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.

rate your pain

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:
  • Fever over 101 degrees
  • Increased pain
  • Redness, swelling, or drainage from your incision
  • Numbness or tingling in your legs
  • Pain or swelling in the calf or thigh of your legs
  • Questions about medication, amount of activity, or care.
  • Sudden onset of shortness of breath

    Each point is equally important

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:

  • Wiggle your toes and flex your ankles 10 times every hour
  • Ankle Pumps: Slowly push your foot up and down. Do this exercise several times a day. This exercise can begin immediately after surgery and continue until you are fully recovered
  • ankle pumps
  • Use pulsating leg wraps, which are to be worn while in bed.
  • Walk in the hallway at least 3 times daily (with your brace on if ordered).
  • Breathing exercises

    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.

    Lumbar laminectomy without fusion.

    General Instructions: Do exercise 3 times per day. Perform slow and controlled.

    1. Knee to Chest
      Lie on your back, knees bent with your feet flat. Tilt your pelvis, flattening your lower back. Lift one leg, knee to chest, pulling gently with your hands. Hold this stretch for 10 seconds, repeat with other leg. Repeat 5 times on each leg. Return to starting position and relax.

      knee to chest exercise

    2. Hamstring Stretch
      Lie on your back as shown. Bend your hip, grasping your thigh just above the knee. Slowly straighten your knee until you feel the tightness behind your knee. Hold 10 seconds. Relax and repeat 5 times. Repeat with the other leg. If you do not feel this stretch, bend your hip a little more, and repeat. No Bouncing! Maintain a steady, prolonged stretch for the maximum benefit.

      hamstring stretch exercise

    Lumbar laminectomy with fusion.

    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.

    Insert image here

    1. Knee Extension, Sitting
      Sit upright in a chair. Straighten your knee, slowly return to the starting position. Relax and repeat 30 times. Keep your back straight while contracting/ tightening your stomach muscles.
    2. knee extension exercise
    3. Ankle Pumping
      Increase ROM and circulation by first pointing your toes downward, then up, in a slow steady motion. Repeat 30 times.
    Cervical laminectomy

    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.

    1. Shoulder Shrugs Lift your shoulders up toward your ears, breathing in also at the same time. Hold for 3 seconds. Now relax your shoulders, and gently breathe out.
    2. ankle pumps
    3. Shoulder Range of Motion Exercises Bring wand directly overhead. Reach back until your feel a stretch.
    4. ankle pumps
    5. Shoulder Range of Motion Exercises Push wand directly out from your side until you feel a stretch. The leading hand should be place on the wand palm side up. The pushing hand should be placed palm side down. Switch when moving out to the other side.
    6. ankle pumps
    Cervical Surgeries

    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.

    rate your pain

    Proper Body Mechanics and Positioning

    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.

    • Wear non-skid shoes to protect your feet and prevent you from slipping and sliding across the floor.
    • Keep your back straight when walking, lifting objects, moving patients or objects.
    • When lifting an object, stand with your feet apart to provide a stable base. Keep your back straight and stomach muscles tight, bend at your hips and knees using arm and leg muscles. If the object is too heavy for you alone-Get Help!
    • If you need to push or pull an object, keep your back straight. Use your leg and arm muscles. Get close to the object by lowering your body to the object. If the object is too heavy-Get Help!
    • Avoid lifting or pulling objects that are above your shoulders.
    • To turn, move your whole body, DO NOT TWIST your body.
    • If you have had lumbar surgery, do not sit for prolonged periods of time. Thirty minutes or so should be fine.

    rate your pain

    Suggested Sleeping Positions

    If you had back surgery, you may sleep

    • On your side-use a pillow between your knees

      rate your pain

    • On your back-use pillows under your knees

      rate your pain

    If you have had cervical neck surgery use only one pillow under your head

    pillow use after surgery

    You may resume your normal sexual activity, within reason. It is preferable to use the bottom position for the first few weeks after surgery.

    Driving

    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.

    1. Front Seat Method
        a. Move the seat as far back as possible to allow maximum use of the door opening.
        b. Back up to the seat and gently sit on the edge.
        c. Scoot back on the seat to get well into the car.
        d. Gently lift your legs into the car.
        e. Fasten your seat belt.
    2. Rear Seat Method
        a. Move the front seat as far forward as allowable to increase rear seat leg room.
        b. Back up to the seat and gently sit on the edge.
        c. Scoot back on the seat to get well into the car.
        d. Gently lift your legs into the car.
    get in and out of car motion

    Getting Your Home Ready:

    Getting your home ready before surgery will make it easier for you to recover. Consider the following tips:

    • You will need to have family/friends stay with you to help for the first week after going home.
    • Get rid of uneven surfaces and remove obstacles from pathways both inside and outside your home.
    • Make note of potential slippery/wet spots and take precautions as necessary.
    • Be sure there are sturdy handrails for steps at the entrance to your home - if not, have someone help you.
    • Remove throw rugs and secure extension cords out of pathways.
    • Make sure lighting is good to prevent falls. Install nightlights.
    • Place emergency numbers on or near the phone. Use a portable phone for safety.
    • Have a comfortable chair with arms and a firm seat.
    • Use containers of liquid soap to prevent difficulties with dropping the soap in the shower.
    • Be sure your bed mattress can hold you without sagging while you sit at the edge; the bed must also allow your feet to touch the floor. A hospital bed is not needed.
    • Make sure you have a non-skid surface in the bottom of your bathtub or shower.
    • Choose footwear that is secure on your feet with non-skid soles.
    • Set up a “recovery center” where you will spend most of your time. Things like the phone, television remote control, radio, facial tissues, wastebasket, water pitcher and cup, reading materials and medications should all be within reach.
    Kitchen:

    Arrange your kitchen so that you don’t have to do heavy lifting, bending or reaching.

    1. Prepare meals ahead of time and stock up on food.
    2. Prepare simple meals using stove top or counter level appliances to avoid bending.
    3. Store items that are needed most on upper shelves of the refrigerator.
    4. Use a Lazy Susan for easier reach.
    Bathroom
    • Tubs and showers must have non-skid surfaces or safety mats both inside and outside. Watch for wet on the tile floors.
    • A hand held showerhead allows greater independence with showering tasks.
    Equipment
    • Special equipment may be helpful to maintain your safety and independence. There are many options available to you.
    Toilet transfers

    There are several pieces of adaptive equipment available for the toilet.

    • Back yourself up until you feel your legs touching the toilet.
    • Reach for the back edge of the raised toilet seat with your hand.
    • Gently lower yourself to the toilet seat.
    • To get off the toilet, reverse the above

      toilet transfer

    Shower transfers

    For your safety, you will need a seat to sit on. Several types of seats are available. The most appropriate type for you will be discussed the day of your class.

    shower transfer
    Shoes
    To put shoes on, you may again need to use the tools. Elastic shoelaces may be helpful if you plan to wear lace-up shoes. The elastic shoelaces can be purchased at the department, drug, or the grocery store.
    1. Using the reacher, hold onto the tongue of the shoe and place it over your toes.
    2. Place the long handled shoehorn at the back of your heel, and push your foot down into the shoe the rest of the way.
    put on shoes

    Follow Up Visit

    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.

    • Questions for your surgeon prior to surgery
    • Questions for your surgeon after surgery
    Laminectomy

    Discectomy

    Anterior Cervical Discectomy and Fusion

    Lumbar Fusion