McLaren Spine Surgery Education
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Procedure Definitions
Lumbar Laminectomy
A laminectomy is a surgical procedure that is used to relieve pressure
in the spinal canal for the exiting nerve root and spinal cord, increasing
the amount of space available for the neural tissue and thus releasing
the nerve(s).
Lumbar Spinal Fusion
Fusion is a conventional surgical technique in which one or more of
the vertebrae of the spine are joined together (“fused”) so that ,motion
no longer occurs between them. In most instances, bone grafts from
another area of the body, along with plates and screws, are placed
around the spine during a fusion - which joins the vertebrae together.
This surgery is often recommended for people with Degenerative Disc
Disease and Spondylolisthesis.
Anterior Cervical Discectomy with Fusion (ACDF)
Anterior cervical discectomy with fusion is an operation that involves
relieving the pressure placed on nerve roots and/or the spinal cord by
a herniated disc or bone spurs - a condition referred to as nerve root
compression
Through a small incision made near the front of the neck (i.e., the
anterior cervical spine), the surgeon:
- Removes the intervertebral disc to access the compressed neural
structures
- Relieves the pressure by removing the source of the compression
- Places a bone graft between the adjacent vertebrae, and
- In some cases, implants small metal plate to stabilize the spine while
it heals.
Spinal Cord Stimulation (SCS)
SCS uses a small implanted device to generate tiny electrical
pulses that replace the feeling of pain with a tingling or
massaging sensation.
Preparing for Surgery:
Pre Admission Testing (PAT)
- A personalized medical history will be taken and your preoperative
testing results will be reviewed. The nurses will instruct you regarding
your medications. Any additional lab work required by your surgeon
will be obtained. You will need to give a urine specimen.
- Please bring a copy of your Advance Directives or Durable Power of
Attorney. It will be placed in your medical record.
- A current list of allergies.
- A list of medications you regularly take with doses and frequency, this
includes over the counter medications; if you use an inhaler or CPAP
please bring it along with you on the day of surgery.
- Also bring copies of your insurance cards, advance medical directives
and medical history.
- There are many medications that you may need to stop 2 weeks prior
to your surgery. Please contact your primary care physician to see if this
applies to you.
Medications
- Let your doctor and nurses know all of the medications you are
taking. This includes herbals, and respiratory inhalers. Also inform
them if you use a CPAP machine to help you breathe at night. Most
arthritis medicines and aspirin must be stopped one week before
surgery. Be sure to ask your doctor if you are unsure about taking
any medication. Writing down a list of your medications and how
much you take every day will be very helpful to your doctor and
nurses.
- If you use any other types of controlled substances, tell your doctor.
Narcotics and other drugs can have an impact on your surgery.
Bring these things with you on Surgery Day:
- Your films if you have them, if you do not have them - don’t worry
your surgeon has them and will bring them with him/her.
- Your brace if ordered by your physician.
Diet
Eat well-balanced meals for good nutrition. Drink at least eight
(8) glasses of water per day. Have a light meal the night before
surgery. Stop eating and drinking at 12:00 midnight.
Braces
Get your brace (if ordered by your physician). On the day of
surgery, you will need to bring it with you to the hospital.
Smoking
It is important for you to cut back as much as you can on your
smoking. Smoking can delay and/or impair the healing process.
Alcohol
If you drink, don’t have any alcohol for at least 48 hours prior to
your surgery. If you drink alcohol everyday, you may experience
withdrawal after surgery. Please let your doctor know if you
consume alcohol regularly.
The night before your surgery:
- Take a shower or bath the night before your surgery with
antibacterial soap. This will help reduce the risk of infection.
- Do not shave the surgical area and do not wear any make-up,
lipstick or nail polish.
- Do not eat or drink anything after midnight. You will be informed
about whether or not to take your medication by pre admission
testing.
Bring a rolling bag with you to the hospital. (if you have one)
Some of the items you should bring from home are:
- Good non-skid walking shoes and socks.
- A knee-length robe or gown, preferably a wrap around robe.
- A loose-fitting sweat suit or jogging suit.
- Personal care items such as a hair brush, toothbrush, toothpaste,
denture case, eyeglass case, contact lens case, hearing aid case.
- YOU MUST BRING YOUR BRACE WITH YOU TO THE HOSPITAL
IF ONE WAS ORDERED FOR YOU BY YOUR PHYSICIAN.
