Major Spinal Surgery Patient Advice
PRE-ADMISSION ADVICE & CONSENTING
Your specialist will discuss your surgery with you during your consultation. A detailed explanation
in a simple and understandable format will be given regarding your surgery, recovery and
achievable post-operative goals. You will be invited to sign an informed consent for your procedure
and given the opportunity to ask any further questions.
If suitable you may attend your nurse/physio led health check on the same day or be invited to
attend at a later date depending on your surgery scheduling. At this time a full medical survey will
be compiled and any blood tests, X-rays and heart traces will be completed.
A physiotherapist will assess your mobility and home needs and advise as appropriate.
All anticoagulants including aspirin/diclofenac/clopidogrel should be stopped 10 days before and
the combined oral contraceptive pill should be stopped 6 weeks before the operation.
PACKING FOR THE HOSPITAL
Bring your pyjamas or loose fitting clothes that can loosely fit over your dressings. Also think about
your footwear, ideally something with a back that is easy to get on and off.
Mr O Von Arx Orthopaedic Consultant at CircleBath
DAY OF OPERATION
From midnight the day of the operation you should not have anything to eat or drink as a routine
precaution for the anaesthetic.
Prior to your surgery, you will meet the anaesthetist and your specialist, giving you the opportunity
to ask any further questions.
AFTER THE OPERATION
After the operation you will go to the Recovery Area as a routine for close and careful monitoring.
After the operation you will be allowed to roll and move freely in bed as comfort allows.
You will have an intravenous drip in your arm, which will be used to give you fluids, painkillers and
also other medication. You can have clear fluids (sips of water) during the post-operative period or
suck on ice cubes.
During your post-operative period you will be given painkillers either into your drip or to be taken
orally and all you need to do is to ask the nurses caring for you for the medication if necessary. It
is sensible to take these regularly to aid your recovery.
As soon as possible the drip will be removed from your arm and you will be able to start a light
diet.
A bladder catheter is occasionally inserted just before the start of the operation to avoid
discomfort while passing urine for the first few days. Laxatives are also given to try and reduce
constipation.
Your wound will be inspected at approximately 2 – 4 days after surgery. There should be no sutures
that need to be removed because a dissolvable stitch will have been put in. Only short little
adhesive tapes (which are not painful to remove) will be across the wound. You should be able to
have a shower about 4-5 days after the operation. If you have a waterproof dressing you may
shower as soon as you feel comfortable to do so.
PHYSIOTHERAPY
Your physiotherapist will advise you on the best way for you to get in and out of bed and give you
advice on how to get the best result from your surgery.
You will be shown exercises to help you mobilise and to begin strengthening your core muscles.
The first day after surgery a gentle attempt will be made to mobilise you, usually by a
Physiotherapist.
I do not recommend any alterations to your living environment i.e. raising of your bed or seating. I
recommend patients to use a kitchen or dining room type of chair rather than a low-slung sofa.
Your level of comfort should guide your level of activity.
Mr O Von Arx Orthopaedic Consultant at CircleBath
DISCHARGE
You will be discharged usually between 3-5 days after the surgery but this can vary depending on
age, operation outcome, home circumstances, etc. Your specialist and physiotherapist will assess
your safety for discharge and advise you accordingly. Prior to your discharge you will be given the
date of your follow up visit as well as an adequate number of painkillers to help control any further
discomfort you may be experiencing. It is normal to have a certain amount of discomfort after any
operation, but as time goes by this will gradually recede.
RETURN TO WORK & ACTIVITY
In general terms, the greater number of patients will spend the first week indoors or in the
environment of their house. You will feel like venturing out after this and return to driving at
around 4-6 weeks.
It is impossible to give you an exact time as to when you may resume work. It is unrealistic to
expect to get back to heavier types of work in under 6 months and some people doing heavy types
of work may never return to bending, stooping, and lifting types of work. Generally speaking, for
people who have had a spinal fusion they should be able to return to work at approximately 12
weeks. Preferably try and arrange things so that you do part time for the first 2-4 weeks back at
work.
This advice will be supplemented by any specific relevant advice to your procedure.
POSSIBLE COMPLICATIONS RELATED TO SPINAL OPERATIONS
Any operation has the potential for complications whether it is a minor or major procedure. The
more major procedures do have higher chances of complications or untoward side effects. All
spinal surgery is major surgery.
1. There are certain possible complications relating to having any general anaesthetic. Spinal
surgery as a general rule cannot be done under local anaesthetic.
2. Wound infection occurs very infrequently (in much less than 1% of patients). All precautions
will be taken to prevent a wound infection. You are given antibiotics, meticulous sterile
techniques are used, suction drains are inserted and a special ultra clean air laminar flow
surgical operating theatre is used to try and minimise infection.
When having a repeat operation or revision surgery the chances of infection are higher and
Diabetic patients generally have a higher chance of infection. The chances overall of you
getting an infection are however extremely small.
3. Deep Vein Thrombosis (clots in the legs) and Pulmonary Embolism (these clots moving from
your legs to your lungs) are a risk as with any surgery.
You will be shown exercises to try and minimize the chance of blood clots forming in your
legs. Special stockings (TEDS) will also be given to you to help to try and prevent them
forming. We deliberately do not use blood thinners (Warfarin or Heparin) while doing spinal
operations because these can increase bleeding around the spinal cord.
Mr O Von Arx Orthopaedic Consultant at CircleBath
4. Occasionally a blood transfusion is necessary. We try to avoid giving blood transfusions but
sometimes this is unavoidable. Modern tests also mean that acquiring a transmissible disease
through a blood transfusion are exceptionally small.
5. If you have a spinal fusion, instrumentation is sometimes used (screws and rods placed into
your vertebrae). The aim of the instrumentation is to hold the spine firmly clamped
together in position while waiting for the bone graft to knit (fuse) together. There is a very
small risk of misplacing your metalwork necessitating a further rectifying procedure.
6. Any spinal operation involves working on or around your spinal cord and nerves supplying the
bowel, bladder and legs for the most of the operation. There is always a chance that these
nerves are damaged in the chances of this happening are extremely small. The coverings of
the nerve and spinal cord (dura) are tissue paper thin and can be torn during some
operations because they are stuck down. If a tear occurs it may be repaired by microscope.
Sometimes however this is not technically possible or safe in which case we will keep you
lying in bed for a few extra days while waiting for the tear to heal on its own. It is important
that you are aware of these potential complications.
7. Occasionally, bone graft is taken from the pelvis, which may lead to some immediate
discomfort post-operatively and very rarely discomfort in the long-term.
8. .At the end of the procedure, great care is taken to ensure that no local bleeding will occur.
There is a reported complication of cauda equina syndrome, which is compromise of the
nerve supply to the bowel and bladder caused by a local clot at the surgical site. You will be
carefully observed for the first 12 hours and taken back to theatre if there is any concern.
We will gladly answer any queries you may have.
Mr Otto Von Arx, Consultant Orthopaedic Spinal Surgeon
Mr O Von Arx Orthopaedic Consultant at CircleBath