The pre-operative visit

A week or two before your operation, your surgeon or the hospital will call you to come in for a pre-operative visit. You’ll meet with various members of the care team who will assess your general health, help you prepare for surgery, discuss your medication, and plan your discharge. It’s a good time for you to ask questions about the procedures at your specific hospital.

About anesthesia
The type of anaesthesia you receive will depend on the operation you are having and your overall health. You will meet the anaesthetist at the pre-operative visit or when you arrive at the hospital for your surgery. Several types of anaesthesia are used in patients undergoing the types of back surgery discussed here:

• Regional anaesthesia numbs only the part of the body that will be operated on. You are fully conscious. The most common type of regional anaesthesia is called an ‘epidural’ or a ‘spinal.’
• General anaesthesia puts your brain and whole body to sleep so you don’t feel or remember what goes on during your surgery.
• Combination anaesthesia Most of the time regional or local anaesthesia that numbs just the surgical area is combined with a sedative and a drug that blocks your memory of the procedure so your can relax and be less aware of what’s happening.

 
The week before surgery

• During your pre-operative visit, you were told which medications should be stopped in the week before surgery. Follow this advice carefully. If you have any questions speak to your surgeon, your family doctor or your pharmacist.
• Your doctor may recommend that you take antibiotics before and after the surgery to reduce the risk of infection.
• If you routinely take herbal supplements, you should know that research shows such products can affect your surgery. Some may decrease the effectiveness of anaesthetics or cause dangerous complications, such as bleeding or high blood pressure. Tell your surgeon about any herbs or other “natural” products you’ve been taking or plan to take after surgery.
• This is a good time to go over your list of What to bring to the hospital and make sure you have everything you need. Be sure to pack and bring all your current medications, including any herbal products and over-the-counter medicines that you take every day.
• Remind family and friends that the date of your surgery is getting close so that they’ll be available to help you.
• Keep the hospital informed. Be sure they have up-to-date phone numbers for family members and friends, and also the phone number of your family doctor.

 
IMPORTANT: If you get a cold or a fever during the week before surgery, or if your health changes in any way, tell your surgeon immediately.

What to bring to the hospital

• A list of all your current medications, and the name, phone number and address of your pharmacy.
• Your health insurance card and hospital cards.
• Your family doctor’s name, address, phone and fax numbers.
• If you wear glasses, contact lenses, a hearing aid or dentures, be sure to bring a case to put them in, as well as any cleaning/storage solutions. These should all be labelled with your name and telephone number.

 
Bring these items ONLY if you will be staying overnight:

 
General tips on recovering from back surgery

• Drink plenty of fluids, even if you don’t feel thirsty. This will keep your body hydrated and may also prevent or ease constipation, a common side effect of certain medications.
• Your appetite may be poor for a while, but it will return. If you can’t manage two or three large meals, eat small amounts of nourishing food several times a day or whenever you feel hungry.
• If you have trouble sleeping at night, avoid day-time napping. Keep to a regular bed-time.
• It’s not unusual to feel that your energy is low for several weeks after surgery. Set realistic goals. Don’t plan to accomplish lots of projects. Instead, save your energy to get through the tasks of daily living and rehabilitation.
• If you need help, ask for it.

While you’re in the hospital

The first 24 hours
During this time, your care team will watch you closely. This includes making sure your blood pressure, heart rate, blood oxygen levels and temperature stay normal, and that you are able to eat, drink and use the bathroom. They will also make sure your pain is being controlled and work to avoid complications.

What to expect when you wake up
The routine will vary between hospitals and will depend greatly on the nature and the extent of the spine surgery. If you have had day surgery here’s what’s likely to occur:

• You may find yourself attached to an intravenous (IV) line which is dripping fluid into your body.
• You may be getting oxygen by mask or through tiny tubes in your nostrils.
• There will be a gauze dressing or bandage over your incision.
• You will have all the tubes removed and you will be on your way home later in the day.

 
If you have had a bigger operation that will keep you in hospital for a while you may also have:

• An extension on the IV line to administer pain medication.
• A thin tube or catheter inserted into your bladder so you can urinate without going to the bathroom or using a bed-pan.
• A surgical drain from your wound connected to a collection device.

 
The drain, catheter, oxygen and IV line will be disconnected over the next day or two, depending on how well you are doing.

You will probably feel some discomfort in your back when you wake up. This is completely normal. Let the nurses know if you are in pain so they can adjust your medication. For the rest of the day your nurses will watch you closely, help you change positions if you need it, make sure your pain is managed and ensure that you are resting comfortably. Depending on when your surgery was completed you’ll be encouraged to sit up on the side of your bed later that day. If all goes well, you can expect to start getting up with help the next day.

IMPORTANT: Be patient with yourself in the first days after your back surgery. Don’t be afraid to share your concerns with your care team. This is probably the first time you’ve had such an operation, but your surgeon, nurses and therapists have helped many patients just like you to get better and return to their normal lives.

Pain relief options

No two people are exactly alike when it comes to pain. Some are very sensitive, even to mild discomfort, while others can withstand much more. Now that your operation is over, you’ll experience some pain, but there are several ways this can be controlled.

IMPORTANT: It isn’t a good idea to ‘tough it out’ after surgery and refuse medicines to ease your pain. Research shows that patients who ask for and receive pain medication actually do better during their rehabilitation. That’s because if you are in pain, it may be harder for your therapist to help you get moving. Pain can also cause you to feel anxious and make you afraid to do your post-operative exercises. If you’re in pain or if you notice your pain is getting worse at any time, tell someone on your care team.

