Pre-admission Spine Surgery Education
What we will cover today…
Understanding your spinal procedure Preparation for surgery Day of surgery expectations Discharge Instructions Recovery Process
Preparation Surgery Recovery
Spine Anatomy 7 Cervical 12 Thoracic 5 Lumbar Sacrum and
Coccyx
Provides us strength
Allows us to stand Supports our
weight Passageway for
spinal cord and nerves
Understanding Your SurgeryLaminectomy
Creation of a “window” in the vertebrae. This allows more room for nerves and releases pressure on the nerve
Understanding Your Surgery
Discectomy Creation of a “window” in part of
the outer ring of the disc. This allows removal of a portion of the disc nucleus releasing the pressure on the nerve
Understanding Your Surgery
Fusion
A graft ( bone or bone protein material) placed between 2 or more vertebrae. Provides stability to the spine- many times screws are used to maintain stability while healing occurs.
Understanding Your Surgery
How fusion is done Bone Graft Immobilization Types of fusion Posterolateral Interbody
ALIF PLIF TLIF XLIF
Preparation for Surgery
Obtain all required pre-admission testing recommended by surgeon and bring information to Pre-Op (may include blood work, EKG, chest x-ray, medical clearance from primary doctor, or self-donated blood)
Clear all medications with your physician, including any herbal substances or nutritional supplements you may be taking
Bring All insurance cards & picture identification to Pre-Op
Do not eat or drink after midnight the night before your surgery
What to bring to the hospital…
Personal care items (such as toiletries) Rubber soled / non-skid shoes or closed back slippers Comfortable clothing for therapy Loose fitting pajamas and /or light weight robe Bedside snacks Important contact phone numbers List of medications, including the ones you may
stopped prior to surgery, dosing information Eyeglasses instead of contacts Dentures / hearing aids if needed Brace if you have one and are asked to bring it Walker or cane if used at home Important: Leave all valuables at home!!!
General Health Guidelines
Weeks before the surgery, you should concentrate on the following: Nutrition
Eat healthyDrink plenty of fluids
Do not drink alcoholic beverages Stop smoking Take your daily medication as directed
by your physician Discuss with your physician any
nutritional and/or herbal supplements you are taking
Day Before Surgery…
Pre-operative shower Take the evening before or day of surgery Wash with Triseptin soap provided at pre-op
Do not eat or drink after midnight As directed by your physician, take
required medications with a sip of water only
Morning of Surgery Your specific surgical time will
be determined at your pre-op visit
Report to the Main Lobby at the time appointed in your pre-op visit
Surgery will last 1-2 hours
Time in the recovery room is generally 1-2 hours
During surgery your family will wait in the surgical waiting room
After recovery, you will be transferred to the nursing unit on 2 South where family members can see you
Evening of Surgery… Following your surgery, you may have:
Intravenous therapy (IV) to provide fluids, medication and/or antibiotics
Drain at your incision site which prevents fluids from building up
Urinary catheter to help drain your bladder Foot pumps to prevent blood clots Incentive spirometer to help with deep
breathing exercises
Pain Management
You will see anesthesia at your pre-op visit
General anesthesia or a spinal anesthetic will be administered during surgery
Pain relief options after surgery include: Epidural anesthesia Patient controlled
analgesia (PCA) pump Injections (as needed) Oral medications (as
needed)
Pain Scale 10
Worst possible pain98 Very severe pain76 Severe pain54 Moderate pain32 Mild pain10 No pain
Blood Clot (DVT) Management
Leg exercises and support stockings (TEDS) or foot pumps help keep the blood flow in your legs moving and to prevent blood clots (DVT)How it happens….
