Pre-admission Spine Surgery Education

1. Pre-admission Spine Surgery Education

2. Preparation Recovery Surgery What we will cover today… • Understanding your spinal procedure • Preparation for surgery • Day of surgery expectations • Discharge Instructions • Recovery Process

3. Spine Anatomy • 7 Cervical • 12 Thoracic • 5 Lumbar • Sacrum and Coccyx • Provides us strength • Allows us to stand • Supports our weight • Passageway for spinal cord and nerves

4. Understanding Your Surgery Laminectomy Creation of a “window” in the vertebrae. This allows more room for nerves and releases pressure on the nerve

5. Understanding Your Surgery Discectomy Creation of a “window” in part of the outer ring of the disc. This allows removal of a portion of the disc nucleus releasing the pressure on the nerve

6. Understanding Your Surgery Fusion A graft ( bone or bone protein material) placed between 2 or more vertebrae. Provides stability to the spine- many times screws are used to maintain stability while healing occurs.

7. Understanding Your Surgery • How fusion is done • Bone Graft • Immobilization • Types of fusion • Posterolateral • Interbody • ALIF • PLIF • TLIF • XLIF

8. Preparation for Surgery • Obtain all required pre-admission testing recommended by surgeon and bring information to Pre-Op (may include blood work, EKG, chest x-ray, medical clearance from primary doctor, or self-donated blood) • Clear all medications with your physician, including any herbal substances or nutritional supplements you may be taking • Bring All insurance cards & picture identification to Pre-Op • Do not eat or drink after midnight the night before your surgery

9. What to bring to the hospital… • Personal care items (such as toiletries) • Rubber soled / non-skid shoes or closed back slippers • Comfortable clothing for therapy • Loose fitting pajamas and /or light weight robe • Bedside snacks • Important contact phone numbers • List of medications, including the ones you may stopped prior to surgery, dosing information • Eyeglasses instead of contacts • Dentures / hearing aids if needed • Brace if you have one and are asked to bring it • Walker or cane if used at home • Important: Leave allvaluables at home!!!

10. General Health Guidelines • Weeks before the surgery, you should concentrate on the following: • Nutrition • Eat healthy • Drink plenty of fluids • Do not drink alcoholic beverages • Stop smoking • Take your daily medication as directed by your physician • Discuss with your physician any nutritional and/or herbal supplements you are taking

11. Day Before Surgery… • Pre-operative shower • Take the evening before or day of surgery • Wash with Triseptin soap provided at pre-op • Do not eat or drink after midnight • As directed by your physician, take required medications with a sip of water only

12. Morning of Surgery • Your specific surgical time will be determined at your pre-op visit • Report to the Main Lobby at the time appointed in your pre-op visit • Surgery will last 1-2 hours • Time in the recovery room is generally 1-2 hours • During surgery your family will wait in the surgical waiting room • After recovery, you will be transferred to the nursing unit on 2 South where family members can see you

13. Evening of Surgery… • Following your surgery, you may have: • Intravenous therapy (IV) to provide fluids, medication and/or antibiotics • Drain at your incision site which prevents fluids from building up • Urinary catheter to help drain your bladder • Foot pumps to prevent blood clots • Incentive spirometer to help with deep breathing exercises

14. Pain Management • You will see anesthesia at your pre-op visit • General anesthesia or a spinal anesthetic will be administered during surgery • Pain relief options after surgery include: • Epidural anesthesia • Patient controlled analgesia (PCA) pump • Injections (as needed) • Oral medications (as needed)

15. Pain Scale • 10 Worst possible pain 9 8 Very severe pain 7 6 Severe pain 5 4 Moderate pain 3 2 Mild pain 1 0 No pain

16. Blood Clot (DVT) Management • Leg exercises and support stockings (TEDS) or foot pumps help keep the blood flow in your legs moving and to prevent blood clots (DVT) How it happens…. Ways to help prevent it…

17. First Day After Surgery • During your first day of recovery, you may have or begin: • Lab tests • Intravenous (IV) fluids, catheter and/or your drainage tube removed • Your dressings or bandages changed • To turn, ambulate, deep breath and use your spirometer • Dressing and bathing activities • Physical and Occupational Therapy