Your surgeon and the anaesthetist will decide which pain relief method is right for you. Here are some possible options, which may or may not be available at your hospital:

• Patient-Controlled Analgesia (PCA)
  It’s stressful to be in pain and have to wait for someone to bring your next dose of medication. Such stress can actually make pain seem worse. Managing your own pain medication gives you a feeling of control which may relieve anxiety and help reduce pain. You will be connected to a special device called a PCA machine. Whenever you press a button, a pump delivers a small, pre-measured amount of pain-relieving medicine through an intravenous (IV) line in your arm. You will feel relief within a few minutes. When you start feeling uncomfortable again, you can push the button to receive more medication. Don’t worry about overdosing: timers on the PCA pump will prevent you from getting too much medication in too short a time and your nurse will closely monitor you and the PCA system. It’s important that you don’t wait until your pain is severe before pressing the button for another dose. You may also want to press it before starting activities that cause you discomfort such as turning, coughing, breathing deeply and exercising your legs. If you’re still in pain even though you’ve pushed the button several times, tell someone on your care team.
• Epidural spinal block
  The feeling of pain in your back and legs begins when pain signals travel along nerves in the spine to your brain. One way to block these signals is to deliver drugs into the spinal canal via a thin plastic tube called an epidural catheter.
• Injections
  You may be given a dose of pain-relieving medication by needle directly into the muscle of your arm, leg or buttock.
• Pills
  If your pain isn’t too severe, pain pills may be enough to control it. Your doctor will prescribe a drug and a dose based on your overall health and level of discomfort.
• About constipation
  After surgery many patients develop symptoms of constipation which can make them feel quite uncomfortable. Many drugs used to control pain have constipation as a side effect. Being inactive can also lead to problems. If you have trouble moving your bowels after surgery, tell someone on your care team.

Caring for your incision

It’s important that you take proper care of your incision to avoid infection. Here’s what you need to know:

• The incision on your back may be covered with a light, dry dressing until your staples or stitches are removed. (Removal usually happens between seven and 14 days after surgery and can be done by your family doctor or a visiting nurse.)
• Some surgeons use a dissolving suture that doesn’t need to be removed at all. Be sure to find out which kind was used.
• If you notice increased drainage, redness, pain, heat or an unpleasant smell around the incision, call your surgeon or family doctor right away. You may have an infection.
• Try to keep your incision dry for the first week. Some people get along taking sponge baths. If you leave the hospital with a dressing, you can still shower (carefully). You can try having someone cover the dressing with a square of plastic that’s kept in place with waterproof tape (available in drug stores) but you still need to keep the stream of water off the wound. If you aren’t wearing a dressing when you leave the hospital, it’s all right to shower. Just be sure to pat the incision dry with a clean towel.

 
If you come home wearing a dressing and it stays clean and dry, it’s best to leave it alone. If it needs to be changed because it gets dirty or some wound discharge soaks through you may need help. The incision is in a hard-to-reach area (your back) and you may need someone to reach it for you. You may require help from a visiting nurse but many people are able to change the dressings with help from a family member or friend. Here’s what the person changing the dressing should do:

• Wash their hands thoroughly with soap and water.
• Open a new gauze pad.
• Gently remove the old dressing and inspect it for drainage–either clear or yellow/green—and odour. (Report yellow/green drainage and odour to your surgeon or family doctor.)
• Wash their hands again.
• Pick up the new gauze pad by one corner and lay it over the incision. Be careful not to touch the underside of the clean dressing. Use paper tape (available in the first-aid section of the drug store) to keep the new dressing in place.

Recognizing complications

Infection
Infection is always possible after any kind of surgery. In hospital, you may be given antibiotic drugs to kill any harmful bacteria already in your system. This can be followed by antibiotic medication that you will take at home. While you are in hospital, your care team will look after your surgical incision, being careful to keep it clean and covered. They will also monitor you for a rise in temperature which could be an early sign of infection.

Blood clots
For the first few weeks after you undergo spine surgery, you have a very small risk of developing a blood clot in your legs. Some blood clots are more serious than others and in rare cases such a clot may travel to the lungs. Occasionally after a large spinal procedure patients are treated with support stockings to compress the veins in the lower legs or anticoagulant drugs which make the blood thinner and less likely to clot. If you do receive one of these drugs be sure to follow the instructions carefully. It’s important to follow recommendations for preventing blood clots, not only while you are in hospital, but after you return home as well.

Precautions after back surgery
If you have had a discotomy or small decompression, there are few if any restrictions. In general, if an action such as bending hurts, don’t do it. If an action feels comfortable, do it slowly in moderation. If a movement triggers pain in your incision or reproduces your pre-surgical pain in your back or leg, stop. You can try it again in a few days.

If you have undergone a larger operation, particularly a large fusion, you may need to restrict your activity for a while. Some surgeons advise the use of a brace or back support to reduce your back movement and to remind you that you have had major surgery. You shouldn’t feel anxious about “breaking” something in your back after fusion surgery—modern surgical techniques mean that the bones have been strongly and firmly fixed. But surgeons tend to be a bit cautious and that is not a bad thing.

Starting your therapy

If you go home
Most patients who have had uncomplicated back surgery (i.e., discotomy, decompression or fusion) go home the same day or within a few days. Your care team will make sure you have the proper instructions about how to get moving again safely.

If you need rehabilitation
Most post-operative spine patients can rehabilitate without professional supervision. Your care team will provide you with all the necessary instructions. Occasionally people need a more intensive program or additional coaching and motivation. A rehabilitation or physiotherapy centre can provide direction and active support, but the rest is up to you.