In the case of planned surgery, the following is important:
The use of blood thinning medication is dangerous if not stopped in time before surgery due to the decreased clotting that blood thinning medication causes. This can lead to uncontrollable bleeding during surgery. It is important to stop taking Aspirin at least ten days prior to surgery. If you are taking Warfarin, this should be stopped according to instructions from your physician or anaethetist.
If you are taking other chronic medication it is important that you check with the sister whether you should be taking these on the morning of surgery or not.
Please notify the staff if you have had any cardiac surgery, have a pace maker, are a diabetic, have allergies or previous unnatural reactions to medications or suffer from any infective diseases. Make sure that you understand when it is that you should stop eating and plan your trip to the hospital so that you do not have to rush to the hospital on the day of admission.
Wear comfortable clothes and slip-on shoes and pack nightclothes and toiletries. Leave valuables at home, hearing apparatus, spectacles and dentures should be taken along.
The operation
You will be allocated a slot on the theatre list and this is usually an indication of when you can expect to go to theatre. There is however several practical and technical reasons that your operation slot may be changed. Sometimes an emergency case will cause a long delay and your operation might even have to be cancelled. This is however unusual.
At some stage following your admission, the ward sister will notify you that your turn has arrived and you will be taken to theatre on your bed and wait a short while in a staging area. You will then be moved into the theatre and you will usually be asked to move over to the theatre table. The anaethetist will put a drip up to allow the anaesthetic agents to be administered. It is usual that the medication will cause a burning feeling in your arm as you are put to sleep.
This is normal and will quickly pass over. All vital signs (heart rate, blood pressure, breathing, oxygen concentration of the blood and many more parameters) will be measured for the full duration of your operation.
Please see the section on procedures and operations for technical data about the operation that your surgeon is suggesting.
A drainage pipe will usually be placed in the wound at the end of the operation and connected to a reservoir. This will allow all excess blood to drain away. Following the operation, you will be taken to the recovery room to recover from your anaesthetic.
Thereafter you will be moved to the ward and the ward will monitor your recovery, assist with your rehabilitation and administer analgesia for any discomfort that you may experience.
What are the possible complications of the operation?
We do not expect to encounter any complications. Spinal surgery is however not risk free and you have to be sure that you understand the more well-known complications.
Risk:
There is a risk that the pain, pins and needles or weakness that you currently experience might not improve following surgery.
Explanation:
If the nerve compression has been too severe or too prolonged, it may be irreversible. Nerves can be unforgiving and may lose part of - or complete function.
Risk:
There is a chance of wound infection that might require antibiotic treatment and in some cases a second operation. In very rare cases, infection might spread and become so severe that it may cause death.
Explanation:
Even with the most advanced modern antiseptic techniques, infection can occur. The frequency is at average about 1 in 300 cases
Risk:
There is always a risk of bleeding in any surgery. This may be during or following surgery. This may lead to obstruction or damage of nerves in the period directly following the operation. Severe bleeding during the operation might require a blood transfusion, but this is rare. In extreme cases it may lead to death.
Explanation:
At the end of surgery, all the bleeding arteries are closed with an electric cautery. These blood vessels may however open up again and start bleeding. If the blood clot grows large it may compress important structures like nerves and can lead to nerve dysfunction. The surgeon however will inspect the wound carefully before the wound is closed and even the smallest bleeding point is stopped. The risk for a significantly big clot is about 1/300.
Risk:
During surgery there is a risk of damage to the nerves or spinal cord which can lead to weakness or paralysis. It can also lead to loss of sensation and other nerve controlled functions including the bowel, sexual and bladder function. This may be temporary or permanent. This however a very rare complication reported to have a risk of 1/1000 or less.
Explanation: The spinal cord and the nerve roots that are attached to them are directly in the area where the surgery is performed. Direct pressure against these structures or blood clots can cause damage. Sharp instruments can damage nerves permanently.
Risk:
There is a risk that the bony fusion that is part of some of the spinal procedures will not grow, leading to follow up surgery to support the fusion. If you are a smoker or use steroids or Warfarin, there is a definite risk that the bony fusion will not grow. It is imperative that you stop smoking before a spinal fusion operation.
Explanation:
The aim of some of the operations is to remove the disc between the two vertebral bodies and to allow a fusion to grow between the two vertebraes. This is facilitated by placing bone between the two vertebraes. In smokers the bone does not grow as well and causes non union of the fusion.
Risk:
There is a risk that you might develop a blood clot in the veins of your legs, called a deep venous thrombosis. This thrombosis can spread to the lungs and heart and can cause death.
Explanation:
This is a risk in all long operations and in operations where you lie in bed for a day or longer. This is because of sluggish flow of blood in the veins. The risk can be lowered by applying compressive stockings as well as foot pumps that keep the blood flowing. It is also important that you should get up and move around as soon as you are allowed.
Risk:
Although it is extremely rare, there is a risk that you may die during surgery because of an anaesthetic complication. Because of modern techniques this risk is now less than 1/10000.
Explanation:
Unexpected events can take place during or after operations. This can include reactions to medications, heart attacks, strokes, kidney failure, lung failure, blood clots in the legs or severe infections. Each one of these conditions will require further treatment and rarely these can be serious enough to lead to death.
Discharge
You would normally be discharged between two days and one week after surgery, depending on the type of surgery. Staff at the hospital will take care of your follow-up consultation, analgesia to take home, sick certificate and wound care provisions in the post-operative period.
Rehabilitation
It is incredibly important to get a lot of rest and exercise following your surgery. Do not try to rush back to work. It is important to walk for exercise and also exercise in conjunction with the guidelines from your physiotherapist. You may perform activities only as prescribed by your health care provider. You should refrain from exercises that involve impact for at least three months. This would include jogging, mountain biking and equestrian pursuits.
Follow up
You will usually be seen after six weeks but will be seen earlier if there are any complications. In cases of spinal fusion you would usually undergo an X-ray of your back a few months after the operation to evaluate the bone growth between the two vertebrae. It is important that this bony growth takes place; otherwise the operation might have to be repeated.
It is important to realise that you will have to protect your back the rest of your life with good back habits. See the section on exercises to see what you can do to keep your back healthy.
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