18. First Day After Surgery • Working with physical/occupational therapy to participate in walking, exercise and daily living activities programs • Working with a Case Manager or Nursing staff to prepare you for the next level of care, your discharge location and any equipment needs • Take pain medication as needed in order to participate with therapy

19. Getting In and Out of Bed Roll your entire body instead of twisting at the waist Once on your side, ease your legs off the edge of the bed to sit up

20. Second Day After Surgery • Depending on your surgery, your recovery progression and your surgeon will determine if additional days are required in the hospital. • During your second day in the hospital you will • Continue to work with physical and/or occupational therapy • Continue to deep breath and use your spirometer • Continue to discuss discharge planning • Take your pain medication as needed

21. Discharge Criteria • You will be discharged from the hospital when you are able to: • Eat and drink to prevent dehydration • Empty your bladder without any problems • Effectively manage any pain • Increase your mobility (walking and exercising) • Have bowel movement without complications

22. Discharge Instructions • Your physician, nurse, or physical therapist will discuss the following: • Spine precautions and special instructions • Pain control and prescriptions • Signs of infection or problems • Bandage changes and care of incision site • Approval for driving, sexual activity, and any other physical activities

23. Back Precautions • Proper lifting techniques • No bending or twisting back • Keep back straight • Limit sitting in upright chairs to 10-15 min • Log rolling to get in and out of bed • Do not lay on your stomach Further instructions will provided at your post-operative physician appointment.

24. Recovery

25. How to prepare your home for discharge • Make modifications to your home prior to surgery that will decrease your risk for falls or injury

26. Preparing Your Home

27. Home Safety Tips… • Remove or tack down throw rugs • Remove clutter from hallways and walkways • Keep electrical and telephone cords safely out of sight (Use cordless phone, if possible) • Rooms and hallways are well lit for visibility • Safety and grab bars are installed as needed • Keep items in the kitchen/bathroom at waist level for accessibility • Arrange pet care, if needed

28. Recovering at home… • Things to keep in mind: • Keep your incision clean and dry • Shower with mild soap and do not put any creams on your incision • Take your medication as prescribed • Progressively increase activities as directed • Use proper lifting techniques. Do not lift anything heavier than a light bag or book • Sit in a supportive chair with arms • Keep your walking areas free of clutter • Keep moving!!

29. Frequently used equipment/aids • If prescribed by your physician, a case manager / nurse / therapist will educate you on the use of these assistive devices: • Canes • Rolling Walkers • Elevated commode seats • Bedside commode or 3 in 1 commode • Back/neck braces • Pillows to be used when sleeping • Ankle pumps • Reacher • Sock aid

30. When to call the doctor • Chest pain or difficulty breathing – Call 911 • Sudden inability to move your leg(s) – Call 911 • Fever above 101° • Pain in your back, NOT relieved by medication • Unusual redness, heat or drainage from your incision site • New numbness/tingling in your leg(s) • Changes in bowel or bladder

31. Steps WE take for Safer Surgery To avoid infection: • Antibiotics To Avoid Blood clots: • Anticoagulants • Foot Pumps To Avoid Heart Attacks: • Talk with your doctor about your medications Courtesy of the Surgical Care Improvement Project Partnership (SCIP)

32. Safer Surgery Continued.. • To avoid pneumonia • Pneumonia vaccine is available, if ordered by your physician • Early mobilization (or getting out of bed) • Incentive Spirometry • To avoid flu • Flu vaccine is available, during flu season, if ordered by your physician

33. Surgical Site Infections • Precautions are taken prior to and during surgery to reduce risk • Smoking increases risk. Ask us how to quit! • Make sure your doctor and healthcare providers wash their hands or use sanitizer before exams, ask “Did you wash your hands?” • Clean your incision based on your discharge instructions daily until follow-up with your doctor • Call your Doctor if you have any signs or symptoms of infection (redness, increased pain, increased drainage, fever)

34. Questions? • Thank you for reading through this presentation. If you have any questions, you may call our Human Motion Institute Spine Line at 706-651-2449.