What To Expect: Before and After Surgery

BEFORE THE SURGERY

Most importantly, you should maintain a healthy way of life before the surgery. Proper sleep and exercise coupled with a healthy diet will prepare your body for the surgery and recovery process.

DON’T FORGET TO EXERCISE
Physical activity is encouraged before spine surgery. Exercises like walking, swimming and bicycling involve repetitive contracting and expanding of large muscle groups to move the limbs through a range of motion. In addition to muscle activty, your heart and lungs get a great workout too. (Note: Remember you should consult with your physician before starting any exercise program.)

You should practice exercises for blood clot prevention. After the surgery, ankle and leg movements will help to maintain muscle strength and promote circulation.

  Point your toes forward toward the foot of the bed.
  Pull your toes toward your chin.
  Repeat 10 times.
  Bend your knee and slide your heel up your other leg toward your hip.
  Stretch your leg out again and relax your leg.
  Using your feet, draw circles using your heels on the bed.

There are also deep breathing and coughing exercises you should practice to prevent lung complications.

  Breathe in deeply through your nose.
  Hold your breath and count to five.
  Breathe out slowly through your mouth.
  Do this five times. On the fifth deep breath, cough from your abdomen as you breathe out.

STOP SOME MEDICATIONS AND NO SMOKING
The use of any non-steroidal, anti inflammatory drugs, also known as NSAIDS, are discontinued before your surgery. These types of medications include Motrin, Midol, Advil, Naprosyn or any other products containing aspirin. Do not stop taking any routine medications unless ordered by your doctor. Do not smoke! Smoking slows down the healing process.

DONATE SOME BLOOD (IF YOU CAN)
It will probably be necessary for you to be given blood (transfused) during surgery. The safest blood for you to receive is your own, which is called autologous transfusion. Ask your doctor if you are able to donate and if so, arrangements can be made through your doctor’s office and with the local blood bank. You will donate blood over a period of a few weeks that will be saved for your surgery. During the weeks you are donating blood, your doctor may prescribe an iron supplement. These pills will make your blood healthier and more beneficial to you.

Family and friends who wish to donate blood for you, can be evaluated to see if they would be candidates for donation. This is known as a designated donation.

Some medical problems may prevent people from being able to donate themselves. If you are unable to donate all the blood your need or if the need is urgent, volunteer blood may be ordered by your physician.

All donated units of blood, autologous, designated and volunteer, are tested for HIV, Hepatitis, viral or bacterial infections that could be transmitted through the blood. Except for autologous units, the blood is discarded if any positive test results occur.

KEEPING UP WITH SCHOOL WORK
You will be in the hospital and recovering at home for a number of weeks. Let your school know in advance that you will not be attending classes. Many school districts will arrange for your to have a tutor at home so that you can keep up with your class work.

WHAT TO BRING TO THE HOSPITAL
Here are some helpful hints on what to bring and what not to bring for your hospital stay.

  Don’t bring much clothing. Hospital gowns/pajamas are preferred and provided by the hospital. You can
      bring a robe for your hospital stay and sweats or some loose fitting clothes to wear home.
  Bring a comfortable, well fitting pair of shoes or socks with non-skid soles.
  You can bring your own soap, shampoo or hair products.
  You can bring menstrual pads, if needed. No tampons.
  You can bring reading materials, a stuffed animal or other personal items that will make you more comfortable
      and more relaxed.

Be sure to mark all of your belongings with your name beforehand so that nothing gets lost.

PREOPERATIVE EVALUATION

EASY EKG
Some patients may have a routine test called an EKG, or electrocardiogram. An EKG checks how your heart is working. Small, round discs are placed on your chest and body. The discs have wires that connect to a machine that records your heartbeat.

POSSIBLE PULMONARY FUNCTION TEST
A pulmonary function (breathing) test may be necessary to show your doctor how well your lungs are expanding and how well you are breathing in and out. During this test you will be asked your breathe into a machine that will measure and record how much oxygen you are taking into your lungs.

THE NIGHT BEFORE YOUR SURGERY
The night before your surgery, you should eat a normal dinner before 8PM. After 8PM, you can only drink clear liquids like water, tea, or juice, before midnight. This instruction, NPO, or nothing by mouth -- no solids after 8PM and no liquids after 12AM (midnight) -- will guarantee that your stomach is empty at the time of the surgery.

