurse did
not approve beforehand. Bring a list of your medications, but leave the medications
at home.
Please come to the hospital at the time given to you at your pre-assessment meeting.
If you suddenly catch a cold or other ailment or suffer changes in your physical condition
please notify your surgeon immediately.
On the night before and morning of surgery take a shower with the antibacterial soap
given during the preop visit, please follow bathing instructions given. Wash your hair
with at least the morning shower. Do not apply make-up , lotions , powder or
deodorant after showering.
Bring an extra set of soft, stretchable pants (like sweatpants) with you to go home in.
Wear loose, comfortable clothing and flat-heeled shoes to the hospital.
Remember, no jewelry/piercings (including wedding rings), contact lenses, or money.
Leave your valuables at home or give them to a relative or friend for
safekeeping.
Bring this book with you on the day of surgery along with your driver’s license and your
insurance card for identification.
Under most circumstances, one person may accompany you to the Day Surgery area.
Your family and friends are welcome to wait in the lobby waiting area until you are taken
to your room.
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Examples of clear liquids that you may drink:
▪ Clear apple juice, cranberry juice, white grape juice
▪ Black coffee or tea (no cream or milk)
▪ Chicken or beef broth
▪ Water
▪ Gatorade
▪ Clear carbonated liquids (soda)
Examples of liquids NOT to drink:
▪ Orange juice
▪ Milk
▪ Any liquid with a nectar or pulp
▪ Alcohol
▪ Coffee or tea with cream or milk
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Post Anesthesia Care Unit (PACU)
When your surgery is complete you will be taken to our Post Anesthesia Care Unit (PACU).
This is a critical care unit with specially trained Registered Nurses who will watch you
closely (one nurse to one patient) while you begin your recovery from the anesthetic you
were given.
Your care will be essentially the same whether you have had general anesthesia.
While you are in PACU your vital signs, including your pain level, based on a scale of 0- 10,
with 10 being the most severe, will be monitored every 5 minutes, or as needed, and
addressed/ medicated with the pain medication ordered by your physician according to the
amount of pain you are experiencing. The medication will be given to you through your
intravenous access. You will be connected to a blood pressure cuff, heart monitors, and a
device called a pulse oximeter that will be placed on your finger to monitor how much
oxygen is in your blood.
Your temperature will be taken on arrival to the PACU and as needed to ensure you are
warm enough, as the operating room is kept cool. A Bair Hugger (warming device) will be
applied until you reach and maintain normal body temperature.
With general anesthetic, you may arrive in PACU with the breathing tube still in your airway
depending on how well you are breathing. When your breathing is stable enough, the nurse
will remove the tube and apply an oxygen mask. You may experience a bit of a sore throat
after the breathing tube comes out. This is normal. If the breathing tube is out prior to your
coming into the PACU, an oxygen mask will be put on you when you arrive the PACU.
A Foley catheter (tube in your bladder) will have been inserted after you were asleep in the
operating room, if needed. Do not be alarmed by this when you get to PACU. If you have
had a general anesthetic, it may feel like you need to urinate, as the tube often causes this
sensation, but you will be reminded that it is there and that it is okay to urinate as the tube
will catch it and go to a drainage bag. This is important for monitoring how much fluid you
are getting out compared to what have gone in intravenously. When you regain this
sensation, you to may feel the urge to urinate but remember, the catheter is there to catch
the urine.
Surgical bandages, as well as any drains that may have been put at the surgical site, are
checked every time your vital signs are checked to ensure that there is not excessive
bleeding.
Ice packs and braces are applied as ordered by your physician.
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Under most circumstances, your total time in PACU will be 45 minutes to one hour,
however, you will be observed there until you are awake enough to be transferred to your
room on the Patient Care Unit.
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Patient Care Unit (PCU)
When you arrive on the PCU, you will have a Registered Nurse (RN) caring for you. The
RN will continue to monitor vital signs (blood pressure, pulse, respirations and temperature,
pulse oximetry) movement and sensation of your legs and pain level frequently. As your
anesthetic wears off, the frequency of vital signs will decrease. The RN also assesses and
manages many other components of your care with help from a Nurse’s aide including the
following:
IV: An IV is in place to administer IV fluids. The IV may be capped when you are able to
take adequate fluids by mouth
Foley catheter, if needed: The Foley catheter will remain in place to drain your urine into a
bag. The catheter may make you feel like you have to urinate. When the catheter is taken
out, you can urinate on your own.
Intake and Output: Your caregivers may need to know the amount of liquid you are
getting. They may also need to know how much you are urinating. Caregivers often call
this “I&O”.
- When you are allowed, drink 6 to 8 cups of water each day. Follow your
caregiver’s advice if you must change the amount of liquid you drink. If you are on I&O, tell
your caregiver how much liquid you drink.
- Ask your caregiver if you need to urinate in a container. The urine may need to be
measured before it is flushed.
Ice: You may use ice to decrease pain or swelling. Ice is best started right after surgery
and used 24 to 48 hours afterwards. Follow your caregivers instructions for how often and
how long to use them. Do not place ice directly on bare skin as this can cause frostbite.
Activity: Will be initiated and directed by Physical Therapy and by nursing staff.
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Deep breathing and coughing: Lung problems are common after surgery. You may keep
from having them by doing breathing exercises. Deep breathe and cough every hour while
you are awake even if you wake up during the night.
- Deep breathing opens up tubes going to your airways. Coughing helps to bring up
sputum from your lungs for you to spit out. Take a deep breath and hold the breath as long
as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum
(spit) that you have coughed up into a tissue. Take 10 deep breaths in a row every hour
while awake. Remember to follow each deep breath with a cough.
- You may be asked to use an incentive spirometer. This helps you take deeper
breaths. Instructions will be provided.
BMs: This is also called having a bowel movement, a BM or a stool. Foods like fruit, bran
and prune juice can help you have a BM. Drinking water can help too. Your caregiver may
give you fiber medicine to make your BMs softer.
Drains: These are thin rubber tubes put into your skin to drain fluid from around your
incision. The drains are taken out when the incision stops draining.
Eating: If you do not have problems after drinking liquids, caregivers may let you eat soft
foods. If you do OK with soft food, you may begin eating your regular diet.
Oxygen: You may need extra oxygen to help you breathe easier. It may be given through
a mask or nasal cannula. A nasal cannula is a pair of short thin tubes that rest just inside
your nose.
Elastic Stockings: These tight elastic stockings help to keep blood from staying in the legs
and causing clots. The stockings are also called Ted Hose.
The PCU staff will work closely with your physician, case manager and other ancillary
departments to ensure that your anticipated recovery and discharge is within 1-3 days after
surgery.
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Tips for Family After Surgery
1.
It is okay to bring your family member’s favorite foods to the hospital, if the treats
are within their dietary restrictions.
2.
Be sure the car used to bring your family member home is large enough to get
into easily. Small, compact cars are not appropriate and can cause unnecessary
discomfort.
3.
Encourage your family member to follow all the instructions and guidelines that
they have been given. This is especially important, since they might be
discouraged by pain and fatigue that often follows surgery.
4.
Call the office if you have any questions or concerns.
5.
Your family member’s temperature will tend to rise in the evening (they might
even experience “night sweats”), but will go down to near normal during the day.
If their temperature stays elevated for 24-48 hours without going down, please
contact the surgeon’s office.
6.
When your family member is home from the hospital encourage them to do as
much as possible without your assistance. This will help them recover more
quickly and give them a greater sense of independence.
7.
Keep number of visitors/hours to minimum so that the patient utilizes energy for
rehab.
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Medications After Surgery
The most commonly prescribed medications after surgery are antibiotics to prevent
infection, anticoagulants to prevent blood clots and analgesics to control the pain.
ANTIBIOTICS
Antibiotics reduce or eliminate bacteria and are prescribed before and after surgery to guard
against infections. Antibiotics are routinely given for at least 24 hours following your
operation. It is important to notify your doctor or nurse if you have any history of drug
allergies or recent infections.
ANALGESICS (pain medicine)
We would like to assure you that pain or discomfort following your surgery will be closely
monitored and controlled. There are various types and methods of mediations used
depending on the severity of your pain. The best method for you will be determined by your
surgeon.
Non-narcotics such as Tylenol are given orally for mild to moderate pain. This medication
can be obtained without a prescription but your surgeon needs to be aware of all nonprescription medications you are taking. (Do not take aspirin, Advil, Motrin, Nuprin,
Aleve, or Ibuprofen while you are on Coumadin, Vicodin, or Codeine.) Possible side
effects of nausea, vomiting or stomach pain sometimes occur so it is best to take these
medications after meals with a full glass of water in order to avoid such problems. However,
if you experience severe dizziness, headaches, ringing in the ears or skin rash you should
contact your doctor immediately.
Narcotic medications such as Demerol, Morphine and Dilaudid are prescribed for moderate
to severe pain. Common side effects from narcotics include nausea, vomiting, constipation,
drowsiness or dizziness. Taking the medication orally with food will decrease many of the
stomach problems. Narcotics are habit forming so you should not take them more often or
for longer periods than your doctor prescribes for you.
As with all medications, keep them out of the reach of children!
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ANTICOAGULANTS (blood thinners)
Blood clots sometimes occur due to the long periods of bed rest after surgery.
Anticoagulants are prescribed to prevent blood clots from forming or getting larger. Your
orthopaedic surgeon will discuss this with you if needed during your hospital stay.
Physical Therapy Department
PRE-OPERATIVE INFORMATION FOR LUMBAR SPINE SURGERY PATIENTS
This packet is designed to give you, the spine surgery patient, general knowledge of what to
expect, and what is expected of you, as you prepare for your upcoming surgery. The
following could be altered slightly by your doctor or physical therapist, according to your
individual needs.
Your physical therapist will work with you to:
1. become independent getting in and out of bed.
2. become independent walking with or without assistive device (possibly 2 wheeled walker).
3. be independent going up and down a few steps.
4. be independent with the basic exercises. You will receive a handout of these exercises.
5. educate you on body mechanics and lifting restrictions.
