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.