What to Know Before Your Spine Surgery

I would like to begin by welcoming you to the informational session on the lumbar spinal fusion. We would like to thank you for choosing the South Carolina Spine Center to provide your care and look forward to working with you and helping you in any way that we can. Our goals for today will include what you'll do at home prior to your surgery, give you some day of surgery instructions, talk about what to expect during your hospital stay, reduce any pre-surgical anxiety you may be having, talk about physical and occupational therapies role in your care, and how to care for yourself once you return home. I want to begin by discussing some of the terminology that you may have heard when you scheduled your surgery. It's common in any kind of spinal fusion to have a laminectomy, which is removal of the bone that's causing pressure on a nerve. The The discectomy is removal of the disc that is in many cases herniated. Fusion is permanently connecting two or more vertebrae to eliminate motion in the spine. The instrumentation that we use is titanium pedicle screws and rods. Bone grafts may also be used to assist with healing. The bone graft is the use of bone and tissue to fill a space. This may be harvested during surgery or in some cases, cadaver bone may be used. The image on your screen shows a disc herniation. On the left side of the screen, you'll see that the normal disc is intact and you see that membrane is totally intact all the way around. If you look at the image on the right, the herniated disc, the membrane is kind of ruptured and the contents of that disc are spilling out and they're compressing the nerve root. When the nerve root is compressed, that is what causes the pain that's either in your arms, legs, or your back. The goals of surgery are to relieve that pain. The next image that you'll see is the laminectomy, which is very common in this type of surgery. That's when we remove a piece of the bone to take the pressure off the nerve. You'll notice that the lamina is the horn shaped piece of bone that protrudes out. When the laminectomy is performed, that area of bone is removed, which decreases or eliminates the pressure on the nerve that is causing pain. If you look down at the bottom image, that just shows you a different view of the spine and the laminectomy. This is what a lumbar fusion looks like. When we fuse the spine, we secure everything with pedicle screws and rods that are made of titanium. have been safety and quality checked many times you should not have any problems with that hardware migrating out or moving it would take a pretty significant amount of trauma in most cases to do so we're going to begin by talking a little bit about what you'll do pre-operatively to prepare for your surgery it's very important as you prepare for surgery that you make sure your home has been put in order we want to make sure that you've shopped for groceries prepared or stored meals for people who have a lot of family around you know you may have a lot of help that might not be such a big deal for you but for other people who may be spending a lot of time alone fruit food preparation is a big deal so you want to make sure that you have things that you can easily warm or prepare for yourself you're not going to feel like standing and cooking meals You want to move regularly used items to counter or table height prior to your surgery. So after you have a lumbar fusion, you're not going to be able to bend and twist and get things out of lower cabinets that might be heavy or awkward. So we just ask that you prepare by putting those items in a place that you can easily access them without straining your back. You'll want to remove any throw rugs or electrical cords that could cause you to trip. You need to make sure that your your hallways and rooms are clutter free and well lit. We do recommend non-skid mats in your shower or bathtub. It will also be important to have a comfortable chair with high back rest and good arm rest for your recovery period once you return home. And you do want that chair to be stable or fixed. You don't want anything that could roll or move and increase your risk of falling. It's very important that you keep clean linen on your bed. We do not advise sleeping with your pets during the recovery period. We also suggest that you have someone assist you with caring for your pets. Large dogs can be a danger as far as knocking you down. Smaller dogs tend to get underfoot and can cause you to trip or fall. We also do not recommend cleaning cat litter boxes for the first few months. We would not want you to introduce any kind of foreign bacteria to your surgical incision site because this could greatly increase your risk of having a post-operative infection. Infection prevention will begin at home prior to surgery. The number one cause of surgical site infections in any type of surgery stems from the bacteria that resides on the skin normally. During pre-testing, the surgery scheduler would have given you three packets of CHG wipes. You'll start using those two days before surgery and the last pack will be used the morning of your surgery. You'll take a bath as you normally would. When you get out of the shower, you'll dry off, wet your CHG wipes, and then you will apply them to your body. If you'll look on page 16 in your surgical guidebook, there's a diagram that will assist you in proper application of the wipes. You will not use wipes on your face or your groin area, and the wipes are numbered. There are six in a pack. It tells you on the diagram which one to use on which body surface. I do advise that you pay particularly close attention to the lower part of your back. Have someone help you with that since that will be where your incision is located. The great thing about these wipes is that they continue to kill germs for several hours after application, so this is very important. not wash it off after you've applied them. If for some reason a rash develops, you do need to wash it off with soap and water and discontinue use of the wipes. It is not very common that you would have a reaction, but some people will get a little skin irritation from that. Be sure that you do not flush your wipes. They will cause major plumbing problems for you, so you need to