You will receive physical therapy twice each day that you are in the hospital.
Day of Surgery
All you are asked to do is ankle pumps to encourage lower extremity circulation.
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Post-op Day #1 (Morning of the next day).
Physical Therapy begins.
1. Exercises begin for lower extremity and core strengthening.
2. You will sit up at the edge of the bed by log rolling and pushing up from your side.
3. You will stand up at the edge of bed with a 2 wheeled walker and maybe take a few
steps.
4. Maybe sit up in a chair depending on your comfort level.
Post-op Day #2 through Discharge
Your rehab will progress as you tolerate, working toward independent walking, exercising, and
activities of daily living.
Bathroom Needs
Once you are able to move with assist, your urinary catheter if indicated, will be removed
and you are encouraged to use the bedside commode or walk to the bathroom with assist of
nursing. Try to avoid using the bedpan.
Meals
As soon as you can tolerate sitting up, you are encouraged to eat all your meals sitting in
the bedside chair. Please ask nursing for help getting into and out of the chair.
Attire
You are encouraged to bring elastic waist pants or shorts and t-shirts to wear during the
day once the IV’s have been removed. You will be more comfortable exercising and walking
in these clothes rather than in the hospital gown.
On behalf of the Physical Therapy Department of Yampa Valley Medical Center, we are
looking forward to working with you. If you have any questions please call us at 970-8712370.
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Understanding Pain Management
Your home exercise program is designed and modified with you in mind. The exercises will
speed your recovery and make you more mobile quicker. It is important that you devote
time each day to the exercises. The exercises should be done at least 2-3 times per day.
You will be starting outpatient physical therapy as soon as you are able to tolerate being
away from home and can get in and out of the car easily.
Understanding Pain Management
It is our aim to make your surgery as pain-free as possible. Having said that, we realize pain
management is not perfect, and you will have some discomfort after your operation. There
are several factors that limit our ability to completely eliminate pain after surgery. The first is
that pain medications have side effects. These include respiratory depression (decreased
ability to breathe normally), hypotension (low blood pressure), nausea and constipation.
Other less common side effects include itching, urinary retention and abdominal distention
(collection of gas within the intestines). These side effects mean that the amount of
medication will have to be reduced at times, to avoid creating dangerous or uncomfortable
conditions. Another factor is tolerance. This is the body’s tendency to become less
responsive to the pain-reducing action of narcotics after being exposed to them for periods
of time. In other words, your body can become used to having these drugs. Unfortunately,
the side effects can still be present. Patients who have taken large doses of narcotics for
months or years have a much harder time keeping comfortable after surgery. For this
reason, it is very important for you to provide accurate information to your surgeon about the
amount of pain medication you have been taking. Inaccurate information could result in a
needlessly painful and stressful post-operative course. It may be necessary to taper or
discontinue your use of narcotics prior to surgery. This may even require in-patient
detoxification. It may be necessary to delay your surgery while this is accomplished.
Once you have had your surgery, we will rely heavily on your own assessment of your pain,
and work with you to relieve it. Most patients will receive intermittent low-doses of pain
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Patients who desire sub-acute rehabilitation prior to returning home must meet their insurance
company’s specific criteria before approval can be granted. If you do not meet this criteria, but
strongly wish to pursue rehab, you have the option to pay privately for your stay.
The requirements for Medicare patients are somewhat different. Medicare patients who are
considering a rehab stay, must first satisfy a three-night stay in the hospital. This three-night
stay cannot be for the purpose of discharge planning alone, but due to true medical need. If
you meet these conditions, Medicare covers the first 20 days of rehab at 100 percent. If you
do not satisfy the three-night stay in the hospital, but still wish to consider rehab, you may
pay privately for the room and board and have the rehab facility bill Medicare Part B for the
therapy services.
Costs for room and board vary from facility to facility and often require a down payment prior
to admission. Patients and families are urged to visit facilities before coming in for surgery.
Please contact the admissions office at the facility to discuss your options. A brief listing of
rehabilitation facilities can be found in the Appendix. Patient choice continues to be our top
priority. Patients are encouraged to visit any facility of their choice and provide us with the
name. We will gladly complete transfer arrangements during your hospital stay.
If you are considering rehab, it is strongly recommended that you also develop an alternate
plan in the event you do not meet the insurance criteria. We often "dual" plan our patients so
that a smooth and efficient discharge from the hospital is achieved.
Home Health Care Services
Your doctor and case manager may determine that you need home health care upon
leaving the hospital. If so, a case manager will discuss your needs and set up the
appropriate services. Home health can provide many services, among them: a registered
nurse, a home health aide, in-home physical therapy and occupational therapy. It is
important to remember that your insurance company determines the agency used
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and the amount of services you will receive. Be sure to call your insurance company
to verify your benefits prior to surgery to check on what type of service is available to
you! Each insurance carrier has rules and regulations and makes decisions based on their
own criteria, regardless of what your surgeon requests. You are responsible for contacting
your insurance company to verify your benefits
Medicare will cover physical therapy in the home for a patient who is homebound.
Medicare may also provide for a nurse and a nurse aide, but only if there is a skilled need.
While we understand that the initial adjustment to being home after surgery is not easy,
most patients manage very well, especially those who have prepared in advance.
Rehabilitation Services
Your surgeon may determine that you need more therapy before you can return home , and
may recommend that you be admitted to a Skilled Nursing Facility for a short stay.
The major goal of the skilled nursing facility is to improve your ability to perform key
activities of daily living. You will be expected to do as much as possible for yourself, dress
in everyday clothes, participate in a minimum of two-three hours of therapy per day, and
schedule visits and other activities around therapy times in order to receive the maximum
benefit from your sessions.
Please understand that the decision for acceptance to any rehab facility is not
controlled by your surgeon or the hosptial. If you meet the criteria set by both the rehab
facility and your insurance carrier and a bed is available, you will be discharged to the facility
when medically appropriate. Medicare does pay for 20 days of inpatient skilled
nursing/physical therapy per year per diagnosis.
Pastoral Care is also available in the hospital to help meet the religious and spiritual needs
of patients and family members of all faiths. Please speak with your case manager to
arrange to speak to someone in pastoral care.
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Acupuncture, Integrated Health at YVMC, Massage, Guided Imagery are available at no
cost to you. Please notify the Care Coordinator if you are interested in these services while
in the hospital.
Pain Management Services are available if you have been on long tern narcotic use, on
long acting opiods, multiple pain medications, have a opiod allergy or multiple narcotic
allergies and/or if you are a current pain management patient. Please let the care
coordinator know if this is an issue.
Free on site Interpreter Services are available for those who need assistance
communicating with the staff in Spanish. In other languages, the staff uses the YVMC
Pacific Interpreters line.
If you have completed health care proxy or a living will, bring a copy with you to the
hospital. If you would like more information about these subjects, please discuss this with
the Care Coordinator, Pre-Op Care Nurse or your case manager.
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PHYSICAL THERAPY CENTERS
CRAIG
Craig PT
535 Yampa Ave
Craig, CO 81625
826-1552
TMH Rehab
1111 W. Victory Way
Craig, CO 81625
824-5992
Rehab of Craig
473 Yampa Ave.
Craig, CO 81625
824-9359
Pearson Physiotherapy
440 Taylor Street
Craig, CO 81625
970-826-4800
PO Box 1345
280 Zerex Street
Fraser, CO 80442
970-726-8503
FRASER
Howard Head
Sports Medicine
GRANBY
Mountainland
Therapy
62801 Highway 40
Granby, Co 80446
Howard Head
Sports Medicine
3 Ten-Mile Drive
Granby, Co 80446
970-726-8503
300 Shelton Ave.
Hayden, CO 81639
276-1663
HAYDEN
SportsMed
KREMMLING
Kremmling
Physical Therapy
MEEKER
214 South 4th Street
Kremmling, CO 80459
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970-887-2733
970-724-3442
Pioneers Medical
Wellness Center
345 Cleveland
Meeker, CO 81641
970-878-9298
OAK CREEK
SportsMed
300 Main St.
736-2294
Oak Creek, CO 80647
STEAMBOAT SPRINGS
Align
702 Oak Street
Steamboat Springs, CO 80477
Forever Fit
345 Lincoln Avenue #205
Steamboat Springs, CO 80487
870-3484
Center for Sports
Medicine
1169 Hilltop Pkwy, 1202 B
Steamboat Springs, CO 80487
879-7799
Johnson & Johnson
1856 Lincoln Avenue
Steamboat Springs, CO 80487
879-4558
Kinetic Energy
PO Box 883299
Steamboat Springs, CO 80488
879-8026
Spine & Sports
1560 Pine Grove Road
Steamboat Springs, CO 80487
879-7031
Sport’s Med
1024 Central Park Drive
Steamboat Springs, CO 80487
871-2370
350 McKinley St.
970-723-4728
WALDEN
North Park PT
Walden, CO 80480
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870-0100
Home Health Associations
Suppliers of home nursing, physical therapy, Etc.
Visiting Nurses Association
940 Central Park Drive
Steamboat Spring, CO 80487
970-879-1632
745 Russell Street
Craig, CO 81625
970-824-8233
Centennial Home Health
1111 Victory Way #117
Craig, CO 81625
970-824-6882
Grand County Home Health
150 Moffat Ave.
Hot Sulphur Springs, CO 80451
970-725-3288
Pioneers Medical Center Home Health
345 Cleveland Street
Meeker, CO 81641
970-878-9861
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Short term Rehabilitation Centers
Doak Walker Care Center
1100 Central Park Drive
Steamboat Springs, CO 80487
970-870-1200
Sandrock Ridge Care and Rehab
842 W. 8th Drive
Craig, CO 81625
970-826-4100
Kremmling Memorial Hospital
214 S. Fourth Street
Kremmling, CO 80459
970-724-3442
Pioneers Medical Center
345 Cleveland
Meeker, CO 81641
970-878-5047
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Section Four:
Post-operative Care
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Caring for Yourself at Home
When you go home there are several things you need to know to ensure your safety, steady
recovery and comfort.
