Information about Surgery

In an effort to provide our patients with as much knowledge as possible about the surgical pathway for improved health, the following is a resource to provide information about steps taken for a typical spinal procedure. As in any case, each patient and each condition are variable and may have factors that cause deviation from the following guidance. Your neurosurgeon and /or you PA will indicate any additional instructions as necessary.

On the initial office visit, you will be seen and evaluated by a Physician’s Assistant or Nurse Practitioner. Prior to your appointment, information is gathered with data sheets describing your family and social history with related problems. This data collection supplies the provider with a great deal of significant information.

There are many different conditions of the spine that can result in a decision to have surgery. The types of surgery are different for each person and each problem. You may have friends that have had surgery, which may or may not be similar to yours. The surgery for treatment of spinal conditions can require a very small surgery or a much bigger operation. Just as the operation can vary from person to person, so will the recovery time and even the postsurgical restrictions. Each person is different and will have a unique surgical experience.

Once it has been determined that spine surgery is necessary, you may need to be seen by your primary care physician for clearance to undergo surgery. You may also need to see a cardiologist and/or pulmonologist, depending on your health history and needs. Once the surgery is scheduled, you will have a preoperative appointment at the hospital for completion of admission papers, blood analysis and other testing if needed.

On the day of surgery, you will be admitted to the hospital. A nurse in the preoperative area will begin an I.V. and administer preoperative antibiotics. An anesthesia provider will visit you and perform a brief history and physical examination. You will be offered medication to relax you prior to surgery. Other testing may be performed at the request of anesthesia at this time.

Once ready for surgery, you will be taken to the surgical suite. Your family is instructed where to wait for the surgeon after the surgery. Once in the operating suite, you will notice a great deal of activity in the room to prepare for the operation. This is all very normal. Many forms of monitoring devices will be placed in preparation for surgery. You will be given medication to put you to sleep.

After surgery, you will spend approximately one to two hours in the recovery room. Postoperative pain will be controlled by medication. If a catheter has been placed in the operating room to drain urine, it may be removed at this time. Upon leaving the recovery room, you will be taken to your room where medication to control pain will be available. You will begin getting out of bed shortly after your surgery. If you are having outpatient surgery, you will be discharged in the afternoon, once you are walking, eating and comfortable.

Fluids and food will begin once you are awake enough to take in these items. Once you can take fluids by mouth without difficulty, the intravenous fluid will be stopped. If you had dietary restrictions at home, the hospital staff and your provider will need to be made aware so they may order the proper diet. A dietician is available for special dietary needs.

You will be encouraged to cough and deep breathe every two hours while awake. A machine called an incentive Spirometer will be explained and left at the bedside. You are encouraged to use the incentive Spirometer every two hours while awake.

Once key to prevention of postoperative complications is early walking. Postoperatively, you can begin getting out of bed before formal physical therapy has actually begun. Physical therapy will assist you with mobilization. The physical therapist will assess your need for assist devices for safe ambulation at home. These items will be arranged for home use prior to discharge if needed. The physical therapist will also give you exercise instructions and will provide you with written material on the exercises to be done performed on a daily basis once you are discharged from the hospital.

You may shower postoperatively. No tub baths are allowed until the skin incision heals. There is no special care required for the incision.

Once you are able to take medication by mouth to control your pain, walk in the halls of the hospital, and urinate without a catheter, you will be discharged home. Inpatient rehabilitation is not needed for most patients following spine surgery. Occasionally, a patient will need extended, inpatient rehabilitation. Many patients can follow the postoperative instructions for exercise and restrictions without the need of formal rehabilitation. The need for formal inpatient rehabilitation is evaluated on a patient by patient basis.

For the first two to three weeks postoperatively, you may be asked not to drive, not to bend or twist, and not to lift more than 10 pounds. These instructions will be unique to each case. All of these instructions are given in written forms as you leave the hospital. On the first preoperative visit, the restrictions are modified to meet the individual level of patient need.

On the first preoperative visit, you are given exercises to perform daily. A goal would be for you to perform these exercises three times daily. You are encouraged to walk as much as you would like. The weight limit for lifting will be modified at this visit. Working out with weights or at a fitness facility will be discussed on an individual basis. Formal physical therapy will usually be initiated on this visit.

On the first postoperative visit, the incision may be in different stages of healing. If there are stitches or staples, they will be removed at this time. Should the incision have “steri-strips”, they will peel off when ready or will be removed by the provider during the first postoperative visit. No special diets are needed postoperatively. We encourage all patients to eat healthy food and drink lots of fluids. Drinking eight glasses of water a day may decrease constipation in the first weeks after your surgery. This is not the time to begin a diet as you need protein to heal and carbohydrates for energy.

Once you are two to three months out from surgery, you may begin a fitness plan for diet and energy. Data suggest that patients with spinal disease would benefit from being of appropriate body weight for their height. Regular exercise with aerobic and weight training will decrease the risk of heart disease, strengthen your bones and prevent many other diseases. As you heal and progress postoperatively your provider will increase your activity and lessen your restrictions. This will all be done on an individual basis. We encourage patients to be active, yet not to the point of needing to increase pain medication to do more activities.

Pain is a feeling of discomfort that will vary from person to person. Each person feels pain differently and responds to pain differently. The providers at TBSI – Neurosurgery want patients to play an active role in controlling their pain postoperatively.

Severe pain after surgery is not “just something you have to put up with.” Today there are many options and medications to treat postoperative pain. Pain control helps you heal faster, feel better and decrease the chance of postoperative problems. There are many types of pain medication. This medication can be placed into categories of non-steroidal, anti-inflammatory drugs, narcotic medications, non-narcotic pain medication or typical medication.