discard those into a waste basket. The second thing that we'll do to prevent any post-operative infection will be to provide you through your pharmacy with an ointment called Mupiracin. It comes in a little tube. It will be called into your pharmacy once you're scheduled for surgery. You'll start using the ointment five days before surgery and we'll use it twice a day. You're going to apply a pea-sized amount to a cotton swab and you'll swab it into each side of your nose twice a day for that five days. The goal of the mupiricin ointment is to cut down on any bacteria that may be colonized in your nose. MRSA or MRSA as it's known to some people is colonized in the nose so we want to make sure if you have MRSA or MRSA that we are killing any germs that may be colonized in your nose just as an added layer of protection to prevent any surgical site infection. If you have not done so already, you'll be scheduled for the Ready for Surgery Clinic, which was formerly known as pre-testing, that has moved to the Tower Point location at 105 Vinecrest Court, right up the road from the hospital. Call 725-4002 if you need to change your appointment. We do request that you arrive five to 10 minutes prior to your scheduled time just to make sure that you get in and get to the right location in a timely manner. On the day of your pre-testing appointment, we ask that you bring any insurance cards you have, including private insurance, Medicare, Medicaid cards, and a valid photo ID, preferably a state issued ID. If you do not have that, we request that you bring a social security card and another form of ID. Bring all of your current medications in the original containers no pill boxes and also include anything that you take over the counter any vitamin or herbal remedies as well you may be instructed to stop or change some of your medications before surgery such as blood thinners insulin over-the-counter medicines they will give you the instructions for that when you have that appointment you will also be instructed what medications to take the morning of surgery a nurse will review your full health history with you. Your surgeon or anesthesiologist will order lab work and other tests to ensure that you're healthy enough for surgery. Commonly ordered tests would include blood and urine tests, a chest x-ray, or an EKG. Inform the surgeon of any infection, dental issues, fever, rash, etc. prior to surgery. We want to make sure that you're healthy enough since this is an elective surgery. Not doing so can lead to your surgery being canceled because we want to prevent any unnecessary risk or complications that could cause you problems down the road. The arrival time to the hospital. You will call the day before surgery, 725-4001 or 725-4002 between 12 noon and 5 pm the day before surgery. They will give you your arrival time for the following day. If for some reason your surgery is scheduled on a Monday, you'll call Friday between 12 and 5 to the same numbers and they'll tell you what time to arrive at the hospital on Monday for your surgery. On the day of surgery, when you get up, you will use your last pack of the CHG wipes prior to coming to the hospital. You want to make sure that you've prepared a bag that includes loose-fitting clothes. We recommend shorts, t-shirts, lounge pants or things that are not going to be binding when you move. You'll want something with a flexible waistband just for your comfort so that it won't irritate your incision. We do recommend walking shoes, no flip flops or sandals. You'll need these with therapy. It's very important that you have your back brace with you when you come for surgery. You'll need it the day of surgery, so be sure that your family does not take that back home. We also suggest that you bring your spine surgery guidebook with you. We will often refer you to the information in the book, and it also has a list of your follow-up appointment times and dates. On the day of surgery, you'll report to the Childbirth and Surgery Center entrance of the hospital on Spring Street. That is indicated with the yellow, red, and blue circle over near the B entrance on the main campus. The glass on that portion of the building is red, yellow, and blue panes, so it's easily recognizable. When you come through that entrance, a security guard will direct you on where to go from there. You can bring one family member with you the morning of surgery. Once your surgery is completed, the surgeon will come out and talk to you about how the procedure went and what to expect. Given the current climate with COVID, the visitation policy is subject to change, so please ask the surgery scheduler to clarify the current visitation policy. Due to COVID, there may be some unanticipated changes in that schedule from time to time. For the procedure, you will have general anesthesia. The anesthesiologist will review the health and medication history and discuss any nausea or pain management concerns. If you've had surgery before, it's very important that you discuss your prior anesthetic experience with the anesthesiologist so that we can customize your anesthetic so that you have the least likelihood of any kind of complications or problems from anesthesia. In the operating room, there's a CT scanner in the OR that allows the surgeon to precisely place the screws within a millimeter of accuracy using real-time imaging. This is very important to ensure that you have the best outcome and that the hardware is fitted in the proper place where there's no pressure on the spinal cord or the nerves. Postoperatively, on the completion of your surgery, you'll go to PACU, which is the post-anesthesia care unit. You'll have a one to two hour stay depending on how you feel. They'll stabilize your vital signs. They'll do a neuromuscular assessment, which means that they'll check your hand grips and your foot presses just to make sure that there are no problems. And they will also use comfort measures to make sure that your pain is well controlled, treat any nausea you may have or any other thing that comes up related to anesthesia. Throughout your stay in the hospital, you'll be asked to rate your pain on a zero to 10 scale. Your medication orders are based on how you rate that pain on the scale. From From zero to three we'll give you the mildest