Control Your Discomfort
1.) Medication Management
•
•
Take your pain medicine at least 30 minutes before activity to control incisional pain.
Gradually wean yourself from prescription medication to Tylenol. You may take two
extra-strength Tylenol in place of your prescription medication up to four times per
day.
•
During the first 3 months after surgery (if you had cervical fusion), do not take over the
counter anti-inflammatory medication such as Ibuprofen (Motrin, Advil) and Aleve.
This type of medication can interfere with bone healing and thus jeopardize the
success of your surgery. If you have prescription anti-inflammatory medication at
home, consult your physician before taking these.
2.) Use of Ice/Heat
•
Use ice for pain control. Applying ice to your wound will decrease discomfort. Do not
use ice for more than 20 minutes at a time each hour.
•
Apply heat to areas of muscle spasm only. Do not use heat around your incision; this
will cause swelling.
3.) Positioning
•
•
Change your position every 45 minutes throughout the day.
Muscle strain and spasm can often be reduced by elevating the arms with pillows.
Using this positioning technique along with pain medication will optimize your
comfort. See Section 5 for pictures.
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4.) Muscle Spasm
• If your doctor has prescribed a muscle relaxer, take this to help muscle spasms.
•
Gentle stretching may ease muscle spasm. Please see Section 6 for horizontal
shoulder stretch. The idea is to “lengthen” the muscle that is in spasm. Remember to
avoid the B.L.T.’s.
• Gentle massage applied to the muscle spasm may help to reduce discomfort.
5.) Breathing
•
Take slow, controlled, deep breaths. Cough deeply and use your incentive spirometer
(I.S.) several times each hour. This helps to expand your lungs after surgery and
prevent pneumonia or respiratory complications. Deep breathing can also assist in
relaxing your muscles and body. Breathing and relaxing while you move will help
reduce muscle tension.
Body Changes
•
•
•
•
•
Your appetite will be poor. Drink plenty of fluids
to prevent dehydration. Your desire for solid food
will return.
You may have difficulty sleeping at night. This is
not abnormal. Don't sleep or nap too much during
the day.
Your energy level will be decreased for the first month.
Pain medications contain narcotics, which promote constipation. Use stool softeners
like Senokot or laxatives such as Milk of Magnesia if necessary while using narcotics.
Do not let constipation continue. If the stool softener and Milk of Magnesia do not
relieve your discomfort, contact your pharmacist, family doctor, or surgeon for advice.
Pain, limited mobility, medication side effects and reliance on others can lead to
depression after surgery. With time, this should improve. Seek medical attention if
these symptoms persist.
Caring for Your Incision
•
•
You may shower (not tub bathe) after 48 hours.
Remove dressing before shower, pat incision dry after shower, and replace dressing
as instructed.
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•
Notify your surgeon if there is increased drainage, redness, pain, odor or heat around
the incision.
Take your temperature daily at 8 a.m. and 4 p.m. Call your surgeon if it exceeds
100.5 degrees.
Signs of Infection
•
•
•
Increased swelling, redness at incision site
Change in color, amount, odor of drainage
•
•
Increased pain around the incision
Fever greater than 101 degrees
Prevention of Infection
•
Take proper care of your incision as explained on previous page.
•
•
Bathing: Take sponge baths for the first two days.
After that, you may shower as long as your wound is clean, dry and not red. AVOID
tub bathing for at least three weeks after surgery. Keep your wound clean and dry as
much as possible to avoid potential infection until it fully heals.
Dressing Change Procedure
This procedure is the same for the neck and hip bonegraft incision
1. Wash hands.
2. Prepare all dressing change materials (open gauze pad and tape).
3. Remove old dressing, dispose of.
4. Wash hands
5. Inspect incision for the following:
- increased redness
- increase in clear drainage
- yellow/green drainage
- odor
- surrounding skin is hot to touch
6. Pick up gauze pad by one corner and lay over incision. Be careful not to touch the
inside of the dressing that will lay over the incision.
7. Place the dressing over the incision and tape it in place.
8. Wash hands.
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Occlusive Dressing
If the incision has the clear, occlusive dressing, please follow these instructions:
• If dressing remains dry, remove occlusive dressing on post-op day #2.You may leave
the incision open to air or redress as described above. Continue to inspect the
incision daily as instructed above.
• If dressing becomes wet with a collection of fluid or blood, remove promptly and
follow the instructions at the top of the page. Change dressing daily and as needed
until incision remains dry. Gauze pads may be obtained from a medical pharmacy.
Dermabond
If the incision has been treated with Dermabond (skin glue), please follow these instructions:
• If dressing remains dry, remove occlusive dressing on post op day #2. Carefully try to lift
gauze from the incision. If the gauze adheres to the incision, do not pull it loose. Just
trim away the loosened gauze as needed. After a few days the gauze should come free.
• If dressing becomes wet with a collection of fluid or blood, remove promptly and
follow the dressing change instructions for "gauze dressing." Change dressing daily
and as needed until incision remains dry.
Stockings
You will be asked to wear T.E.D. stockings while in the hospital. These stockings are used
to help compress the veins and decrease the chance of blood clots. You will wear the
stockings most of the day, taking them off for one hour in the morning and one hour in the
evening. You will continue to wear these stockings for three days after surgery unless Dr.
Fabian tells you differently.
Blood Clots in Legs
Surgery may cause the flow of blood to slow and clot in the veins of your legs. If a clot
develops, you may need to be admitted to the hospital to receive intravenous blood thinners.
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Prompt treatment usually prevents the more serious complication of pulmonary embolus.
Moving around throughout the day, especially walking, will reduce the chance of a blood
clot.
Signs of Blood Clots in Legs
•
•
Swelling in thigh, calf or ankle that does not go
down with elevation of the legs
Pain, tenderness in calf
These signs are not 100 percent certain, but are
warnings. If they are present, promptly notify your
surgeon.
Prevention of Blood Clots
• Frequent foot and ankle pumps
•
•
Walking
Stockings/T.E.D. hose
•
Elevating your feet/legs
Pulmonary Embolus
An unrecognized blood clot could break off in the vein and go to the lungs. This is an
emergency and you should call 911 if suspected.
Signs of an Embolus
• Sudden chest pain
•
•
Difficult and/or rapid breathing
Shortness of breath
•
•
Sweating
Confusion
Prevention of Embolus
•
Prevent blood clot in legs
•
Recognize a blood clot in leg and seek medical care immediately.
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Section Five:
Post-operative Activity Guidelines –
Cervical & Lumbar
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Post-operative Activity Guidelines - Cervical
Bed Positioning
Lying on Your Back
•
•
Place a pillow under your knees or
thighs, under your neck, and under
your arms. This positioning reduces
stress on your spine.
When you change positions, tighten
your abdominal muscles and log roll
keeping your hips, shoulders, and ears lined up together.
To place a pillow behind your head, make sure it is supporting
both your shoulders and head. Avoid large pillows as they can push your head and
neck forward. The goal is to choose a pillow that will keep your neck straight, not bent
forward, backward or to the side. Wear your cervical brace at all times for support as
directed by your doctor.
Lying on Your Side
• With your knees slightly bent up toward your chest, place a pillow between your
knees and one under your neck.
ADDITIONAL NOTES:
•
•
Remember to tighten the abdominal muscles and log roll when changing positions.
Adding a pillow under your arm will also reduce stress on your neck and spine.
Lying on Your Stomach
• If you absolutely cannot avoid this position, place a pillow under your stomach to
provide support for your back.
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Bed Mobility
Getting Out of Bed
To move in and out of bed, you must "log roll" to prevent bending or twisting of your spine.
Start by bending your knees up while lying on your back. Now roll onto your side keeping
your hips, shoulders, and ears moving together to avoid twisting (i.e., roll like a log).
As you slide your feet off the bed, use your arms to push up into a sitting position. Scoot
your hips forward until your feet are on the floor and you feel stable. Using your arms to help
scoot typically helps minimize your surgical pain. Scoot far enough forward so your feet are
flat on the floor (heels included) to support your lower back.
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Post-operative Activity Guidelines - Cervical
Returning Back to Bed:
Reverse the technique for
returning to bed. Back up to the
bed until you feel the bed at the
back of your legs. Reach for the
bed with your hands as you
lower to a sitting position on the
bed. Scoot your hips back on
the bed. The further back you
scoot, the easier it will be for
you to lay down on your side.
As you lean down on your arm,
bring your feet up onto the bed
until you are lying down on your
side. Then, roll onto your back keeping
your shoulders, hips and ears in alignment.
Sitting Posture
Many times, patients choose to sleep in a
recliner chair for a few days after neck
surgery. The adjustable back position of the
recliner offers comfortable upright positioning
for the head and neck as well as armrests that
support the arms. Additionally, it may be
easier to stand up from a chair instead of the
bed.
POSITION OF COMFORT: Immediately after
surgery, patients complain of neck and
shoulder pain and have trouble finding a comfortable resting position. Placing pillows
under your forearms and elbows may help to reduce the pull on your neck and shoulder
muscles while sitting in the recliner or lying in bed. Additionally, your therapist may
suggest gel ice-packs over your shoulder muscles to reduce soreness.
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Post-operative Activity Guidelines - Cervical
Transfers
Into a Chair
Back up to the chair until you
feel it touch the back of your
legs. With your hands, reach
behind you to grasp the
armrests of the chair. Using your
arms and legs, begin to squat
and lower yourself into the chair.
SPECIAL INSTRUCTIONS:
•
•
Tighten your stomach
muscles to provide support for the lower spine.
Your feet should be firmly resting on the floor or a foot stool. Do not let your feet
dangle as this will place additional stress on your spine.
Out of a Chair
Scoot forward until you are sitting near the edge of the
chair. With your hands on the armrests push yourself up
into the standing position. Straighten your legs and shift
your weight forward over your feet. Bring your hands to the
walker as you are moving into the standing position.
Helpful Tips with Sitting
• Do not let your feet dangle when sitting. Have your feet
firmly supported to prevent pulling at your back.
