Frequently Asked Questions About Spinal Surgery
Welcome to the Waterloo Regional Spinal Program
We in the Spinal Program are very passionate about the care of our patients. Our Spinal Program has prepared this Spinal Surgery “guide” containing customized information to help you and your family prepare for your spinal surgery. It includes information about what will happen before, during, and after your surgery. Please read the following frequently asked questions once you know you are having spinal surgery. Let your family also read this page and feel free to ask us any questions. This guide has been adapted from the spinal program at University Health Network, Toronto, Canada.
Thank you.
Spinal Surgery Team
Once you have made the decision to go ahead with your spinal surgery, your surgeon’s office will then arrange a date for your surgery and call you to inform you of this date. At the same time, you will be given an appointment date for a pre- admission visit. At this visit, you will have any necessary medical tests and blood taken, meet with an anaesthesiologist and do a nursing assessment. You may also meet with a medicine specialist to assess your fitness to proceed with surgery. They may also make recommendations around medications you are currently taking.
PLEASE NOTE: For those patients still making a decision to go ahead with the surgery, our office will not book you for surgery until a decision for surgery has been made.
There are many possible benefits to having spinal surgery which you have already talked to your surgeon about. Whatever the reason, there will always be a recovery period after surgery. During this period you will not be functioning to the best of your ability.
How can I prepare for my surgery?
Initially, you will not be as mobile or independent as you were before surgery. Let your family and friends know that you will need some help. You will probably need help with things like grocery shopping, cooking, and housework. In some cases, people who live alone choose to stay with family or friends just after surgery. Some people pay for housekeeping or other services such as grocery delivery.
Will I need any equipment?
After surgery, you may need some equipment for a few weeks to help with your mobility and everyday activities. Some examples can be a walker or bathroom equipment.
Before you leave the hospital, please be prepared to have family or friends pick up the equipment for you from a medical supply store. Sometimes you can arrange for a vendor to deliver the equipment to you.
What should I bring to the hospital?
Please don’t bring too many personal belongings or valuables to the hospital. All you need is:
a good pair of shoes or slippers that are closed at the toe and heel with a non-slip sole.
toiletries such as soap, shampoo, shaving supplies (don’t bring heavily scented lotions or perfumes).
a house coat or dressing gown if you wish (but we will give you hospital gowns to cover you both in back and in front).
entertainment (books, magazines, puzzles)
you may bring your cell phone, laptop computer (Internet is available).
Please be careful with all valuables as the hospital does not accept responsibility for them. We suggest not bringing any jewelry to the hospital.
When should I stop eating or drinking before surgery?
Do not eat or drink anything including water starting at midnight the night before your operation.
What about my pain medication?
Please tell the anaesthesiologist at your pre-admission visit if you have been taking narcotic pain medication for a long time. If you take narcotics or other prescription medications, you will talk about which ones you should take the morning of surgery. Do not take them with more than a sip of water.
If you do not understand these instructions, or have any questions about your medications, please ask the nurse, pharmacist or anaesthesiologist whom you will see at your pre-admission visit.
What about smoking?
If you smoke, we recommend that you stop smoking before your surgery. Your surgeon will discuss this with you. In some cases, depending on the surgery you are having, you may need to stop smoking for at least 3 months before your surgery because smoking makes it difficult for bones to heal and can cause problems after surgery. Smoking can also increase the risk of breathing problems after surgery, such as pneumonia.
We know that quitting smoking is difficult. Here are some resources to help you - Smokers’ Helpline: Toll free number: 1-877-513-5333 Website: www.smokershelpline.ca and www.gosmokefree.ca
What about my blood thinners (e.g. Coumadin, warfarin, Plavix, Aspirin) and anti- inflammatory drugs (e.g. celebrex, naproxen, arthotec, mobicox, advil, ibuprofen)?
You should stop taking these drugs 7 days prior to your surgery. If you have questions or concerns, please call your spine surgeon’s office. You should ask your surgeon before you go home after the surgery when you can restart these drugs.
Once surgery is over, your surgeon will meet or call your family members to let them know about your general condition and how the surgery went.
What should I expect while in the hospital?
You will receive medical treatment including medications, and intravenous fluids after surgery. You may have compression stockings on your legs to prevent blood clots in your legs after surgery. When possible, getting up and walking around is the best way to recover and prevent complications such as blood clots or pneumonia etc.
You will probably have a urinary catheter for a short time. Nurses will monitor your vital signs (temperature, blood pressure, etc.) and care for your surgical incision. Nurses and patient care assistants will help you with your day to day needs such as bathing, toileting and turning in bed. Physiotherapists and nurses will also help get you out of bed and help you walk.