Try to get a good night's sleep the night before. Some patients find that it may help to prepare the night before. Leave your bag at the front door and pick out what you'll wear -- it may help you to relax you, knowing that some things will be less hectic in the morning.

ADMISSION DAY

When you arrive and check in, the nurses will ask you a few more questions in order to fill out paperwork and complete the admission process. You will get a hospital gown and slippers to wear and an IV (intravenous catheter) will be started. You'll have the IV from that point until a few days after the surgery.

From there, you'll meet your operating nurse and anesthesiologist and you will be prepared for surgery.

SPINAL CORD MONITORING DURING SURGERY
Your doctor will use spinal cord monitoring to tell how well your spinal cord is communicating messages to your brain. Just before your surgery another type of doctor, a neurophysiologist, will place electrodes on various parts of your body, which will monitor the brain and/or spinal cord reaction to stimulation. During the operation, the neurophysiologist will monitor the nerves in question carefully and the report the responses to your surgeon. The monitoring will take place before, during, and shortly after your surgery to provide a full measurement of your nerve responses to your physician.

AFTER YOUR SURGERY

RECOVERY ROOM
When the operation is over, you will wake up in "recovery". The nurses will be closely monitoring you and other people who have just had surgical procedures. You'll have the IV in your arm providing your body with the fluids you need. A catheter will be in your bladder to drain urine into a container next to the bed, so you won't need to get up to go to the bathroom.

While in recovery, the nurses will check your vital signs, circulation and motion in your limbs frequently. Vital signs that are monitored include your pulse, blood pressure and temperature. You will have sequential compression devices (SCDs) on your legs that will help to increase circulation and promote proper blood flow.

You may feel cold because of the anesthesia, so be sure to ask the nurse for a warm blanket if you need one. Your parents may or may not be able to see you in the recovery area, depending on the hospital's policy. After some time in recovery, you will be moved to the Intensive Care Unit. (ICU)

INTENSIVE CARE UNIT (ICU)
The ICU a unit where the nurses will watch you closely. You will be attached to a monitor so the nursing staff can observe your heart rhythm and breathing. There is a possibility that you will need a machine to help you breathe, but most patients have an oxygen mask or oxygen tubes in their nose.

After your surgery, your surgeon may order spirometry. The incentive spirometer is a small piece of equipment is used after surgery to gauge the amount of air you are taking into your lungs. During surgery, the anesthesia you are on relaxes everything in your body including your lungs. After the surgery, your lungs are fatigued and won't want to inhale and exhale deeply enough. The incentive spirometer helps to exercise your lungs and prevents any breathing complications that could occur. The nurses will teach you how use the incentive spirometer. You will need to cough, breathe deeply as well as move your arms and legs often to prevent complications.

The nurses will turn you every two hours to prevent sores on your skin. Your incision will be covered by a large dressing that will be removed after a few days. A drainage tube is inserted into the bone graft incision to remove any excess fluid. The drainage will stop as you heal and the tube will be removed.

Depending on the surgery you've had, you may have chest tube inserted to keep the lungs expanded during the beginning of your recovery process. The tube is connected to a container that makes a bubbling sound. The doctors and nurses will continually monitor the breath sounds in your lungs and daily x-rays will be performed to help the doctor decide when the tube should be removed.

You will receive medication from the nurses through your IV. Some patients may get medication through a Patient Controlled Analgesia Infuser (PCA). This will allow you to press a button that will deliver doses of pain medication through your IV. Your doctor will choose which medication works best for you, so if your pain is not relieved by the medication you're on make sure to let the nurse know. You will use the PCA for a few days and then you'll begin taking medicine by mouth.

Your doctor and nurse will also listen to your stomach and let you know when the anesthesia has worn off your intestines, so you can begin drinking sips of water or clear liquids.

You will most likely be out of ICU and into a regular room within a day or two after surgery.

TIPS FOR RESTING COMFORTABLY
  While lying on your side, you can prevent strain on your back muscles by keeping the spine straight, tipping
      the hips slightly back for balance, bending the upper leg, placing one pillow between your legs and the other
      to support your upper arm. You should try to stay in this position for two hours at a time for comfort
      and to prevent lung complications.
  To prevent muscle strain while on your back, place a pillow under your knees.
  "Logrolling" is a way of turning your body without twisting your spine. Your nurse will help you and teach you
      how to turn. Make sure to keep the spine straight, like a log, while turning. Don't twist at the shoulders
      or hips. The nurse will use a turn sheet to help you and you can help by reaching for the side rail when the nurse
      is turning you. The turn may be made more comfortable by placing a pillow between your legs.