•
Protect your back by sitting in a chair with a back
support. You can use a pillow or a towel as a lumbar roll.
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Post-operative Activity Guidelines - Cervical
Into the Car
Back up to the car seat until you
feel it at the back of your legs.
Reach a hand behind you for the
back of the seat and the other
hand to a secure a spot either on
the frame or dashboard. (The
door and walker are not secure
options. If you need to use them,
have someone hold the
“unsteady” objects.) Lower
yourself slowly to sitting. Scoot
your hips back until you are securely on the seat.
Leading with your hips, bring one foot into the car at a time until you are facing forward.
Prevent twisting by keeping your shoulders, hips, and ears pointing in the same direction.
You may want to recline the seat to increase the ease of lifting your legs. You can keep
your seat slightly reclined while riding to support your back from the “bumps” in the road.
Out of the Car
When getting out of the car bring your legs out one
at a time. Make sure to lead with your hips and
shoulders and do not twist your back. Place one
hand on the back of the seat and one hand on the
frame or dashboard. Push up to standing. Reach
for the walker when you are stable.
Helpful tips with car transfers:
•
Have an empty plastic bag on the seat to help
you slide in/out.
•
Have the seat positioned all the way back so
you have maximum leg clearance.
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Post-operative Activity Guidelines - Cervical
If you need to have one hand on the walker for leverage, have someone hold the
walker down on the front bar for stability.
Your doctor will determine when you can return to driving. You need to have full
neurologic function and minimal pain or discomfort before driving. You will also need to
discontinue taking medications that may affect your driving skills and safety.
•
Onto the Commode
Back up to the commode like you would a chair. Without twisting to look, reach back for
the handles of the commode or toilet seat and squat using your arms to help slowly lower
you down to a sitting position. Your feet should be flat on the floor for support while you
are sitting.
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•
Post-operative Activity Guidelines - Cervical
•
Move at your own pace and at your own comfort level.
•
Each day, increase the frequency and distance you walk. Go at your own pace.
Frequent walks are very important to help keep you moving and decrease your
stiffness and pain. By six weeks, a goal is to walk three miles unless otherwise
instructed by your physician or therapist.
Take six to eight walks per day at home. During at least one of the walks, you want to
increase the distance as tolerated.
•
Using Stairs
Negotiating consecutive steps:
•
Use a handrail and/or cane for
assistance.
•
If one leg feels weaker than the other,
go up the steps with your stronger leg
first and down the steps with your
weaker leg first. "Up with the Good and
Down with the Bad.”
•
If you feel unsteady, take one step at a
time. This will make negotiating steps easier and safer for you.
•
•
Concentrate on what you are doing. Do not hurry.
Since you cannot bend your neck to look down, feel the step with your feet.
•
Have someone assist or spot you as you feel necessary or indicated by your
therapist. This person should stand behind and slightly to the side of you when going
up the steps. When going down the steps, the person should be in front of you.
Helpful Stair Tips
•
Keep the steps clear of objects or loose items.
•
Plan ahead. After surgery, keep items in areas where you need them so that you can
limit stair use.
•
Install one or two handrails. Two handrails will increase the ease and safety with
steps.
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Post-operative Activity Guidelines - Cervical
Negotiating a Curb or One Single Platform Step
• You can use the rolling walker.
•
•
•
•
•
Move close to the step.
Place the entire walker over the curb onto the sidewalk. Make sure all four
prongs/wheels are on the curb.
Push down through the walker towards the ground.
Step up with the stronger leg first, then follow with the other leg.
Reverse this process for going down the stairs. Place your walker below the step,
then step down leading with the weak leg first.
Neck Brace
Soft Collar
The least restrictive and least supportive of all cervical braces is the
soft collar. Patients may be instructed to wear the soft collar at all
times or only when out of bed. The soft collar is simple to put on and
only requires fastening a Velcro strap at the back of the neck. Your
chin should rest at a small divot in the front of the collar. Be careful
not to turn your head side to side in this brace as it will not prevent you
from performing this motion.
Philadelphia Collar
A slightly more supportive brace is the Philadelphia collar also
referred to as the “Philly collar.” This brace is made out of foam and
has a rigid plastic support at the neck. The chin trough prevents you
from turning your head side to side. Some people will call this your
‘shower brace’ because it is made of non-absorbing foam and can
get wet (the straps will become wet, but can air dry). This collar is
designed to give support and prevent motion that may be detrimental
to your healing or surgery. If you are told to wear this collar out of bed,
please do so. The Philly collar fastens on the side with the back portion
sliding inside of the front portion so the Velcro straps can be fastened
securely.
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Post-operative Activity Guidelines - Cervical
Miami J Collar
The Miami J Collar is another firm brace that is sometimes used after surgery or after a neck
trauma to prevent motion and provide support. It is made of plastic with
soft foam pads that Velcro to the plastic. The foam pads can be
removed to launder and air dry. Your chin should rest on the chin
trough at the front and center of the collar. The back portion should
slide inside the front and then the straps fastened securely. An
orthotist, doctor or therapist should make sure this brace is adjusted
correctly to your size.
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Post-operative Activity Guidelines - Lumbar
Bed Positioning
Lying on Your Back
•
Keep a pillow under your knees or thighs and under your neck when lying on your
back. This supports your back and reduces stress on your spine.
•
When you change positions, tighten your abdominal muscles and log roll keeping
your hips and shoulders together.
Lying on Your Side
• With your knees slightly bent up toward your chest, place a pillow between your
knees and one under your neck. This helps to keep optimal alignment of your spine.
•
•
Remember to tighten the abdominal muscles and log roll when changing positions.
Adding a pillow under your arm will increase comfort and further reduce stress on
your spine.
Lying on Your Stomach
•
Avoid this position. It places too much strain on your lower back.
•
If you absolutely cannot avoid this position, place a pillow under your stomach to
provide support for your back.
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Post-operative Activity Guidelines - Lumbar
Bed Mobility
Getting Out of Bed
To move in and out of bed, you must "log roll" to prevent bending or twisting of your spine.
Start by bending your knees up while lying on your back. Now roll onto your side keeping
your hips, shoulders, and ears moving together to avoid twisting (i.e., roll like a log).
As you slide your feet off the bed, use
your arms to push up into a sitting
position. Scoot your hips forward until
your feet are on the floor and you feel
stable. Using your arms to help scoot
typically helps minimize your surgical
pain. Scoot far enough forward so your
feet are flat on the floor (heels included)
to support your lower back.
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Post-operative Activity Guidelines - Lumbar
Returning Back to Bed:
Reverse the technique for
returning to bed. Back up to the
bed until you feel the bed at the
back of your legs. Reach for the
bed with your hands as you
lower to a sitting position on the
bed. Scoot your hips back on
the bed. The further back you
scoot, the easier it will be for
you to lay down on your side.
As you lean down on your arm,
bring your feet up onto the bed
until you are lying down on
your side. Then, roll onto your
back keeping your shoulders,
hips and ears in alignment.
Transfers
Into a Chair
Back up to the chair until you feel it touch
the back of your legs. With your hands,
reach behind you to grasp the armrests of
the chair. Using your arms and legs, begin
to squat and lower yourself into the chair.
SPECIAL INSTRUCTIONS:
•
•
Tighten your stomach muscles to
provide support for the lower spine.
Your feet should be firmly resting on the floor or a foot stool. Do not let your feet
dangle as this will place additional stress on your spine.
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Post-operative Activity Guidelines - Lumbar
Out of a Chair
Scoot forward until you are sitting near the edge of the chair. With your hands on the
armrests push yourself up into the standing position. Straighten your legs and shift your
weight forward over your feet. Bring your hands to the walker as you are moving into the
standing position.
Helpful Tips with Sitting
•
Do not let your feet dangle when sitting. Have your feet firmly supported to prevent
pulling at your back.
•
Protect your back by sitting in a chair with a back support. You can use a pillow or a
towel as a lumbar roll.
From Bed
It is important to stand by pushing on the bed with your arms and NOT by pulling on the
walker. Place your hands on the bed, and push up to standing. Focus on straightening
your legs and shifting your weight forward over your feet. As you start to straighten, bring
one hand forward to the walker then the other hand. When sitting back down, be sure to
reach for the bed one hand at a time to control your body.
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Post-operative Activity Guidelines - Lumbar
Into the Car
Back up to the car seat until
you feel it at the back of your
legs. Reach a hand behind you
for the back of the seat and the
other hand to a secure a spot
either on the frame or
dashboard. (The door and
walker are not secure options.
If you need to use them, have
someone hold the “unsteady”
objects.) Lower yourself slowly
to sitting. Scoot your hips back
until you are securely on the
seat.
Leading with your hips, bring one foot into the car at a time until you are facing forward.
Prevent twisting by keeping your shoulders, hips, and ears pointing in the same direction.
You may want to recline the seat to increase the ease of lifting your legs. You can keep
your seat slightly reclined while riding to support your back from the “bumps” in the road.
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Post-operative Activity Guidelines - Lumbar
Out of the Car
When getting out of the car bring your legs out one at a
time. Make sure to lead with your hips and shoulders and
do not twist your back. Place one hand on the back of the
seat and one hand on the frame or dashboard. Push up to
standing. Reach for the walker when you are stable.
Helpful tips with car transfers:
•
Have an empty plastic bag on the seat to help you
slide in/out.
•
Have the seat positioned all the way back so you have
maximum leg clearance.
If you have to have one hand on the walker for
leverage, have someone hold the walker down on the front bar for stability.
•
Your doctor will determine when you can return to driving. You need to have full
neurologic function and minimal pain or discomfort before driving. You will also need to
discontinue taking medications that may affect your driving skills and safety.
Onto the Commode
Back up to the commode like
you would a chair. Without
twisting to look, reach back
for the handles of the
commode or toilet seat and
squat using your arms to
help slowly lower you down
to a sitting position. Your feet
should be flat on the floor for
support while you are sitting.
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Post-operative Activity Guidelines - Lumbar
•
Each day, increase the frequency and distance you walk. Go at your own pace.