A physiotherapist may work with you to increase your mobility, beginning with getting in and out of bed, and then walking and climbing stairs.
An occupational therapist may and give you information about home safety equipment you may need at home. You may also be seen by other health professionals if necessary.
How soon will I be getting out of bed?
The sooner the better! Expect to get up the first day after surgery. You might sit at the edge of the bed or go for a walk. Many things affect the way you feel right after surgery, including what kind of surgery you had and how you respond to pain medication, but the sooner you start to move the better you will feel. Moving around early also helps to prevent problems such as blood clots or respiratory infections. It will also help to get your bowels working properly.
What will my pain be like after surgery?
It is normal to feel pain after spinal surgery. This is part of the healing process. We aim to control your pain so that it is at a level that is not too uncomfortable for you.
You may have some relief of your chronic pain but you will feel pain at the area of the incision. After surgery, we will ask you to rate your pain on a scale from 0 to 10, where 0 is no pain at all and 10 is the worst pain you could imagine. In general, we aim for only ‘mild’ pain when you are resting in bed (i.e. less than or equal to 4/10). When you are moving around in bed or getting up or walking, your pain may be ‘moderate’ (5 or 6/10). We want to prevent and treat ‘severe’ pain (7/10 or more).
What are the benefits of controlling pain related to your surgery?
Managing your pain during the first few days after surgery lets you move more easily and lower the risk of chronic pain.
Who will manage my pain?
The Pain Service has anaesthesiologists and specially trained Advanced Practice Nurses. The Pain Service will see you each day starting on the morning after your surgery until your pain is stabilized on pain tablets. After this, your surgical team will help you manage your pain.
How will my pain be managed?
For many spinal surgery patients, you will wake up in the recovery room with a button to press for pain medication. This is called Intravenous Patient Controlled Analgesia (IV PCA). This is an intravenous medicine that you give yourself by pressing a button. The Pain Service can give you more information. Please use this to keep on top of your pain as much as possible. IV PCA has safety features built into it so that you will not give yourself too much medication. Remember: if you are having a fusion, you should not take any anti-inflammatory medications (NSAIDS) for at least 3 months after your surgery. If you are not having a fusion, you may keep taking these medications.
Are there any side effects of pain medication?
All narcotic pain medication have common side effects such as:
drowsiness
constipation
nausea
general itchiness
If you have any of these, please let your nurse know because there is medication that can treat these side effects.
How long will I be in hospital after my surgery?
Your hospital stay will be the shortest part of your recovery after surgery. Some people go home as soon as the next day after surgery. Your surgeon will talk with you about your hospital stay before surgery.
After surgery, the nurses and Allied Health team, will let you know when you are ready to go home.
On the day of discharge from hospital, please be ready to leave the hospital by 11:00 a.m.
What if I have a collar or brace on after surgery?
If you have been advised to wear a brace or collar, make sure that you ask for information on how to wear it appropriately and whether it should be worn at all times. Your physiotherapist or occupational therapist will discuss any mobility or safety equipment needs with you.
Please be aware that braces, collars and mobility equipment may not be covered by OHIP. If you have private or extended health insurance you can ask your insurer whether they will cover the cost of these items.
Most people go home after surgery or stay with friends or family. In some cases, temporary changes may have to be made to your home so that you can stay on a main floor and not have to climb stairs. Or, you may stay with friends or family so that you can get the care you need.
In some cases, we may refer you to an in-patient rehabilitation hospital after surgery. But this is the exception. Most patients who go to a rehabilitation hospital have had some serious movement restrictions before surgery. The decision about going to in-patient rehabilitation will be made after your surgery by the spinal team.
How will I manage at home?
Personal Care (eg. bathing, dressing and other self-care tasks): You may be eligible for help at home from a Personal Support Worker (PSW). A service coordinator (social worker) at the hospital may assist you with this. This happens before you are discharged from the hospital. Services are limited and if, for example, you don’t qualify, or feel that you would like more than what is provided, you may choose to hire privately. The social worker can give you a list of private health care agencies.
Home Making:
OHIP funded home support does not help with homemaking activities such as laundry, cooking, cleaning, grocery shopping and pet care. Our social worker can give you more information about paid services such as Meals on Wheels and grocery delivery services.
Physiotherapy
Most people do not need physiotherapy when they first go home. Instead, try to walk as much as possible. Short walks throughout the day are very good for you and will help you recover. You will feel better and stronger. When you come back to see your surgeon at your follow up appointment they will give you a physiotherapy referral.
Do I Need a Follow-up Appointment?
