Patients' Guide to Spine Surgery
The following information is provided to answer many questions you may have, regarding preparing for spine surgery, recovery and your rehabilitation.
Please remember that everybody is an individual and therefore this information is provided as a guideline only.
Pre Admission Programme
Your admission to hospital will be arranged by our staff. The practice manager will go over the details with you after your consultation with Mr Malham. A letter will follow informing you of the date and time, hospital and anaesthetist for your operation.
PLEASE NOTE : Any blood thinning medication should be ceased as detailed below:
- Aspirin (Cartia) and Clopidogrel (Plavix) to be stopped 10 days prior to surgery.
- Warfarin (Coumadin) to be stopped 5 days prior to surgery.
- Pradaxa and Xalatan to be stopped 2 days prior to surgery.
You may receive a telephone call from the hospital prior to your admission. This will be from the business office to confirm your insurance status and personal details, or from a registered nurse to discuss your hospital stay, recovery process and the outcomes you will achieve following surgery and prior to discharge.
The information obtained will assist in planning referral to rehabilitation, community support, physiotherapy and occupational therapy services.
You may have blood tests and an ECG (heart rhythm test) taken before or on admission. If you have other medical problems Mr Malham will also arrange for a specialist physician to see you before your operation and during your hospital stay.
Recommendations on what you should take to Hospital
- Do not take valuables (jewellery). Remove rings and do not wear nail polish.
- All current medications and any repeat prescriptions
- X-rays, CT scans and MRI scans
- Nightgown/pyjamas/dressing gown
- Comfortable clothing, track suit or similar
- Comfortable shoes/slippers/socks/underwear
You will be admitted on the day of surgery or the day before surgery depending on the timing of your operation, or if you need to be seen by the specialist physician prior to surgery.
You should present to the Admissions Office on arrival (Epworth Richmond Hospital, 2nd floor). After registration you will be escorted to your room.
Day of Surgery
Stop eating and drinking 6 hours before your operation. You need an empty stomach before your anaesthetic.
You will be provided with a hospital gown to wear.
A pre-med will be given (tablets or an injection) to relax you. After the pre-med has been given, you must stay in bed until an orderly takes you to the operating theatre.
After Your Operation
From the operating theatre you will be taken to the recovery room until you are awake and stable from the anaesthetic and surgery.
Mr Malham will check on you in recovery. When you are awake, he will ring your nominated relative/friend and let them know how you are doing. Standard practice is that you will stay in recovery for one hour to be monitored before returning to the ward and receiving visitors.
An intravenous line will be positioned in your arm for fluids and pain relief. You may also have a mask over your nose and mouth for oxygen until fully awake. For longer operations you may also have a urinary catheter present to drain your bladder.
Depending on the type of surgery, you may have a safety draining tube in your back. This is to drain any excess blood from the wound. Drains are usually removed by a nurse 24 – 48 hours following the operation.
It is important not to eat or drink following the surgery until you pass wind or bowel sounds return (stomach rumbling). This is because the anaesthetic makes your stomach go to sleep and if you eat too soon you may vomit. The nurses will check on these signs to make sure it is safe for you to eat.
Your physiotherapist will show you deep breathing exercises. It is important to do these regularly to keep your lungs working well while you are lying in bed.
You will also be given exercises to do every hour, moving your ankles and knees to avoid blood clots in the calves which can break off and move to the lungs. To assist with this you will also have calf (TED) stockings fitted on the day of your operation.
Your wound will be closed with either dissolvable sutures or skin clips. The nurses as required would change wound dressings. Arrangements will be made for skin clips to be removed after you have returned home by either your GP or district nurse. Neck clips are removed on day 5 and back clips on day 10 (day one is the first day after surgery.)
Your pain control programme will be decided on after consultation with you, your anaesthetist, the nursing staff and Mr Malham.
During the first two to three days you will experience some pain. This pain comes from muscle retraction and the skin wound. This will be controlled by intravenous medication through a patient controlled pump (PCA). Once you are off the drip you will be given intramuscular injections and/or tablets if required.
It may be necessary to continue taking pain relief when you are discharged and a prescription will be arranged.
Position and Movement Following Surgery
Activity in bed and early mobilisation is encouraged to prevent complications.
It is important when lying in bed that you keep your spine straight and in good alignment. You can lie on your sides or back. Nurses will assist you to roll side to side during the first 12 – 48 hours.
Depending on the type of surgery you may be allowed out of bed within 24 hours of the operation. A physiotherapist will instruct you for the first time when getting out of bed and then a nurse will continue to assist you. You may be dizzy the first time you get up so ensure there is a physiotherapist or nurse present.
It is important when getting up to lie on your side as close to the edge of the bed as possible. Sit on the edge of the bed first for a few minutes before standing up. Sitting puts more pressure onto the back and this can often be uncomfortable. Discomfort will be minimised by standing and walking.