Frequent walks are very important to help keep you moving and decrease your
stiffness and pain. By six weeks, a goal is to walk three miles unless otherwise
instructed by your physician or therapist.
•
Take six to eight walks per day at home. During at least one of the walks, you want to
increase the distance as tolerated.
Using Stairs
Negotiating consecutive steps:
•
Use a handrail and/or cane for
assistance.
•
If one leg feels weaker than the
other, go up the steps with your
stronger leg first and down the
steps with your weaker leg first.
"Up with the Good and Down
with the Bad.”
•
If you feel unsteady, take one
step at a time. This will make
negotiating steps easier and
safer for you.
•
Concentrate on what you are
doing. Do not hurry.
•
Since you cannot bend your neck to look down, feel the step with your feet.
•
Have someone assist or spot you as you feel necessary or indicated by your
therapist. This person should stand behind and slightly to the side of you when going
up the steps. When going down the steps, the person should be in front of you.
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Post-operative Activity Guidelines - Lumbar
Helpful Stair Tips
•
•
Keep the steps clear of objects or loose items.
Plan ahead. Right after surgery keep items in areas where you need them so that you
can limit stair use.
•
Install one or two handrails. Two handrails will increase the ease and safety with
steps.
Negotiating a Curb or One Single Platform Step
•
•
You can use the rolling walker.
Move close to the step.
•
Place the entire walker over the curb onto the sidewalk. Make sure all four
prongs/wheels are on the curb.
•
Push down through the walker towards the ground.
•
•
Step up with the stronger leg first, then follow with the other leg.
Reverse this process for going down the stairs. Place your walker below the step,
then step down leading with the weak leg first.
Back Brace
There are several types of back braces that help provide
support and/or limit motion to your back.
One of the more popular braces used after a spinal fusion is
known as the California brace, or lumbosacral brace. This
brace is a soft brace with Velcro closures, and it’s worn
positioned down over your hips. The brace is adjusted on the
sides and centered low over the abdomen. Make sure the
two Velcro panels fasten on either side, not in the front.
Pull the "rip cord" to tighten the brace. It is best to do this last
part standing to ensure a snug fit.
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Post-operative Activity Guidelines - Lumbar
To remove the brace, unfasten the "rip cord" and secure it to one side of the brace. Now,
undo the Velcro closure on the other side of the brace and remove brace. There is no recoil
mechanism so the strings must be "reset" by pulling either end of the brace lightly until the
cords are fully extended.
Another type of back brace is the “TLSO” (thoraco lumbar sacral orthosis). This brace is
commonly referred to as a body jacket or “clam shell” brace. Patients having thoracic or high
lumbar surgery may need to wear this type of brace.
A back brace is often recommended for patients to wear during the post-operative period so
that motion is limited at the surgical site. Wearing the back brace as instructed (whenever
out of bed) will aid in optimal healing. Some patients may need to wear their brace for as
little as 4 weeks or as long as 3 months. Your surgeon can give you the best idea of your
personal timeframe.
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Post-operative Activity Guidelines – Cervical &
Lumbar
Activities of Daily Living
Using a Reacher
Using a reacher limits the amount of bending
required to dress. Sit down in a chair with your
back supported. Use the reacher to hold the front
of your undergarments or pants. Bring the
garment over one foot at a time pulling the
underwear, then pants up to your thighs. Stand
up, squat to reach your clothing and pull up both
garments at the same time. Reverse the process
to remove your clothing.
Using a Reacher to Pick Up Items
A reacher helps you obtain those countless items
that fall while you are under "no bending"
restrictions. Use it as an arm extension to reach to
the floor.
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Post-operative Activity Guidelines – Cervical & Lumbar
Using a Sock Aid
Using a sock aid helps you reach your
feet without bending. Sit supported in a
chair and hold the sock aid between your
knees. Slide the sock onto the plastic cuff
making sure to pull the toes of the sock all
the way onto the sock aid. Hold the ropes
and drop the sock aid down to your foot.
Place your foot into the cuff and pull up on
the ropes as you point your toes down
until the sock is on your foot. Let go of one
rope and pull the cuff back onto your lap to
don the other sock.
Removing a Sock with the Reacher
Use the black hook on your reacher to push
your sock over the back of your heel. You can
continue pushing the sock completely off your
foot or use the jaw of the reacher to pull the
sock completely off your foot.
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Post-operative Activity Guidelines – Cervical & Lumbar
Bathing
Stepping in/out of the tub.
•
•
If your shower is part of the tub, you should hold onto the front wall of the shower and
step in or out sideways versus stepping in forward. This side-step places much less
stress and motion on your lower spine.
If you have a walk-in shower stall, step in as usual making sure not to twist as you
turn to the controls.
•
You may want to have a bathtub or shower seat available for the first few days that
you shower. You can borrow these types of items or buy them inexpensively. A
smaller patio resin/plastic chair can work for this if you have one already. Small
tub/shower benches can be purchased at most drug stores or medical supply stores.
•
You are not allowed to take a tub bath or swim for at least 3 weeks until your doctor
clears you to do this.
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Your Personal Goals - Cervical
Post-op Exercise Prescription Plan for the Spine Patient
EXERCISE
REPS
1. ____________________________________
reps _______ times/day _________
2. ____________________________________
reps _______ times/day _________
3. ____________________________________
reps _______ times/day _________
4. ____________________________________
reps _______ times/day _________
5. ____________________________________
reps _______ times/day _________
6. ____________________________________
reps _______ times/day _________
7. ____________________________________
reps _______ times/day _________
8. ____________________________________
reps _______ times/day _________
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FREQUENCY
Your Personal Goals - Lumbar
Post-op Exercise Prescription Plan for the Spine Patient
EXERCISE
REPS
1. ____________________________________
reps _______ times/day _________
2. ____________________________________
reps _______ times/day _________
3. ____________________________________
reps _______ times/day _________
4. ____________________________________
reps _______ times/day _________
5. ____________________________________
reps _______ times/day _________
6. ____________________________________
reps _______ times/day _________
7. ____________________________________
reps _______ times/day _________
8. ____________________________________
reps _______ times/day _________
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FREQUENCY
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Section Six:
Body Mechanics –
Cervical & Lumbar
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Body Mechanics – Cervical & Lumbar
General Rules
HOW TO USE THIS SECTION: This section will give you some general tips on how to
practice and adapt safe body mechanics to your everyday work activities. There are eight
main sections (Standing, Sitting, Lifting, Turning, Reaching, Pushing vs. Pulling, Sleeping
and Do’s & Don’ts). Under each section, there are some general rules of thumb followed by
more specific examples of activities you may perform. This is not an exhaustive list, but
should help you learn to apply and practice optimal body mechanics when performing
activities.
NOTE: There is not only one correct way to do a task. It depends on your abilities. You may
need to alter ways of moving based on your strength, flexibility, pain level, and/or other
medical conditions.
Standing
•
•
Do not lock your knees. A bent knee takes stress
off your lower back.
Wear shoes that support your feet. This helps to
align your spine.
•
If you must stand for long periods of time, raise
one foot up slightly on a step or inside the frame
of a cabinet. Resting a foot on a low shelf or
stool can help reduce the pressure and constant
forces placed on your spine. Shift feet often.
•
While standing, keep shoulders back so that
they do not roll forward.
Keep back as upright as possible and keep your
head and shoulders aligned with your hips.
Shaving
•
•
Stay upright with one foot on ledge of cabinet
under sink.
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Body Mechanics – Cervical & Lumbar
Showering
When showering, try not to let your head bend forward or backwards. (ie: washing hair)
If you have enough strength, squat down with knees or use a tub bench and/or a hand-held
shower spout, so your neck remains straight.
Brushing Teeth
•
While brushing teeth, stand up straight and keep knee bent with foot on cabinet lip.
•
To avoid bending forward, spit into a cup and use a cup for rinsing you mouth with
water. You can also support your back by leaning one arm on the sink/counter as you
spit into the sink. Bend at your knees, not your back.
Ironing
•
While ironing, keep ironing board waist level to avoid leaning forward at your back.
Sink
•
Keep one foot propped on lip of cabinet to reduce the stress on your back.
Sweeping/Mopping
•
•
•
Use the full length of the broom to sweep.
Do not hold broom handle close to floor.
Try to keep your spine as straight as possible.
•
•
Sweep with the motion coming from your hips instead of your shoulders.
Do not get down on your knees to scrub floors, instead use a mop..
Holding a Child
• To maintain good posture and decrease stress on back, hold the baby/child to the
center of your body, not propped on a hip.
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Body Mechanics – Cervical & Lumbar
Do not bend over with legs straight. This motion puts great pressure on your lower
back and can cause serious injury.
Refrigerator
• Bend at knees and hips to get things out of the lower portion of the refrigerator. It is
better to squat or kneel instead of bending.
•
Dishwasher
•
To get objects out of the dishwasher, squat or kneel down by door.
•
Try sitting on a swiveling office chair to unload the dishwasher. You can place the
items up onto the counter by pivoting around with your feet.
•
Then stand and put items into the cupboard.
Tub Cleaning
•
•
Do not overextend yourself when cleaning low places such as bathtubs.
Try to move lower by squatting and brace yourself with a fixed object.
Wiping Lower Surfaces
• When wiping or dusting low objects, do not bend the lower back.
•
Try to kneel or squat next to object.
Bathroom
•
Do not get down on your knees to scrub bathtub. Use mop or other long-handled
brushes.
•
Always use non-slip adhesive or rubber mats in tub or "aqua/water shoes."
Making Bed
•
•
Do not to bend over too far when making a bed.
Try to move sheet to corners and kneel or squat to pull them around mattress.
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Body Mechanics – Cervical & Lumbar
Do not bend over at the waist to lift anything or twist while lifting. Avoid trying to lift
above shoulder level.
Laundry - Unloading Wash
• To unload small items at bottom of washer, lift up one leg when reaching down into
the washer.
•
•
Do not bend at the waist to reach into washer when loading/unloading.
Laundry - Loading Washer
•
•
Place laundry basket so that bending and twisting can be avoided.