Yes. You will have a follow-up appointment with your surgeon after surgery. You will receive a date for follow up before you are discharged from hospital. You may need to have an x-ray done on the day of your follow up appointment. Please bring your health card (OHIP) with you to all your hospital visits.
When should I call my Surgeon’s Office?
Sustained fever greater than 38 degrees Celsius that does not respond to a dose of 2 tablets of Tylenol (Do not take Tylenol if you have contraindications or allergies to Tylenol).
Drainage from the incision that is increasing (Spotty drainage may be normal for the first few days).
Incision is very red or warm to the touch and worsening.
New intractable or worsening pain
Calling 911 or going to the Emergency department
Difficulty breathing, shortness of breath or pain with breathing
Chest Pain
Leg Pain – specifically calf tightness or swelling
Bowel loss and incontinence
New difficulty emptying your bladder
New decreased sensation in your genitalia
For neck surgery patients:
Seek urgent medical care (emergency department) if you have a lot of trouble swallowing, hoarseness of your voice that is getting worse, a lot of swelling or pain on the front of the neck
How do I care for my incision?
Do not scratch your incision area.
Do not use lotion, powder or oil on the incision for 4 weeks. After 4 weeks, you can use Vitamin E around the sides of the incision as long as it is dry and healed.
Keep your incision covered with the dressing for the length of time your nurse told you to before your discharge home. After that, leave it uncovered as long as there is no leaking.
How do I cope with my pain at home?
You will be given a prescription for pain medication. Take the medication as prescribed.
Ask your family doctor for a refill of your pain medication if you need it. Your surgeon will not prescribe a refill of your pain medication.
You may feel different levels of pain especially as you begin to do more of your daily activities.
To help keep the pain under control, take the medication before going for a walk or before doing any activities that may cause pain, or before the pain becomes very bad.
As you feel less pain, you can slowly take less and less of the pain medication. Your family doctor can help with this.
You may get constipated because of the pain medication. To help with that, take the laxatives prescribed, try to eat food high in bulk or fibre (for example bran and fruit). Drink plenty of fluids.
Take a stool softener every day while you are taking narcotics. If you have not had a bowel movement after 1 or 2 days, take a laxative if you need to.
In the case of low back surgery, you may feel some muscle spasms across your back and down your legs. If the nerves in your legs are inflamed or irritated, you may have some leg pain until the inflammation settles.
How do I stop taking the pain medication?
The pain will be less each week. You may ask your family doctor to prescribe a milder type of pain medication and to assist you in weaning off your pain medication. It is better to slowly reduce the medication than to suddenly stop taking it.
Is it normal to feel tired after surgery?
Yes, feeling tired is a normal part of recovery. You may feel tired for weeks or months after the surgery. Try to focus on the future and take positive steps toward your recovery.
What activities can I do after surgery? Is there anything I should be careful about?
Unless your surgeon has told you to wear a brace or collar or has told you to avoid certain movements, the general rule is“Let pain be your guide.” You should not do anything that causes you a lot of pain. It is expected that you will have some pain.
Generally:
avoid lifting more than about 4.5 kg (10 lb) avoid deep bending
avoid sitting for long periods of time without getting up every 30 to 60 minutes to walk around
avoid vigorous housework or yard work
stop playing sports (including walking on the treadmill or stationary bicycle) until you have talked to your surgeon
walk, climb stairs and do your usual daily activities until you see your surgeon on your follow-up appointment in 6 to 8 weeks
What about driving?
You will not be able to drive right after your surgery. You should not drive if you are on narcotics, in a lot of pain, very tired or if you have problems with your vision.
Do not drive while wearing a brace or collar. Generally, you are not insured to drive a car while wearing a neck collar.
When can I return to work?
Talk to your surgeon and employer about when you can go back to work. A graduated return to work may be best.
What can I eat or drink after my surgery?
You may not feel hungry after your surgery, and a large meal may not sit well in your stomach. Try eating small frequent meals until you build back up to what you normally would eat.
If you have an upset stomach or vomiting, you can take anti- nausea medication, such as Gravol, which you can buy from your pharmacy without a prescription. Take it as directed and keep drinking fluids until the nausea passes. Then gradually start eating solid food again. If this problem continues, see your family doctor.
If you have had neck surgery, you may also have a sore throat or some discomfort for several weeks when swallowing. Try to eat different kinds of food that are easy to swallow. For example, you can start with soft food such as yogurt, Jello, ice cream, mashed potato, pudding, clear soup and minced food. Drink fluids such as water, tea, coffee, apple juice and orange juice. (Mix orange juice with some water which is better for your sore throat).