Ways to help prevent it…
First Day After Surgery During your first day of recovery, you may
have or begin: Lab tests Intravenous (IV) fluids, catheter and/or your
drainage tube removed Your dressings or bandages changed To turn, ambulate, deep breath and use your
spirometer Dressing and bathing activities Physical and Occupational Therapy
First Day After Surgery Working with
physical/occupational therapy to participate in walking, exercise and daily living activities programs
Working with a Case Manager or Nursing staff to prepare you for the next level of care, your discharge location and any equipment needs
Take pain medication as needed in order to participate with therapy
Getting In and Out of Bed
Roll your entire body instead of twisting at the
waist
Once on your side, ease your legs off the edge of
the bed to sit up
Second Day After Surgery
Depending on your surgery, your recovery progression and your surgeon will determine if additional days are required in the hospital.
During your second day in the hospital you will Continue to work with physical and/or
occupational therapy Continue to deep breath and use your
spirometer Continue to discuss discharge planning Take your pain medication as needed
Discharge Criteria
You will be discharged from the hospital when you are able to: Eat and drink to prevent
dehydration Empty your bladder without
any problems Effectively manage any pain Increase your mobility
(walking and exercising) Have bowel movement
without complications
Discharge Instructions
Your physician, nurse, or physical therapist will discuss the following: Spine precautions and special instructions Pain control and prescriptions Signs of infection or problems Bandage changes and care of incision site Approval for driving, sexual activity, and any
other physical activities
Back Precautions
Proper lifting techniquesNo bending or twisting backKeep back straight
Limit sitting in upright chairs to 10-15 min Log rolling to get in and out of bed Do not lay on your stomach
Further instructions will provided at your post-operative physician appointment.
Recovery
How to prepare your home for discharge
Make modifications to your home prior to surgery that will decrease your risk for falls or injury
Preparing Your Home
Remove or tack down throw rugs
Remove clutter from hallways and walkways
Keep electrical and telephone cords safely out of sight (Use cordless phone, if possible)
Rooms and hallways are well lit for visibility
Safety and grab bars are installed as needed
Keep items in the kitchen/bathroom
at waist level for accessibility Arrange pet care, if needed
Home Safety Tips…
Recovering at home… Things to keep in mind:
Keep your incision clean and dry Shower with mild soap and do not put any
creams on your incision Take your medication as prescribed Progressively increase activities as directed Use proper lifting techniques. Do not lift
anything heavier than a light bag or book Sit in a supportive chair with arms Keep your walking areas free of clutter Keep moving!!
Frequently used equipment/aids
If prescribed by your physician, a case manager / nurse / therapist will educate you on the use of these assistive devices: Canes Rolling Walkers Elevated commode seats Bedside commode or 3 in 1 commode Back/neck braces Pillows to be used when sleeping Ankle pumps Reacher Sock aid
When to call the doctor Chest pain or difficulty breathing – Call
911 Sudden inability to move your leg(s) –
Call 911 Fever above 101° Pain in your back, NOT relieved by
medication Unusual redness, heat or drainage from
your incision site New numbness/tingling in your leg(s) Changes in bowel or bladder
Steps WE take for Safer Surgery
To avoid infection: Antibiotics
To Avoid Blood clots: Anticoagulants Foot Pumps
To Avoid Heart Attacks:
Talk with your doctor about your medications
Courtesy of the Surgical Care Improvement Project Partnership (SCIP)
Safer Surgery Continued..
To avoid pneumonia Pneumonia vaccine is available, if ordered by
your physician Early mobilization (or getting out of bed) Incentive Spirometry
To avoid flu Flu vaccine is available, during flu season, if
ordered by your physician
Surgical Site Infections Precautions are taken prior to and during
surgery to reduce risk
Smoking increases risk. Ask us how to quit!
Make sure your doctor and healthcare providers wash their hands or use sanitizer before exams, ask “Did you wash your hands?”
Clean your incision based on your discharge instructions daily until follow-up with your doctor
Call your Doctor if you have any signs or symptoms of infection (redness, increased pain, increased drainage, fever)
Questions? Thank you for reading through this
presentation. If you have any questions, you may call our Human Motion Institute Spine Line at 706-651-2449.