Your personal guide to Surgery

Anterior lumbar interbody fusion :: Anterior Cervical Decompression Fusion :: Lumbar Disc Replacement
Posterior Cervical Spine Surgery :: Spinal Deformity Surgery :: Lumbar Decompression and Fusion
Lumbar Discectomy :: Surgical Risks :: FAQ

How to prepare yourself for hospital admission and surgery

Once your surgeon has decided that you require an operation, you will be given an appointment to meet the clinical co-ordinator. The clinical co-ordinator will conduct a pre-surgical education session with you and your family to give you a better understanding of the operation planned and discuss the expectations and results following surgery. The session will consist of an audio-visual session followed by a discussion to prepare you for the operation and life after surgery. You are encouraged to bring your family with you when you come and it may be a good idea to come prepared with all the questions you would like answered. It is important for us that you have a clear understanding and realistic expectations of the operation.

What do you need to bring with you to the pre-surgical education session?

• Details regarding your medical history and previous operations.
• A list of all current medications (including herbal) and dosages.
• A list of allergies.
• Any recent X-rays, CT scans, MRI scans and bone scans.
• Any recent test results.

Preparing for Surgery

To optimise the results of your surgery, it is important that you have a complete understanding of what will be done and a positive attitude that you are taking the right step.

Smoking: If you are a smoker, it is advisable that you try to stop or taper off your smoking before surgery. Smoking irritates the airways in the lungs and may respiratory problems during and after your surgery. Research has also shown that smoking slows down and prevents the fusion of your spine and impairs wound healing.

Alcohol: Limit your alcohol consumption for 1 week prior to surgery.

Medications: There are certain medications that interfere or affect the results of your surgery. They may accentuate swelling and discomfort after surgery and may increase the bleeding during surgery.

• Medications such as Aspirin, Dispirin, Cartia, Cardiprin, Clopidogrel, Assasantin, and anti-inflammatory drugs such Naprosyn, Neurofen, Voltaren, Brufen, Indocid etc must be stopped 2 weeks prior to surgery.
• Common Painkillers that do not contain aspirin may be taken up until the time of surgery. Eg Panamax, Panadol, Panadeine Forte, Digesics, Capadex, Tramol, Ms Contin and Endone.
• Discontinue the use of natural remedies at least two weeks prior to your surgery. Eg Vitamin E, Evening Primrose Oil, Fish oil, Herbal teas, Green teas and St. Johns Wart.
• If you take strong blood-thinning medication such as Warfarin and Coumadin, you will need to discuss with your GP and surgeon as to what is required prior to surgery. If you have any concern about this or any adverse effects this may have on your health, please speak to your surgeon or the clinical co-ordinator.

One week before surgery:

• Plan, cook and freeze meals for the week following your operation.
• Arrange a support person to be with you for the first day at home.
• You will need to organise transport home from the hospital.
• Contact the hospital administration regarding your admission.
  St George Public Hospital 02 93503032 or St George Private Hospital 02 95985581.
  2 days prior to admission.
• Pay any bills that are due during your stay in the hospital.
• Cut finger and toe nails, and remove nail polish.
• Establish a comfort zone, including items such as telephone, TV guide, tissues, phone book, in preparation for the first few days after your operation.
• Call the hospital to confirm booking, fasting time and hospital costs.
• Call Spine Service to confirm post-operative appointments 1 day prior to admission.
• Ensure you have all your relevant contact numbers.
• Remove any obstacles in your home that you could fall over after your surgery.

Day of admission:

• When you have a shower, pay special attention to your back and groin area. It may be advisable to also wash your hair, as it may be a few days before you are comfortable enough to wash it again.
• Leave home in plenty of time.
• Take the phone number of your support person.

What do I take to hospital with me?

• All your medications.
• X-rays and scans (if your surgeon doesn't have them).
• Comfortable clothes that do not have a tight waistband, slip on shoes, toiletries, your brace, reading material and a pop-top water bottle (optional).
• Take your Medicare card, private health insurance details, pharmaceutical entitlement card, Veteran Affairs Card or workers compensation approval details (if applicable).
• If you have any allergies, remember to tell the nurses on admission and the anesthetist before the surgery.

What to expect following surgery

Pain: You will feel discomfort and pain at the operative site immediately after surgery. You will be given pain medications; however, the soreness and stiffness in your back and/or limbs will continue for some time. Please ensure you take regular pain relief.