Place basket on top of washer or dryer instead of bending down with your back.
Unload - Dryer
•
Do not bend at lower back when removing laundry from dryer.
•
Set basket on floor and squat or kneel next to basket when unloading dryer or frontload washer.
•
You could try a "golfer's bend" to unload the washer/ dryer by supporting with one
hand on the unit and holding the opposite leg straight out as you bend forward. This
allows you to keep your back straight and take some of the pressure off your back
with your arm supporting you.
Lifting Laundry
•
Pick up laundry basket by squatting near it. Do not bend over to lift.
Kneeling Lift
•
•
With awkward objects, kneel and move object onto one knee.
Bring it close to your body and stand up.
Carrying Luggage
• Carry bags on both sides of body instead of on one side. Try to keep weight equal on
both sides.
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Body Mechanics – Cervical & Lumbar
Reaching
•
•
Store common items between shoulder and hip level.
Get close to the item. Use a stool or special reaching tool, if you need to.
•
Tighten your abdominal muscles to support your back. Use the muscles in your arms
and legs (not your back) to lift the item.
Dusting
• Use dusting implements that reach distances so you don't have to reach far or lean
your head backwards.
Cleaning
•
To clean overhead or tall objects, use a step
stool so that you don't have to over-reach.
Reaching Out
•
When getting objects that are low, but not low
enough to kneel or squat, brace yourself by
placing your hand on a fixed object such as a
counter.
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Body Mechanics – Cervical & Lumbar
Sleeping
•
Sleep on your side or back. If you sleep on your side, bend your knees to take some
pressure off your back, put a pillow between your knees to keep your curves aligned.
•
Do not sleep on a soft bed or couch. This takes your three spinal curves out of
alignment and adds extra stress to your back. Avoid sleeping on your stomach, which
can strain your neck and back.
Household Chores
Kitchen
•
Do NOT get down on your knees to scrub floors. Use a mop and long-handled
brushes.
•
Plan ahead! Gather all your cooking supplies at one time. Then, sit to prepare your
meal. This cuts down on excessive trips to the refrigerator, cupboards, etc.
Place cooking supplies and utensils in a convenient position so they can be obtained
without too much bending over or stretching.
•
•
Raise up your chair by putting cushions on the seat or using a high stool when
working.
Bathroom
• Do NOT get down on your knees to scrub bathtub. Use mop or other long-handled
brushes.
• ALWAYS use non-slip adhesive or rubber mats in tub.
•
Attach soap-on-a-rope so it is within easy reach.
All Areas
•
Remove throw rugs. Cover slippery surfaces with carpets that are firmly anchored to
the floor with no edges to trip over.
•
Be aware of all floor hazards such as pets, small objects or uneven surfaces.
•
•
Provide good lighting throughout. Leave a light on at night in the bathroom.
Keep extension cords and telephone cords out of pathways.Avoid slippers without
covered toes or shoes without backs. They tend to cause slips and falls.
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Body Mechanics – Cervical & Lumbar
•
•
•
Sit in chairs with arms. It makes it easier to get up.
Rise slowly from either a sitting or lying position so as not to get light-headed.
No heavy lifting for the first three months after your surgery and then only with your
surgeon's permission.
•
Stop and think and always use good judgment.
Do's and Don'ts for the Rest of your Life
Whether or not you have reached all the recommended goals in three months, all spine
surgery patients need to participate in a regular exercise program to maintain their fitness
and the strength of the muscles around their spine. With both your surgeon and primarycare physicians’ permission, you should be on a regular exercise program three to four
times per week lasting 20-30 minutes. In general, the aim of spine surgery is to return the
patient to a full activity level, but the conditions leading to spine surgery cannot be
completely corrected by even the most successful operation, so certain precautions should
be taken.
What to do in general
•
Avoid bending, lifting and twisting as much as possible. It may be possible to return to
strenuous physical activity, including heavy lifting, but discuss this with your surgeon.
•
Maintain ideal body weight.
•
•
DO NOT SMOKE!
Maintain proper posture.
•
When traveling, change positions every one to two hours to keep your neck and back
from tightening up.
What to do for exercise: choose a low-impact activity
• Enroll in recommended exercise classes.
•
•
Follow the home program as outlined in this Guidebook.
Take regular one- to three- mile walks.
•
•
Use home treadmill and/or stationary bike.
Exercise regularly at a fitness center.
•
Engage in low-impact sports, such as bowling, walking, gardening, dancing, etc.
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Section Seven:
Discharge Instructions
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Cervical Laminectomy
1. Immediate post-op to discharge from hospital:
You may get out of bed as soon as comfortable.
Walk as desired. Keep wound clean and dry. Wear
brace or collar as instructed.
2. Discharge to first office visit: If you were given a
brace or rigid collar, wear this when you’re out of
bed, soft collar at rest. Continue to walk as desired.
Gradually increase distance. You may shower but
do not bathe in tub or swim. You should remove
any dressings from surgical incision before showering. If you are not wearing a brace,
you may drive short distances as soon as you are comfortable. Driving is not
advisable while wearing a neck brace. You should plan to take it easy and rest for the
next week at home, and then gradually increase your activity as tolerated.
3. First visit (approximately 10 days post-op) to six weeks: Gradually increase
activities. Remain on feet for longer periods of time and increase your walking
distances. You may return to sedentary job in as little as 2 weeks if commute is less
than 20 minutes and you are pain free. You may tub bathe and swim. No bending,
twisting or lifting more than 10 pounds.
4. Six to twelve weeks: You may return to light duty or physical labor if pain free. You
may lift up to 25 pounds but continue to avoid bending and twisting of the neck. At your
six week visit, you will be shown specific exercises to strengthen your neck muscles.
5. Twelve to twenty four weeks: Continue to avoid heavy lifting or repetitive bending
and twisting of the neck. Continue these restrictions until advised further.
Swimming: Refrain from pool activity that causes repetitive twisting of the head and
neck. Even the simple activity of walking in the water can be therapeutic during this
time of recovery.
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Cervical Fusion
1. Immediate Post-op to discharge from hospital: You may get up as desired
wearing rigid collar/brace. Use soft collar in bed.
2. Discharge to first office visit: Try to be up as much as possible, using hard brace
when up and soft collar when in bed. You may shower, but do not tub bathe or swim.
You should remove any dressings from the surgical sites before showering and replace
if desired after shower. You should avoid driving at this time. You may be a passenger.
Avoid strenuous activity. You may walk as much as you feel comfortable with, but no
other exercise is advisable for now.
3. First visit (approximately 10 days to six weeks, post-op): Gradually increase
activities using brace/collar as before. You may shower, tub bathe, swim and
participate in any desired low impact aerobic activity, such as walking, exercise bike
or Stair Master. You may return to work as instructed by your physician. Do not drive
if you are still wearing a brace. Continue to avoid lifting anything over 10 pounds.
4. Six to twelve weeks: You may be weaned from brace/collar depending upon your
xrays. If out of brace, you may drive, otherwise continue as before. No running,
contact sports or lifting of weights over 25 pounds. Use soft collar as desired for
comfort.
5. Twelve to twenty-four weeks: Continue to avoid heavy lifting (over 25 pounds),
repetitive bending and twisting of the neck. Continue these restrictions until your
xrays indicate that you are completely healed and your physician releases you to full
activity.
Swimming: refrain from pool activity that causes repetitive twisting of the head and
neck. Even the simple activity of walking in the water can be therapeutic during this
time of recovery.
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Lumbar Laminectomy
1. Immediate post-op to discharge from hospital: You may get out of bed as soon as
comfortable. Keep wound clean and dry.
2. Discharge to first office visit: If you were given a back brace, wear this when out of
bed. Continue to walk as desired, gradually increasing the distance. You may shower
48 hours after surgery. Remove dressings, shower, dry off incision and replace
dressing if desired. Do not tub bathe or swim. You may drive short distances as soon
as you feel comfortable. For the next week, you should rest at home. Avoid strenuous
activity. Avoid bending, lifting and twisting for the next month. You can walk as much
as is comfortable, but no other exercise is advisable for now. Call if there is any
incision drainage, redness or fever. It is not unusual to have some leg pain and/or
numbness. Please contact your surgeon if these symptoms are severe.
3. First visit (approximately 10 days post-op) to six weeks: Gradually increase
activities. Remaining on feet for longer periods, increasing walking distances. May
return to sedentary job at 2 weeks if commute is less than 20 minutes and you are
pain free. May tub bathe and swim. No bending, twisting or lifting. Sit only in chairs
with good lumbar support. Sexual intercourse if desired (patients on bottom or side).
May start regular aerobic activity such as vigorous walking (work up to 3 miles in 45
minutes), StairMaster, swimming and low-impact aerobic classes.
4. Six to twelve weeks: You may return to physical
labor or light duty if pain free, lifting 25 pounds or
less. No bending or twisting. You may drive up to
one hour. Continue your exercise program. You will
be shown specific therapeutic exercises at your sixweek visit.
Swimming: refrain from pool activity that causes
repetitive twisting of the head and neck. Even the
simple activity of walking in the water can be therapeutic during this time of recovery.
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Lumbar Fusion
1. Immediate post-op to discharge from hospital: You may get out of bed as soon as
comfortable. Keep would clean and dry.
2. Discharge to first office visit: If you were given a back brace, wear this when out of
bed. Continue to walk as desired. Gradually increase your distance. You may shower
after 48 hours or per your physician's instruction. Remove dressing, shower, pat incision
dry and replace dressing if desired. Do not tub bathe or swim. Avoid riding in a car.
3. First visit (approximately 10 days to six weeks, post-op): Gradually increase
activities. Remain on feet for longer periods of time and increase walking distances.
You may drive short distances for necessities at three weeks and return to sedentary
job at three to six weeks if commute is less that 20 minutes and you are pain-free.
You may tub bathe and swim. No bending, lifting or twisting. Limit sitting and use
good lumbar support to avoid placing undue pressure on the spine. Sexual
intercourse if desired (patient on bottom). Wear back brace whenever up.