THE FIRST FEW DAYS AFTER YOUR SURGERY

Your IV will provide you with nourishment for the first few days since you will not be able to eat solid food right away. Gradually, you'll be able to start eating regular foods, but since you have not been eating and you have no been active, there is a possibility that you will become constipated. The nurses can give you a laxative if needed.

You will be turned every two hours while you are recovering. You will be able to help the nurses turn and change your position as you get stronger. You will also continue the incentive spirometer lung exercise in addition to coughing and breathing deeply, to keep your lungs working well while you are in bed. You may also still get blood drawn for routine tests and x-rays performed while in your regular room.

As your recovery progresses and you feel stronger, your back will start to feel better and your pain will decrease. Once you are eating regular foods, the IV in your arm and catheter in your bladder will be removed. Although you will feel much better at that point, keep in mind that your body has been through a lot and will need more time to completely recover.

EAT RIGHT TO GET BETTER
A healthy diet is an extremely important to promote healing. Should you have any eating problems while you are in the hospital, it is recommended that you talk to the registered dietician. The nurse can contact the dietician for you.

It is important for you to eat the following nutrients:
  Protein, found in foods like meat, cheese, eggs, fish, and beans.
  Vitamin C, found in foods like oranges, strawberries, grapefruit, broccoli and tomatoes.
  Calcium, found in milk, cheese, yogurt, broccoli, and shellfish.
  Iron, found in raisins, spinach, greens, and liver.
  You'll also need to take supplements, like iron and a multivitamin.

TLSO BODY JACKET
Patients with certain rods may be in a walking body jacket or cast on the upper body. Body jackets are specially fitted for each person and provides extra support necessary to ensure proper fusion and fixation of your rod and backbone. Your physician will determine how long you have to wear the body jacket and information regarding your jacket will be provided at discharge. You may have the body jacket for up to six months following the surgery. The body jacket can be removed when showering or lying in bed.

EXTERNAL BONE GROWTH STIMULATOR
Some doctors may prescribe an external bone growth stimulator to aid the healing process. Depending on your situation, it may be prescribed to be worn for a specific number of hours each day, for a period of 3 to 9 months following your surgery. The device provides an electromagnetic field that among other things, increases blood flow to the area and promotes migration in bone healing. Don't worry -- external stimulators aren't painful and are lightweight and portable.

CLEANING UP
About a week after surgery, you can begin showering, but no bathing. Get a long handled brush to help you reach, so you wont have to bend and twist to wash yourself. When it comes to handling your wound, pat it dry, don't rub as you may irritate it. You may need assistance for the first few showers.

GETTING OUT AND ABOUT
Keep outings to short distances and if you have to go for a longer drive, make sure to recline the seat and place a pillow behind your lower back. If you drive, you doctor will indicate when you can resume that activity.

Usually, you can resume most activites, except for strenuous exercise and contact sports, within two to three weeks after being discharged from the hospital. Once the body jacket is no longer needed, most activities can be resumed except for contact sports. You should postpone any strenuous activities for approximately a year, after the spinal fusion is completely healed. Most patients can return to school withing three to four weeks after getting home from the hospital.

LIVING WITH YOUR IMPROVED SPINE
The rods in your back are permanent and you now have perfect posture. You will not be able to bend the way you did before surgery and you will have to adjust to picking up things, tying your shoes and getting out of bed. To pick up objects, you will need to bend at the knees and use your leg muscles to lift. (This is actually the proper way for anyone to lift objects and not cause back strain.) You might want to get shoes without shoelaces for the first few months because bending over that far may be difficult. When getting out of bed, use the logrolling method you learned in the hospital then put your legs over the edge of the bed first and then sit up. Do not twist, bend of lift more than 15 lbs.

You'll be going to physical therapy, so be sure to ask about exercises you can do at home. It's very important to make sure to schedule follow up appointments with your surgeon -- your doctor needs to monitor your healing process on a regular basis.

Correcting your curvature provides you with improved health and body image. Congratulations.