Leave your cash, credit cards, lap-top computers and ALL jewelry,
including watches, at home.
The morning of your surgery:
Before leaving home, take any medications you have been instructed to take
with a drink of water, and be sure and leave all of your jewelry at home
including rings.
When you arrive on the day of your surgery, go directly to “Inpatient Pre-Op
Holding”.
*Your family will be asked to check in with the waiting area while we get you
ready for surgery. At this time your family will be introduced to our Nurse
Liaison.
-
You will be asked to put on a hospital gown, and remove all jewelry or
valuables and give them to your family. It is best not to wear these to the
hospital.
- You will be asked to mark your surgical site, and several different staff
members will verify this with you.
- An IV (intravenous) line will be started to provide fluids and medication
needed during surgery.
- Only two visitors at a time will be allowed prior to surgery, in pre-op area.
- Anesthesia will come and talk to you about your anesthesia and answer
any questions about that part of the procedure. You will be asked to sign
consents at this time.
- Any repeat tests that may need to be preformed will be done to insure your
health is optimal.
- When everyone is satisfied and OR is ready, someone from the OR will
come to get you.
- Before you go back to the OR, you will have the opportunity to see your
family again. At this time we will ask you to remove dentures/partials, and
glasses/contacts.
Surgery Time
A procedure time has been assigned to each patient depending on their
anticipated needs. At times, situations arise beyond our control and the
expected surgery time may be adjusted. We may call and move the time of
your surgery up, or there may be some delay. Every effort will be made to
respect you and your families’ time.
Recovery after Surgery:
You will be taken to the recovery room for approximately 2-3 hours
for observation. Don’t worry if you are in the recovery area longer
than the average of 2 hours. Everyone is given as much time as they
need in this area.
Pain Management
Your follow-up care will include assessment of pain. In an
individualized way a variety of approaches to reduce your pain may
include muscle relaxants and combination medications such as
narcotics and anti-inflammatory agents. Every patient is encouraged
to be an active participant in their pain management to aid in the
best approach possible during the recovery period.
It is normal to have pain after surgery; however, we strive to make
sure it is not severe. You will be asked frequently to rate your pain
level, using the following Pain Scale.
Rating your pain
will assist nursing
in providing you
with appropriate
pain medication.
Please tell your nurse if you have pain. - Por favor , digale a su enfeermera si tiene dolor .
Do not be afraid to ask for something for pain.
No tenga miedo de pedir algo para el dolor .
Patient Controlled Analgesia (PCA)
- You can press a button that will give you medication through your IV
when you feel pain or discomfort.
- You will be encouraged to take pain pills along with your PCA. When
your pain is controlled, your PCA will be discontinued.
- Sometimes the pain medicine can make you feel sick to your stomach.
If this happens let us know and your doctor can order something to
make you feel better.
Surgical Dressing
You will have a dressing applied to your surgical area. Your doctor will
instruct the physican assistant when to change the dressing. The dressing
may be removed and your incision may be left open to air when the
drainage is gone.
- Ice can be applied to your surgical area.
Hygiene:
-
You may shower if your incision is dry and not draining.
- Use an antibacterial soap.
- Do not take a tub bath !
Diet
You may resume your normal diet unless otherwise instructed by your
physician.
Nutrition & Healing
While you are in the hospital, meals are selected from a restaurant –style
menu. In the morning you will select lunch. In the afternoon you will
select dinner and breakfast for the next day. Simply tell the host what you
would like from the selections printed. If you prefer to see the menu, you
can ask to circle the items you want. Remember the anesthesia may affect
your taste buds for a few days after surgery.
If you are on a special diet – especially diabetic tell the nurse you would
like to see the dietitian for an inpatient nutrition consultation. This
consultation is free.
Healing
Protein is the most important nutrient in healing. Eat about twice as many
protein foods as usual for 2-3 weeks after surgery. If you are not hungry,
especially if you are not eating meat, fish, poultry, legumes, cheese, milk
and yogurt a week after surgery, do one of two things: buy a commercial
supplement such as Boost, Ensure or Instant Breakfast or make a smoothie
of milk, or whey protein powder, frozen yogurt and fruit.
Vitamin C is another important nutrient found only in fruits and vegetables.
