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Preparing for Spine Surgery: What You Need to Know as a Patient

dr carlsonJeffrey R. Carlson MD, MBA, CPE, FAAOS

Spine surgery is a major procedure which requires thorough preparation to maximize all factors for a successful outcome. I want to offer my insight and practical recommendations to patients preparing for spine surgery based on my many years of medical practice and observing what works best for my patients.

Preoperative Assessment

Before the surgery, a comprehensive medical evaluation is necessary to assess the patient’s overall health and identify any potential risk factors. This assessment typically includes medical history review, physical examination, and diagnostic tests such as MRI scans, or CT scans., lab work, EKGs, etc. It is also crucial for patients to provide accurate information about their medical conditions, medications, allergies, and previous surgeries to enable my team to make informed decisions.  Do you have dental issues that need to be taken care of?  You need to do it before surgery.  Is your A1-C too high?  You’ll need to get that under control before you will be allowed to undergo anesthesia.

Medical Clearance

Patients with chronic medical conditions (such as heart disease, diabetes, or high blood pressure) may need to obtain medical clearance from their primary care physician or a specialist before undergoing spine surgery. This clearance typically involves a review of the patient’s medical history, a physical examination, and laboratory tests. The goal of medical clearance is to ensure that the patient’s medical condition is well-controlled and that there are no underlying health issues that could pose a risk during or after surgery.

Lifestyle Modifications

To optimize your surgical outcome and minimize complications, certain lifestyle modifications are recommended. Patients should focus on adopting a healthy lifestyle that includes regular exercise, a balanced diet, and maintaining a healthy weight. Smoking cessation is particularly important, as smoking can significantly impair healing and increase the risk of surgical complications.  It is particularly detrimental to spine surgery patients and many published research studies show that smoking increases back pain, even without surgery.

Prepare the Home Environment

I advise my patients to prepare their home environment before undergoing spine surgery to ensure that they have a safe and comfortable place to recover. This may involve making modifications to the home, such as installing handrails or grab bars in the bathroom or bedroom, removing loose rugs or other tripping hazards, and ensuring that the home is well-lit.  If you need an assistive device, like a walker, practice using it in your home BEFORE surgery.  You probably will have in-home Nursing and Physical Therapy after surgery – is there a clear and safe space in your home for these professionals to examine/work with you?

Go shopping before your surgery and stock up on easy-to-heat meals and food items that won’t take much prep time or work.  Have your comfy clothes or pajamas ready to go so that you can slip right into them when you get home.  Accept offers of help from friends and family while you recover.

Emotional Preparation

Spine surgery can be emotionally and physically challenging, and it is essential for patients to prepare themselves mentally. Understanding the surgical procedure, potential risks, and expected outcomes can help alleviate anxiety. Patients are encouraged to ask me questions and seek additional information or resources to gain a better understanding of the surgery. Setting expectations appropriately and understanding that some discomfort and inconvenience is normal during surgical recovery will help you to put your situation in proper perspective.

Medication and Nutrition:

Patients should follow my instructions (or those of their pain management physician) regarding medication management before surgery. Certain medications, such as blood thinners, may need to be adjusted or temporarily discontinued to minimize the risk of excessive bleeding during surgery. NSAIDs may also be restricted during the pre- and post-operative period.  Certain supplements and vitamins may also need to be restricted.

Post-operative Constipation

Narcotic pain medications given during and after surgery slow the digestive tract and frequently cause constipation. Be prepared and purchase stool softeners, laxatives, psyllium fiber or prunes ahead of your surgery.  If you notice you aren’t regular, start taking action immediately, before a small issue becomes a big problem.

Pre-operative Instructions

Patients will receive specific instructions regarding fasting before surgery, showering with antibacterial scrub for three days prior to surgery, and medication intake before surgery. Compliance with these instructions is crucial to ensure a safe surgical procedure. You must arrange for transportation to and from the hospital or surgical center, as driving after spine surgery is not allowed due to the effects of anesthesia and postoperative pain medication.

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