4. Six to twelve weeks: May return to non-strenuous work if you are pain-free. Avoid
bending, lifting or twisting anything over ten pounds (equals a gallon of milk). Start
regular low-impact aerobic activity such as vigorous walking (work up to three miles
in 45 minutes), StairMaster or low-impact aerobic classes. You may drive up to 30
minutes. You will be shown specific therapeutic exercises at your six-week visit. You
should wear your back brace whenever up.
5. Twelve to twenty-four weeks: Continue to avoid lifting (less than 10 pounds) or any
repetitive bending or twisting of back. Wear back brace until your physician advises
you further. Continue these restrictions until advised that fusion has healed.
Swimming: refrain from pool activity that causes repetitive twisting of the head and
neck. Even the simple activity of walking in the water can be therapeutic during this
time of recovery.
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Postoperative Care Instructions
Wound Care
Prior to discharge from the hospital, your dressing will have been changed, and if a wound
drain was present, this too will have been removed. The dressing you go home wearing
needs to stay in place for an additional three days. During the time you are wearing this,
you may shower or sponge bath, taking great care to keep any incisional area dry and
clean. For showering, use Saran®, Cling®or Cinch® wrap to cover the dressing and keep
direct water spray off the area. After you are done showering, the wrap can be removed,
the area blotted dry with a towel and in most cases, this will keep the dressing reasonably
dry. In those cases where the dressing became wet or some drainage is visible, don’t
hesitate to place a new sterile gauze dressing. 4 X 4 gauze wound dressing materials are
readily available in most drugstores. After the third day, dressings are removed and the
incisional area can be left open to air. Most incisions are closed with what is known as a
“sub-cuticular” stitch, which means resorbable suture has been placed under the skin.
There is no need to remove this type of suture. Sometimes the ends of the stitch or knots
will migrate towards the surface and these will be removed in the postoperative office visits.
Steri-strips are used in these cases to cover the incision and may remain adherent for a
couple of days after you remove the covering wound dressing. 2-5 days after the initial
dressing removal,any remaining steri-strips can be discarded. Any increased drainage,
particularly at greater than a week out postoperatively, or odor, redness or pus needs to be
reported and evaluated as soon as possible. Most wound infections in spinal surgery are
somewhat delayed, and can present at 2-4 weeks after surgery, so keep an eye on the
wound during this timeframe.
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Ice/Cold Therapy
It cannot be emphasized enough how valuable icing of the incisional area can be in the
postoperative period. All in-patients will receive various forms of this therapy and outpatients are encouraged to use ice packs or other similar products during the first month
after surgery. The first 10-14 days are key in effective ice/cold therapy. A slurry of water
and ice is the most effective method of transferring cold. Dr. Fabian recommends cold
therapy for the first 10-14 days 6-8 times per day, for 15-20 minutes per session. Obviously,
the patient needs to prevent potential frostbite or irritation of the skin, so always periodically
check the integrity of the skin.
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Reasons to Call Your Doctor
Following discharge to your home, if you experience any of the following call your
doctor immediately:
1)
Excessive redness around your incision
2)
Temperature greater than 100.5 degrees
3)
Pus draining from the wound
4)
Worsening pain not relieved by pain medication
5)
__________________________________________
6)
__________________________________________
__________________________________________
__________________________________________
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Home Set-up after Spine Surgery
Re-arranging a few items in your home, assessing what equipment you will need and
understanding how to adapt to your environment will help facilitate a smooth transition from
the hospital setting back to your home.
Kitchen:
1. Make sure all frequently used items are taken out of lo w storage places and placed
on the counter for easy access.
2. Move all food in refrigerator to the top shelves.
3. Remove all throw rugs as they present a tripping hazard.
4. On cooking days, cook for 3-4 meals instead of one, so cooking is kept at a minimum.
5. Place a high stool or chair in the kitchen area to sit on while working. (chopping food,
washing the dishes, stirring on the stove or using the microwave.)
6. Use the reacher tool to grab items less than two pounds in high and low places to
help maintain balance.
7. Empty trash when only half full.
Living Room:
1. Do not sit on low couches without arm rests, as they are difficult to get out of.
2. Place a pillow on a low surfaced chair or recliner to increase the seat height.
3. Before sitting down, make sure all items are within reach (ie. Telephone, remote
control, water, snacks).
Bedroom:
1. Sleep on the side of the bed that is closest to the bathroom.
2. Place a nightlight in the room for easy visibility when getting up.
3. If using a commode, place it at a 90 degree angle to the bed, and keep mobility
assistive devices close.
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Bathroom:
1. If a tub/shower is the only option for showering, consider a tub transfer bench with or
without legs. (If a shower stall is an option, it is recommended to use a commode for
both the toilet and as a shower chair.)
2. Place the bench in a position so that water controls are within reach. It is best if the
bench is placed on the side of the faucet, and a hand held shower head is used.
3. A high raised toilet seat is recommended if there are places next to the toilet to hold
onto when standing up, a commode is recommended if there is nothing next to the
toilet to hold on to when standing up or lowering down.
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Nutrition
Good nutrition before and after surgery is important for healing after surgery. Your wounds
may not heal well if you eat a diet that is low in nutrients. Calories, protein, vitamins such as
vitamin C and vitamin A and minerals such as iron and zinc are important nutrients to help
heal wounds.
Eating well
Following a well-balance eating plan with variety of foods from
each food group helps to ensure adequate amount of nutrients
to prepare your body for the stresses of surgery. You can get
more information from the MyPyramid Web site
(www.mypyramid.gov).
A well balanced eating plan includes:
Grains: Choose a variety of food made from wheat, rice, oats, cornmeal, barley or
another cereal grain. Make half your choices whole grains. Food from this food group
offers a good source of fiber, zinc, and B vitamins.
Fruits and Vegetables: Choose a variety of fruits and vegetables to get an abundant
of color and nutrients in your diet. Focus on a minimum of 5 servings of fruits and
vegetables per day. Foods from these food groups are a good source of vitamin C and
vitamin A.
Milk or milk alternates: Aim at getting 2 to 3 servings of milk or alternate dairy product
each day. Choose milk, cheese, yogurt or fortified soy or rice milk. Foods from this food
group provide a good source of protein, calcium, vitamin D and B vitamins.
Meat and Beans: Foods from this food group are good sources of protein, iron, and
zinc. These foods help our body heal from surgery, infection and injuries. Foods in this
group include beef, chicken, fish, seafood, pork, tofu, nuts, and nut butters. Focus on eating
5 to 6 oz of meat or the equivalent in a meat alternate per day.
Calories help to provide your body with energy and having enough energy supports
the healing process.
After surgery you may find that you are struggling with a poor appetite and you are eating
less. This may slow the healing process.
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The following are some ideas to help you eat enough calories and protein to help you
recovery after surgery:
•
•
•
•
•
•
Eat smaller more frequent meals. Eat 5 to 6 meals per day.
Keep snacks such as nuts, fruit, cereal yogurt & milk handy.
Choose nutrient dense drinks in place of water or coffee. Nutrient dense drinks
include milk, fruit juice, fruit smoothies and even lattes.
Add fruit, nuts, cream, or half and half to cereals.
Use milk to make soups
Have cheese or peanut butter with crackers or fruit.
The following are suggestions to help you eat more protein:
•
•
•
•
•
•
•
Add 1 tablespoon dry milk powder to 1 cup of milk, hot cereal, soups, or gravies
Spread peanut butter or another nut butter on crackers or toast
Add extra chopped meat or shredded cheese to soups, salads or casseroles.
Have yogurt with fruit and nuts.
Melt cheese on bread, English muffins, or tortilla
Add shredded cheese to vegetables
Choose desserts that contain eggs such as egg custard, bread pudding or rice
pudding.
A diet with adequate amount of vitamins and minerals helps with healing too. Vitamin C and
zinc are especially important for healing. Good sources of vitamin C include orange juice,
strawberries, tomatoes, cantaloupe, broccoli, cranberry juice, green peppers, and potatoes.
Foods high in zinc include meats, cereal, and dried beans.
If you are not able to eat enough food, you may not be getting enough calories, protein,
vitamins or minerals. In this case, a liquid supplement may be suggested by your doctor or
registered dietitian. Liquid supplements such as Ensure Plus, Boost Breeze Carnation
Instant Breakfast and Enlive can help supplement your diet when you are eating poorly.
Please tell the nurse you would like to see a dietitian if you are struggling with a poor
appetite or desire information on other nutrition related topics.
Nutrition Services at Yampa Valley Medical Center: 970-870-1048.
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High Calorie, High Protein Recipes
High-Calorie, High-Protein Fruit Smoothie
(Makes 1 large serving)
Ingredients
6 ounces (¾ cup) orange juice
1 banana
6 frozen strawberries (unsweetened)
1 ounce (3 tablespoons) protein powder or 3 tablespoons nonfat dry milk
Directions
Place all ingredients in blender. Blend until smooth.
Nutrient Information (per serving): 320 calories, 60 grams carbohydrate, 19 grams protein,
2 grams total fat, < 1 gram saturated fat, 190 mg sodium, 1,020 mg potassium, 160 mg
calcium.
High-Calorie, High-Protein Instant Pudding
(Makes 4 servings)
Ingredients
1 box instant pudding mix
12-ounce can evaporated milk
½ cup whole milk
Frozen whipped topping (optional)
Chocolate syrup (optional)
Directions
• Wash the lid on the can of milk.
• Pour the canned and the whole milk into a large bowl or blender container.
• Slowly pour the instant pudding mix into the milk and mix or blend until smooth.
• Pour into 4 dishes. Refrigerate and serve cold.
• For more calories, top with frozen whipped topping and drizzle with chocolate syrup.
Nutrient Information (per serving): 240 calories, 33 grams carbohydrate, 8 grams protein,
9 grams total fat,5 grams saturated fat, 470 mg sodium, 390 mg potassium, 288 mg calcium.