Gradually increase walking time as tolerated over the next few days. Aim for 3 to 4 small walks per day rather than one large walk.
During your hospital stay you will be provided with an elevated toilet seat and straight backed high chair. Both of these reduce the stress on your back.
After neck surgery you be given a soft cervical collar to wear for 4 weeks. This soft collar is for comfort only when out of bed, sitting, standing, walking and travelling in a car only as a passenger. Do not wear the collar in bed at night.
After back surgery, no soft or hard braces are to be worn. These braces weaken the back muscles. You will be given exercises by the physiotherapist to strengthen your “core” muscles (abdomen, back, pelvis and leg muscles).
Decreased activity, limited appetite, reduced fluid intake and multiple medications may cause constipation. Walking, drinking plenty of water, increasing fibre content of diet and taking a mild laxative will help this. Continue this once you go home.
Rehabilitation & Recovery
Following surgery there is a recovery or convalescence period and you may experience tiredness, discomfort, weakness and impaired mobility. This is normal and will improve.
A physiotherapist will assist in your recovery and return to independence around the ward following surgery. This will include help with mobility, instructions on what to do and not do, and development of a home exercise/activity programme.
Most patients are able to return directly home after surgery. A proportion of patients require transfer to inpatient rehabilitation. The need for rehabilitation will be assessed by Mr Malham and discussed with you, the physiotherapist and nursing staff. Placement in a rehabilitation centre will take into account where you live and other family considerations. Once independent, rehabilitation can be continued as an outpatient.
Time Frame for Recovery
- The first 4 weeks (weeks 1-4) are usually spent getting over the operation, walking and a home exercise programme. No bending or twisting.
- The second 4 weeks (weeks 5-8) can include swimming and a light gym program.
- The third 4 weeks (weeks 9-12) increasing activity, light jogging and a medium gym programme.
- From week 12 onwards, resumption of normal activities. Normal gym programme, running, cycling and golf.
During surgery, blood loss can occur causing a drop in iron levels. Iron is needed for blood to carry oxygen. This can cause tiredness and headache. You may need a blood transfusion or iron tablets to improve this. The blood given to you is all screened and safe. The iron tablets (usually 1 tablet a day for six weeks) may cause dark stools and constipation.
The body also needs calcium for bone repair. Dairy foods are the best sources for calcium, such as milk drinks, yoghurt, cheese, and custard. Sunlight helps the body make vitamin D for bone strength so go outside daily and enjoy some sunshine. If you have low Vitamin D levels or osteoporosis you may be prescribed calcium and Vitamin D tablets.
Protein foods are good for muscle repair. Eat lean red meats, chicken, fish and vegetables.
Smoking inhibits healing especially bone fusion. If you haven’t already given up prior to your operation, now is a good time to consider quitting! Smoking increases your risk of stroke, heart attack and lung cancer.
Generally with lumbar surgery it is best to keep your back straight. You can lie, stand, walk, and sit only for meals 4 weeks post operatively. Avoid bending at twisting activities.
When sitting for meals, limit this to 20 minutes and use an upright chair/stool.
Avoid driving until you discuss this with Mr Malham at your 4 week postoperative review. You can travel by car as a passenger for short distances only and remember to recline the seat 30 degrees to keep your back straight.
You may resume normal sexual activities as long as you take the passive role. If back discomfort increases stop immediately.
Returning to Work
Returning to work will depend on the type of surgery performed and the work that you perform. Mr Malham, or a member of his team, will advise each patient individually.
|Surgery||Light Duties/Office Work||Manual Work|
|Neck Surgery||2-3 Weeks||4-6 Weeks|
|(Anterior Cervical Discectomy and Fusion or Posterior Micro Foraminotomy)|
|Back Surgery||2-4 Weeks||6-8 Weeks|
|(Lumbar Microdiscectomy or Laminectomy)|
|Lumbar Fusion Surgery||6-8 Weeks||12-16 Weeks|
|(Posterior Lumbar Interbody Fusion, Transforaminal Lumbar Interbody Fusion or Anterior Lumbar Interbody Fusion)|
Please Note: this is a guide only and each case is assessed on an individual basis during recovery
Post Operative Appointments
A Post Operative Appointment is usually scheduled 4 – 6 weeks following discharge. It is important that you keep this appointment so that Mr Malham can check your progress.
Usually the ward clerk will schedule a Post Operative Appointment prior to your discharge or you may be asked to contact our rooms from home. If so, please remember to contact Mr Malham’s rooms as soon as possible to schedule this postoperative appointment.
Be Prepared Checklist
The following suggestions are made to maximise your safety on returning home following your procedure.
Prof. Malham’s Private Consulting Rooms
89 Bridge Rd,
Richmond VICTORIA 3121
Phone: (03) 9866 6650
Fax: (03) 9866 6681
Epworth Private Richmond
89 Bridge Rd,
Richmond VICTORIA 3121
Phone: (03) 9426 6666
Fax: (03) 9427 0353
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