How long will my recovery from spine surgery take?
Expect a full recovery from surgery to take from 3 to 12 months or even up to 1 1/2 years for internal healing. It may take you weeks or months to feel your usual energy so you can do your everyday activities again.
Recovery depends on your surgery and how well you could move before your surgery. Keep positive, eat well, rest and exercise. Focus on small improvements each day and keep your long-term goals in mind.
Rest and Sleep
Limit your visitors.
While getting moving is important, getting enough rest is important for recovery.
Sleeping/lying positions
If you sleep on your side, use a pillow between your knees to avoid twisting your lower back. You may want to sleep with a night roll between your pelvis and ribcage (under your waist) to assist in supporting your lower back in a neutral position.
If you sleep on your back, use a pillow under your head. You can increase your comfort by placing a pillow under your knees.
Whether on your side or on your back, keep your spine aligned in a neutral position – avoid bending forward or to the side. Ask any questions concerning re-positioning with your nurse, physical and/or occupational therapist.
General Activity
Deep breathing, coughing, foot and ankle exercises are done until you are up and walking regularly.
Until you are comfortable repositioning yourself – ask your nurse and/or physiotherapist to assist you.
Sit up on side of bed or stand with assistance from your nurse or physiotherapist.
Your physiotherapist and/or nurse will assist with post-operative exercises and walking
Continue to exercise daily.
Sit up in your chair at all meals.
Walk with assistance.
If you have been instructed to wear a brace after your surgery – do not get out of bed until it is on properly.
Precautions to Avoid Damaging your Spinal Surgery
Each “new activity” that you restart after your surgery should be approached with caution; begin slowly and build up time, speed, and intensity in gradual stages. Move your lower back within tolerance. You should only experience mild discomfort.
DO NOT FORCE THE MOVEMENT, CONTROL THE MOVEMENT
If any particular movement produces pain, consult with your health care provider to determine if it is safe to proceed with that activity.
Avoid sudden, awkward jarring movements; a sudden shift off balance can strain or injure even a healthy back.
As a general rule, light work (i.e. desk job) may be started within a few weeks after surgery, and heavy work (e.g. manual labour) is usually not started before at least 6 weeks postoperatively. Get your doctor’s approval before starting sports or heavy labour. Also check with your physical and/or occupational therapist prior to returning to work to assist in addressing any ergonomic issues. You may have to return to work gradually.
Golf, curling, jogging, racket sports, tennis, weight lifting, and skiing are all sports that can cause you to re-injure your back if you are not careful. For any of these sports you should obtain professional instruction in proper back healthy techniques.
You should avoid sports that involve rough physical contact, where there is a higher stress to your back. The following sports should be discussed with your doctor: hockey, basketball, football, wrestling, snowmobiling, gymnastics, and diving.
Equipment
Your health care team may decide you need one or more of the following equipment items:
Bath seat, shower seat, or transfer tub seat
Raised toilet seat/commode
Wall grab bars
Non-slip surfaces in tub/shower, bath mat outside of the tub
Long-handled reacher, sock aid, elastic shoelaces, long-handled shoe horn
Long-handled sponge or brush
Sturdy, firm armchair, above knee height
Walker or cane
Any other items identified for you by your health care providers
Brace if indicated (needs to be properly fitted to your present body shape)
Some of the equipment is provided on a free loan basis by Saskatchewan Abilities Council and some will be purchased. A physical therapist or occupational therapist helps to determine what you need and where to get it. Plan on using the equipment for up to 3 months following surgery to help your lower back recover.
If you are travelling a long distance:
Plan to make frequent stops. Get out of the car to move and stretch when you stop. Make frequent changes of body position by changing the recline feature of your car seat.
Bring extra pillows and ice packs; use ice for 10 minutes at a time.
Remember to take your pain medications before you leave the hospital.
Sexual Activity
Communicate with your partner about your back condition.
Avoid staying in one position or repeating a movement for a prolonged period of time.
Begin with short sessions at the beginning, gradually building time as tolerated.
Plan to change position and/or technique often. Do not stay in a position if it is painful. Avoid excessive arching of neck and back.
Use pillows as necessary for extra support. Use a firm mattress or chair with good support.
Surgery may not totally remove the pain.
Pain is not always a sign of dysfunction or damage but may also be a sign of recovery of function, motion, and/or strength.
Getting back into performing activities may hurt after surgery. There may be discomfort but there is not any harm done to your healing back if you work with control, stop repetitive poor postures and poor work habits and perform your exercises properly.
Repetitive poor positioning is the most consistent cause of back problems. It can take three to six months of focus and work on your part to develop a new habit.