Tingling / Numbness: A degree of tingling and/or numbness in your limbs may be experienced after surgery and may take some time to subside.

Drains: Some patients may return to the ward with a drain tube near the surgical site to help prevent any collection of fluid at the operation site. The drain is usually removed in 24-48 hours.

Drips: You will have a small plastic needle (cannula) to receive fluids and antibiotics during and after surgery. The cannula will be removed when you are drinking sufficient fluids and after the doctor has stopped the prescribed antibiotics.

Catheter: A catheter will be inserted into your bladder under anaesthesia to drain you bladder during and immediately after surgery. This catheter will keep you comfortable, so you will not have to get out of bed to go to the toilet on the first day. The catheter is usually removed the day after surgery.

Calf compressors: Following your surgery, you will have inflatable compressors on your calves to reduce the risk of deep vein thrombosis (DVT). You may also be given a pair of anti-thrombotic stockings.

Coping with the Blues: It is not uncommon for patients to feel a little depressed or emotional after your surgery. The doctors and nurses will help you through this vulnerable phase.

Diet: You will start on a post-operative diet and gradually increase to a full diet. To avoid constipation, you should include plenty of roughage, cereals, fruit & vegetables in your diet. You should also aim to drink 2-3 litres of fluid daily.

Bowels: It is common not to have bowel movements for the first few days. Once you have started on a full diet, you will be given medications to help with bowel movements.

Possible complications of surgery

Every spinal surgery has a potential risk for complications. Major complications that can occur include, but are not limited to: infection, blood clots, nerve damage, recurrent disc herniation, heart attack and stroke. Although rare, these complications may result in pain, prolonged recovery and ongoing disability. Please discuss this with your surgeon and clinical co-ordinator prior to surgery.

Commonly asked questions:

Will I need a blood transfusion?

Although some blood loss occurs during surgery, a blood transfusion is not generally required. More extensive surgeries may occasionally require a blood transfusion.

How long will I stay in hospital?

The length of your stay in the hospital will depend on the surgical procedure that you have had and can vary from an overnight stay to a week. It will also depend on how your wound is healing. You will be given a rough idea regarding the length of your stay during the pre-surgical education session. However, your surgeon will make a final decision after the operation.

When can I walk?

You will usually be encouraged to begin walking the morning after surgery.

Do I have to wear a back brace?

Yes, you will be required to wear your brace when sitting, standing and walking after surgery. Your physiotherapist will wean you off as appropriate.

When can I have a shower after my surgery?

You can have a shower the day after your surgery. If your dressing gets wet, a new one can be applied.

When do I see my doctor after my surgery?

During your pre-surgical education session, the clinical co-ordinator will make an advance appointment for you to visit the rooms after you have been discharged from the hospital. This date can be changed depending on the length of your hospital stay.

Do I have stitches to come out?

The wound is usually closed with dissolvable sutures under the skin and these do not need to be removed. Metallic staples or non-dissolvable sutures, if used, will need removal. On your first appointment (10 days post-op) the surgical wound will be examined and the sutures/staples will be removed.

Do I need to attend physiotherapy sessions?

Following surgery a physiotherapy programme will be started to retrain you to maintain good posture and teach you the correct way of moving your spine.

Is there a certain position that I should sleep in at night?

The most important thing is for you to be comfortable. Some people find it comfortable to sleep with a pillow between their legs or under their thighs.

When is it safe to engage in sexual relations?

This is a very personal domain and is left up to you; whenever you think that you and your partner are ready. Clinically, a two-week period is recommended, provided you are the less active partner.

How long should I wait before driving a car?

The recommendation is to wait 3-4 weeks before driving a car. This may vary depending on your surgery and your progression during rehabilitation.

When can I go back to work?

This is assessed on patient-to-patient bases. If you have a physical occupation, it may take up to 3-6 months. With a sedate occupation, you could be back at work as soon as 3 weeks. Do not commence work until you speak to your doctor and physiotherapist.

When is it safe to bend and/or lift items heavier than a bag of sugar?

During the post-surgical physiotherapy sessions, you will be taught the correct way to bend and lift. Bending from the hips is fine if carried out in a controlled manner, but avoid heavy lifting objects (more than 3kg) till your physiotherapy commences.