For a healthy diet, the goal is 21/2 cups of vegetables and 2 cups of fruit
per day. It would be appropriate to take an additional 500 milligrams of
Vitamin C each day.
Zinc is a mineral needed for healing found in very small quantities in
most foods. Foods rich in zinc are beef and pork, oysters, wheat germ
and Total cereal. Having too much zinc in the diet also impairs healing.
The recommendation is to take a multi vitamin daily. Do not buy a bottle
of zinc, as this would be too much for your relatively small incision and
could lower your immune system.
To print your own guide to eating healthy go to www.ChooseMyPlate.gov.
Tips From The Nurse on Constipation
1 cup prune juice
2 Tablespoons of Milk of Magnesia (M.O.M.)
Stir
Warm in microwave
Drink slowly while warm.
This can be repeated once with the M.O.M., within 2 hours, but the
prune juice is good for you - so help yourself!
Discharge Instructions:
You will receive your discharge instructions before you leave.
Discharge papers must be prepared individually to cover all of
your needs.
Remember:
- No bending
- No lifting over 5 pounds
- No twisting
- No driving until your doctor gives you permission
- Fact: a gallon of milk weighs 8 pound when full.
When to call your doctor after discharge:
Healing at Home
Braces
You may have received a brace from your
surgeon. Do not worry if you did not
receive a brace - not all surgeries require
this device.
If you received a brace, you must be
wearing it when you are up and moving
about after surgery. You do not have to
wear the brace when in bed or laying on
the couch or reclining chair, unless you
want to and it provides you comfort.
Walking
Start walking as soon as the day of your surgery. Start with a trip to
the bathroom, then into the hallway. Increase both the distance and
frequency that you walk as much as you can tolerate. You should
have your nurse walk with you during the first 24 hours after your
surgery.
Exercises
The next few pages demonstrate exercises. The exercises are specific
to the type of surgery you had. Do only the exercises your surgeon
tells you to do at your post-op appointment with him/her.
Continue performing these exercises 3 times per day when you get
home. A few weeks (usually 8) after your surgery, your physician may
recommend outpatient physical therapy to maximize your strength
and recovery.
Above all, follow the instructions of your surgeon.
Preventing blood clots
To improve circulation in your legs and reduce the risk of
blood clots, you will be asked to:
When you wake up you will be asked to breathe deeply and
cough. These simple but important breathing exercises should be
done 10 times every hour while you are awake to prevent problems
with your lungs. You will have a device called an incentive
spirometer to help you.
You may have oxygen for 24 hours after surgery to help you
breathe better.
General Instructions: Do exercise 3 times per day. Perform slow and controlled.
General Instructions: Continue to wear your brace while
performing these exercises. Do exercises 3 times per day,
5-10 repetitions each. Perform slow and controlled.
General Instructions: Continue to wear your brace while
performing these exercises. Do exercises 3 times per day,
10 repetitions each. Perform slow and controlled. A cane,
yardstick, or broom handle can be used for exercise 2 and 3.
General Instructions: Continue to wear your brace while
performing these exercise. Do exercises 3 times per day, 10
repetitions each. Perform slow and controlled. Place your
middle fingers on the top of your shoulders. Rotate your
arms backwards in a circle motion. Try to bring your shoulder
blades together in the back.
The way we move as we go about our day is important to our physical health
and well being. By practicing good body mechanics we can protect our body,
especially our back, from pain and injury. Here are a few simple reminders of
things we can do to practice good body mechanics and prevent injury.
You may resume your normal sexual activity, within reason. It is preferable to use the bottom position for the first few weeks after
surgery.
Do not drive after your surgery until approved by your doctor.
Car Transfers - Helpful Hint: A plastic garbage bag on the seat makes sliding easier.
Keep in mind, it is usually easier to sit in the
front seat than the back seat (more leg room)
and two-door cars are usually easier than
four-door cars (wider door opening).
Two different methods for car transfers are
detailed below. Use the method which
works best for you.
Getting your home ready before surgery will make it easier for you to
recover. Consider the following tips:
Arrange your kitchen so that you don’t have to do heavy lifting,
bending or reaching.
There are several pieces of adaptive
equipment available for the toilet.
You will return to your surgeon for your follow up visit 10-14
days after surgery. This appointment was written on the initial
paperwork sent to your home by your surgeon office.
The surgeon will check on your progress.
Make a list of these questions so you don’t forget.