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Basic High Protein Milkshake
1 serving
Ingredients
3/4 cup ice cream
1/4 cup whole milk
2 T Nonfat dry milk
Flavoring of choice
Mix in blender.
Nutrition Information (per serving): 250 calories, 14 g protein
No-Bake Peanut Butter and Cereal Cookies
(Makes 20 large cookies)
Ingredients
1 cup light corn syrup
1 cup sugar
18-ounce jar peanut butter
5 cups dry cereal (such as Special K or Whole Grain Total)
Directions
• In a saucepan, bring corn syrup and sugar to a boil.
• Add peanut butter and stir until melted.
• Pour syrup over cereal and stir to coat well.
• Use a metal or plastic ¼ cup measure or #2 scoop to place cookies on a sheet of waxed
paper.
Nutrient Information (per cookie made with Total cereal): 270 calories, 35 grams
carbohydrate, 7 grams protein, 13 grams total fat, 3 grams saturated fat, 200 mg sodium,
200 mg potassium, 100 mg calcium.
If you are unable to prepare your own meals….
You may want to consider getting help with meal preparation from family members, your
friends or your church when you are having trouble preparing your meals. Meals on Wheels
may also be available to you for a small fee and they provide balanced lunch meals during
the week.
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Section Eight:
Appendix
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Anesthesia For Spine Surgery: The Basics
It is common for patients to arrive at the hospital quite nervous about the anesthesia part of
(their?) his or her upcoming surgery. Patients often have a solid grasp on understanding the
surgery but find the anesthetic part to be intimidating and mysterious Your anesthesiologist
will work to unravel this mystery for you and help put your mind at ease. His or her task will
include keeping you safe and comfortable during surgery and controlling your pain in the
immediate postoperative period.
The purpose of these “extra” notes is to try to help you understand the anesthesia part of
your surgery and provide a little insight into the preoperative, intraoperative, and
postoperative processes from an anesthesiologist’s perspective.
Major spine surgery is performed under a general anesthetic. General anesthesia is a
technighe that causes unconsciousness and prevents the thinking part of the brain from
being awake or even aware that surgery is occurring.
Preoperative
A patient typically meets the anesthesiologist on the day of surgery after being admitted to
the preoperative area. Here the anesthesiologist will review your health history and discuss
anesthetic issues and risks specifically to you and your surgery. Your questions will be
answered. Should you desire, one of our anesthesiologist would be happy to speak with
you ahead of time and address any concerns you have.
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Intraoperative
Once their preoperative evaluation is complete
and all is ready, you will be given a dose of mild
sedating medicine and transported to the
operative room. Once in the operating room,
several monitors are attached to you, allowing
your anesthesiologist to monitor your physiology
during the surgery. When ready to go, you will
be give an intravenous anesthetic that helps you
“fall asleep” very quickly (within in seconds!).
When completely asleep, a soft plastic tube will
be place in yo9ur mouth into your windpipe
(trachea) to allow your anesthesiologist to control
your breathing. It will be removed before you
wake up.
For spine surgery, a patient is typically turned
into a prone position (on your belly). Because of
this position, it is not unusual for a patient to feel a bit still in the shoulders the day following
surgery.
Postoperative
When your surgery is complete, your anesthesiologist will help you “wake up” . You will
then be transported with your anesthesiologist to the recovery room. The purpose of the
recovery room is to allow you to wake up completely and to make sure that you are
comfortable and safe. From the recovery room, you will be transported to the patient care
unit (i.e., your hospital room).
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As mentioned above, our chief priorities as anesthesiologists are to keep you safe and
asleep during your surgery, and to help make sure tryout are safe and comfortable in the
immediate postoperative period. We want you to have a great experience and a successful
spine surgery. If we can be of further assistance, please don’t hesitate to contact us: Elk
River Anesthesia at Yampa Valley Medical Center. See you soon!
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Glossary of Terms
Annulus – The outer rings of rigid fibrous tissue surrounding the nucleus in the disc .
Anterior – A relative term indicating the front of the body.
Bone Spur – An abnormal growth of bone, usually present in degenerative arthritis or
degenerative disk disease.
Cartilage – A smooth material that covers bone ends of a joint to cushion the bone and
allow the joint to move easily without pain.
Computed tomography scan (also called a CT or CAT scan) – A diagnostic imaging
procedure that uses a combination of xrays and computer technology to produce crosssectional images, both horizontally and vertically, of the body. A CT scan shows detailed
images of any part of the body, including the bones, muscles, fat and organs. CT scans are
more detailed than general xrays.
Congenital – Present at birth.
Contusion – A bruise.
Cervical Spine – The part of the spine that is made up of seven vertebrae and forms the
flexible part of the spinal column. The cervical spine is often referred to as the neck.
Corticosteriods – Potent anti-inflammatory hormones that are made naturally in the body
or synthetically for use as drugs; most commonly prescribed drug of this type is prednisone.
Degenerative Arthritis – The inflammatory process that causes gradual impairment and
loss of use of a joint.
Degenerative Disc Disease – The loss of water from the discs that reduces elasticity and
causes flattening of the disks.
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Disc – The complex of fibrous and gelatinous connective tissues that separate the vertebrae
in the spine. They act as shock absorbers to limit trauma to the bony vertebrae.
Discectomy – The complete or partial removal of the ruptured disc.
Dura – The outer covering of the spinal cord.
Dural Tear – A laceration or tear of the dura that can occur during surgery. Leakage of
spinal fluid occurs at this site. This is often treated with bed rest for 24-48 hours thus
allowing the tear to heal.
Facet – The small plane of bone located on the vertebra.
Foramina – Plural form of foramen (a natural opening or passage through a bone).
Foraminotomy – The surgical procedure that removes part or all of the foramen. This is
done for relief of nerve root compression.
Fracture – A break in a bone.
Fusion – The surgical procedure that joins or “fuses” two or more vertebrae together to
reduce movement at this joint space. As a result, pain is lessened.
Herniated Disc – The abnormal protrusion of soft disc material that may impinge on nerve
roots. Also referred to as a ruptured or protruding disc.
Inflammation – A normal reaction to injury or disease which results in swelling, pain and
stiffness.
Joint – Where the ends of two or more bones meet.
Lamina – The bone that lies posterior to the vertebrae.
Laminotomy – The removal of a small portion of the lamina.
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Laminectomy – The removal of the entire lamina.
Ligaments – Flexible band of fibrous tissue that binds joints together and connects various
bones.
Lumbar Spine – The portion of the spine lying below the thoracic spine and above the
pelvis. This part of the spine is made up of 5 vertebrae. Also called the lower back.
Magnetic Resonance Imaging (MRI) – A diagnostic procedure that uses a combination of
large magnets, radiofrequencies, and a computer to produce detailed images of organs and
structures within the body.
Myelopathy – A condition that is characterized by functional disturbances due to any
process affecting the spinal cord.
NSAID – An abbreviation for nosteroidal anti-inflammatory drugs, which do not contain
corticosteroids and are used to reduce pain and inflammation; aspirin and ibuprofen are two
types of NSAIDs.
Nerve Root – The portion of a spinal nerve that lies closest to its origin from the spinal
cord.
Neuropathy – A functional disturbance of a peripheral nerve.
Nucleus Pulposis or Nucleus – The relatively soft center of the disc that is protected by
the rigid fibrous outer rings.
Osteoporosis – A condition that develops when bond is no longer replaced as quickly as it
is removed.
Osteophyte – A bony outgrowth.
Pain – An unpleasant sensory or emotional experience primarily associated with tissue
damage.
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Pain Threshold – The least experience of pain that a person can recognize.
Pain Tolerance Level – The greatest level of pain that a person is prepared to tolerate.
Paresthesia – An abnormal touch sensation, such as burning or tingling.
Posterior – A relative term indicating that an object is to the rear of or behind the body.
Radiculopathy – A condition involving the nerve root that can be described as numbness,
tingling or pain that travels along the course of a nerve.
Sacral Spine – The last section of the spinal column located below the lumbar spine. It is
made up of several semi-fused pieces of bone.
Sciatica (also called lumbar radiculopathy) – A pain that originates along the sciatic
nerve.
Scoliosis – A lateral, or sideways, curvature and rotation of the back bones (vertebrae),
giving the appearance that the person is leaning to one side.
Soft tissues – The ligaments, tendons, and muscles in the musculoskeletal system.
Spine – A column in the body consisting of 33 vertebrae.
Spinal Stenosis – A narrowing of the vertebral canal, nerve root canals, or intervertebral
formina of the spine caused by encroachment of bone upon the space. Symptoms are
caused by compression of the nerves and include pain, numbness and/or tingling,
Spine – The flexible column of 24 vertebrae, disks, ligaments and muscle that lie between
the head and pelvis and behind the rib cage. Also referred to as the spinal column.
Spinous Process – The part of the vertebrae that you can feel through your skin.
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Spondylosis (spinal osteoarthritis) – A degenerative disorder that may cause loss of
normal spinal structure and function. Although aging is the primary cause, the location and
rate of degeneration is individual. The degenerative process of spondylosis may impact all
of the spine creating over growth of bone and affecting the intervertebral discs and facet
joints.
Spondylolisthesis – A forward displacement of one vertebra over another.
Sprain – A partial or complete tear of a ligament.
Strain – A partial or complete tear of a muscle of tendon.
Stress fracture – A bone injury caused by overuse.
Tendon – The tough cords of tissue that connect muscles to bones.
.
Thoracic Spine – The portion of the spine lying below the cervical spine and above the
lumbar spine. This part of the spine is made up of 12 vertebrae.
Torticollis (also called wryneck) – A twisting of the neck that causes the head to rotate
and tilt on an angle.
Transverse Process – The wing of bone on either side of each vertebra.
Trigger Point – Hypersensitive area or muscle or connective tissue, usually associated with
myofascial pain syndromes.
Ultrasound – A diagnostic technique which uses high-frequency sound waves to create an
image on the internal organs.
Vertebra (e) – The bone or bones that form the spine.
Xray – A diagnostic test which uses invisible electromagnetic energy beams to produce
images of internal tissues, bones and organs onto film.
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