Narcotic pain medication is used for control of moderate to severe pain on a short term basis. These medications are effective for pain control after surgery. Some common names for these medications are Darvocet, Vicodin, Lortab, Norco, Vicoprophen or any of the Tylenol’s with codeine. These medications are generally well tolerated. The most common complaints of side effects are drowsiness, constipation and/or nausea. You should not drive while taking these medications.

Non-steroidal, anti-inflammatory or other non-narcotic medication can reduce the swelling and soreness as well as relieve mild to moderate pain. These medications are Tylenol (acetaminophen), Motrin (Ibuprofen) or Aleve (naproxen). There are also prescription non-steroidal, anti-inflammatory medications. The benefit of these medications is that there is no worry of addiction. These medications can lessen the need for stronger medication and in some cases eliminate the need for narcotic pain medication altogether.

Just as there are many medications for pain, there are many ways to take this medication for pain relief. Tablet or liquid medications tend to last longer and cause less discomfort than injections. Once discharged from the hospital, only tablet or liquid medication can be prescribed. Injections for pain control should only be given in the hospital to monitor pain relief and for possible unfavorable reactions.

Over the postoperative period you are encouraged to use pain medication only as needed and not on a routine basis. Routine use of pain medication will cause you to become tolerant and this medication will not work as well over time. As time progresses, you should be able to decrease use of pain medication.

We would encourage you to call if you have questions after your surgery. Many patients will have a low grade fever for a day or two postoperatively. You may also have a small amount of clear or almost clear liquid from your incision. This should not be alarming. You should call immediately if you run a fever greater than 101 degrees for more than four consecutive hours or have significant oozing from the incision.

• You should not do any pulling, pushing, twisting, or lifting with your hand. 
• Gentle finger wiggling, flexing, stretching, opening and closing without applying any pressure or tension will help prevent your hand from becoming stiff and is encouraged to begin the day after your surgery.
• It is recommended to NOT drive until after your first follow up visit with your provider.  If you feel you are able to drive prior to your office visit or with one hand, we recommend you limit your driving to short trips. 
• DO NOT DRIVE WHILE TAKING NARCOTIC MEDICATIONS.
• Unless your job requires exceeding the guidelines provided above, you may return to work as soon as you would like.

• You can remove the large bulky bandage/dressing 36-48 hours after your surgery.
• You can take a shower the day after your surgery, however, do NOT actively wash or immerse your incision. 
• Keep the incision clean and dry and a Band-Aid over the incision.  If the incision gets wet, blot it dry.
• Contact your provider if you notice any excessive swelling, redness, widening of, or drainage from the incision or a fever of 101 or greater.

• You will experience minor pain after your surgery-tenderness around the scar usually lasts for 8-12 weeks after surgery.  To help take the edge off the pain, you may be provided with a prescription pain pill.
• Some of the pain medications can lead to constipation - an over the counter stool softener is recommended.
• If you normally take blood thinning medications such as Aspirin, Plavix, or Coumadin, you may resume their use in 5 days.

• Patients of Dr. Toussaint and Dr. White – the TBSI – Neurosurgery office staff will contact you to schedule your 2 week follow up appointment from the date of your surgery within 5 business days.  If for some reason you have not heard from our office, please contact us at 979-776-8896.
• Patients of Dr. Briner – Please contact our office at 979-776-8896 within 5 days from the date of your surgery to schedule your suture removal follow up appointment.  You will need to have your sutures removed within 10-14 days.
• If you have any questions or concerns before your scheduled appointment, please contact our office at 979-776-8896.

• You should not lift, push, or pull anything heavier than 10 lbs. or lift anything above your shoulders until your first post-operative clinic visit
• Let pain be your guide- if it hurts, don't do it. Otherwise, you may walk, take the stairs, ride in a car, or fly in a plane as long as it feels comfortable to do so.
• You may start driving when you feel you are safe to do so.
• DO NOT DRIVE WHILE TAKING NARCOTIC MEDICATIONS.
• Unless your job requires exceeding the guidelines provided above, you may return to work as soon as you would like.

• You will experience minor pain after your surgery.  Tenderness around the scar usually lasts for 8-12 weeks after surgery.  To help take the edge off the pain, you may be provided with a prescription pain pill. 
• Some of the pain medications can lead to constipation – an over the counter stool softener is recommended.
• If you normally take blood thinning medications such as Aspirin, Plavix, or Coumadin, you may resume their use in 5 days, unless otherwise instructed.

• You can remove the large bulky bandage/dressing after you are discharged from the hospital.
• You should let the steri-strips covering the incision fall off on their own – they usually fall off within 7-10 days after your surgery.
• If you have sutures, they will be removed at your first post-operative clinic visit.
• You can take a shower the day after your surgery, however, do NOT actively wash or immerse your incision.  Do NOT submerge your incision under water, such as in a bath or a swimming pool.  Keep the incision clean, dry, and covered with a Band-Aid.  If the incision gets wet, blot it dry.
• Contact your provider if you notice any excessive swelling, redness or drainage from the incision or a fever of 101 or greater.

• The TBSI – Neurosurgery office staff will contact you to schedule your 2 week follow up appointment from the date of your surgery within 5 business days.  If for some reason you have not heard from our office, please contact us at 979-776-8896.
• Patients of Dr. Briner – Please contact our office at 979-776-8896 within 5 days from the date of your surgery to schedule your suture removal follow up appointment.  You will need to have your sutures removed within 10-14 days.
• If you have any questions or concerns before your scheduled appointment, please call our office at 979-776-8896.