FAQ before surgery

You may be scheduled for pre-surgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. Based on physical examination and reports of pre surgical tests, fitness for surgery is acquired form physician and anaesthetist. Anti-coagulants (blood thinners) need to be stopped 5 days before surgery. Some medications need to be continued or stopped the day of surgery. A consent is signed a day before surgery. It states all the risks and benefits of surgery and after understanding them the patient allows the surgeon to perform the procedure. No food/ or water is allowed from 8 hours before the procedure (usually overnight fasting) If any medications are advised to be taken in the morning of surgery, they are taken with sips of water.

After surgery, pain is managed with narcotic medication. They can cause constipation, so patients are advised to drink lots of water and eat high fiber foods.

It is recommended to maintain good nutrition and adequate hydration. Diabetics should maintain blood sugar levels.  It is recommended not to smoke or drink alcohol during the recovery period as it may delay wound healing, fusion and recovery.

On discharge there is a dressing at the site of surgery. If a waterproof dressing is applied, patient is allowed to bath. It is recommended to keep the wound dry.

If any discharge, redness, swelling or unexpected severe pain is noticed kindly contact the surgeon immediately.

As the wound heals, it may itch which is sign of healing. After suture removal, it is advised not to itch or apply anything over the wound until it matures (usually 4 weeks after surgery)

Pain at the surgical site is expected for a few days- weeks. This is usually tolerable and keeps decreasing day by day. This is because skin, muscles and bone need time to heal. Sometimes radiating pain to arms and legs may persist and take a while to go. Tingling and numbness may remain for a few months. The full benefits and therapeutic effects may take 6-9 months. Many times the aim of surgery is to halt the progression of disease only. This is the time taken for the bones to fuse. It is necessary to have regular follow ups and X-rays and take medications as prescribed. If the pain persists or becomes severe at any point, kindly contact the surgeon.

If the patient is on any blood thinners before the surgery, these are started again at discharge after consultation with physician/ surgeon.

Do not smoke. Smoking delays healing by increasing the risk of complications (e.g., infection) and inhibits the bones’ ability to fuse.

Do not drive for 2 to 4 weeks after surgery or until discussed with your surgeon.

Avoid sitting for long periods of time.

Avoid bending your head/back forward or backward.

Do not lift anything heavier than 2 kgs

Housework and yard-work are not permitted until the first follow-up office visit.

 

You may need help with daily activities (e.g., dressing, bathing), but most patients are able to care for themselves right away.

Gradually return to your normal activities. Walking is encouraged; start with a short distance and gradually increase to 1 to 2 km daily. A physical therapy program may be recommended.

If applicable, know how to wear a cervical collar/ lumbar belt/brace before leaving the hospital. Wear it when walking or riding in a car.

If your temperature exceeds 101° F, or if the dressing is soaked or become dirty. If you experience sever back neck pain, paraesthesia or if the weakness increases in arms/ legs.

Recurrences of neck/ back pain are common. The key to avoiding recurrence is prevention:

Proper lifting techniques

Good posture during sitting, standing, moving, and sleeping

Appropriate exercise program

An ergonomic work area

Healthy weight and lean body mass

A positive attitude and relaxation techniques (e.g., stress management)

No smoking

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots (deep vein thrombosis), and reactions to anaesthesia. If spinal fusion is done at the same time as a discectomy, there is a greater risk of complications. Some complications may include:

Vertebrae failing to fuse. There are many reasons why bones do not fuse together. Common ones include smoking, osteoporosis, obesity, and malnutrition. Smoking is by far the greatest factor that can prevent fusion. Nicotine is a toxin that inhibits bone-growing cells. If you continue to smoke after your spinal surgery, you could undermine the fusion process.

Hardware fracture. Metal screws and plates used to stabilize the spine are called “hardware.” The hardware may move or break before the bones are completely fused. If this occurs, a second surgery may be needed to fix or replace the hardware.

Bone graft migration. In rare cases (1 to 2%), the bone graft can move from the correct position between the vertebrae soon after surgery. This is more likely to occur if hardware (plates and screws) is not used or if multiple vertebral levels are fused. If this occurs, a second surgery may be necessary.

Transitional syndrome. Fusion of a spine segment causes extra stress and load to be transferred to the discs and bones above or below the fusion. The added wear and tear can eventually degenerate the adjacent level and cause pain.

Nerve damage or persistent pain. Any spine surgery comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. Some pathologies may permanently damage a nerve making it unresponsive to surgery.

Infection. The risk usually varies between 1-5%. Some are minor and some can be serious. A minor infection can be treated by antibiotics and your stay in hospital may be prolonged. Sometimes it may require further surgery to clean the wound. If implants are installed, they may need to be removed and further extensive fusion is performed.

Dural Tears: There is a small risk of dural tear during surgery. It is a tear in the outer lining/ covering of spinal sac land contains fluid known as CSF. This fluid may leak from the tear. These are usually repaired during surgery or closed with tissue sealents. Even then, it may leak through the wound and cause headaches. Sometimes it may get infected and further surgery and longer hospitalization stay may be required.