medication, from four to seven gives you something that's a little stronger in the moderate range, and from eight to 10 is considered severe pain and we will give you the strongest medication to ensure that you are able to remain comfortable and do what you need to do. We do have to take into consideration your oxygen levels, your alertness, your blood pressure, and other factors to determine if pain medications can be safely given. Some of the different types of pain that people who've had spinal surgery will experience would be incisional pain, which is exactly what that sounds like. That's pain at the incision site. It's a soreness. It's a pressure. It responds very well to the pain medications. The muscle spasms are the tight grabbing sensation in the lower back caused from going through the muscle during the surgery. We treat that with muscle relaxers three times a day, and typically it responds very well to that. The third type of pain, which is often what gets you into our office as a surgical candidate to start with, is the shooting, stabbing, or burning sensation in the arms or the legs. Please understand that the nerve pain may persist after surgery or may be slightly worse due to manipulation of the nerves during surgery. We do have some different treatment options for that. We often use gabapentin, Lyrica, or even steroids at the surgeon's discretion to control that pain. Some patients will wake up and be pain free, others it may take a little bit longer to heal. Do not be discouraged if when you wake up from surgery or in the first few days or weeks postoperatively you still have some leg pain that tends to bother you. That should get better with time as the inflammation heals. Remember, your Your pain medication will not make the pain go away completely. We aim to manage the discomfort so that you can eat, sleep, and participate in therapy. The pain medications are not scheduled. They do have to be requested. If for some reason the medication is not effective, please let your nurse know. We also encourage you to ask questions and be sure that you understand the pain management efforts that are in place. You'll also have a cold therapy unit. called a polar ice. If you notice in the image there, there is a cooler that has a long hose that goes to a pad behind your back or your surgical site. It circulates cold ice water to the incision site to decrease the pain and the swelling at the operative site, and most people really like that. It helps them to be more comfortable. There are two types of dressings that you'll be exposed to while you're healing from your surgery. On the left is the AquaSeal dressing. We use that in the hospital only. We will replace your AquaSeal at the time of discharge. When you go home, this dressing is waterproof. You can shower with it on. If for some reason that dressing starts to roll up, it's coming off, it's soiled and needs to be changed, we'll also provide you with the dressing on the right, which is called an island dressing, that can be replaced as needed at home if it becomes wet are soiled, but we do like for you to leave the AquaSeal in place for the first seven days as long as it's intact. You will also have a JP drain. If you notice in the image, there's a bulb that will be attached to a little bag. It will drain away the old blood that collects under the skin. The drain can stay in for up to three days. It will be removed prior to discharge. The blood that it drains from that surgical site is not useful to you so we simply pull it out from that incision site and discard it for comfort. The day of surgery you'll need your back brace. We will put that on anytime you're out of bed except for when you're showering. The therapist and the nurses will work with you on proper application of the brace. The spinal Some precautions will be reviewed with you by the therapist and the nurses. We call it the BLTs, no bending, lifting or twisting, and they'll work with you on how to avoid those things in your everyday activities. We do suggest that you not lift anything heavier than a gallon of milk. Physical therapy will begin the day of surgery as long as you're in your room by four o'clock. They'll work with you on getting in and out of bed, in and out of a chair, walking and climbing stairs. The occupational therapist will help you more with your activities of daily living, bathing, dressing, and your hygiene needs. The occupational therapist will provide you with a packet of assistive devices, a reacher, a sock aid, a long-handled shoe horn, and a bath sponge to help you to care for yourself without compromising yourself in bending, lifting, or twisting. Some of the equipment that you may need at home would include a rolling walker, a bedside commode, or a shower chair. Insurance will normally cover a walker every five years. Insurance will likely not cover a bedside commode or a shower chair. We are more than happy to prescribe those if you feel like you need them, but just be advised that most insurance will not cover them and you will have some out-of-pocket expense for those items. So we're going to talk a little bit about preventing post-operative complications. One One of the biggest risks for any type of surgeries is blood clots. So while you're in the hospital, you'll have these sleeves on your legs. These are called antithrombotic pumps. They pump up every few seconds. They'll give your legs a little gentle squeeze to make sure that the blood is not pooling in your legs to put you at risk for blood clots. It is very important that you get up walking frequently and walking early after your surgery to prevent any complications. We do ask that when you're sitting in the chair that you pump your feet and ankles a few times every hour. During commercials is a good time if you're watching television. That also helps return the blood that's pooling in your legs to your heart so that you're not set up for blood clots. Another risk of having any type of surgery is pneumonia. So on the day of surgery, a respiratory therapist will bring you an incentive spirometer. This is a device that helps us to exercise your lungs so that you're coughing and deep breathing properly and you don't end up with a pneumonia postoperatively. Anytime you have surgery, there's also a risk of infection. As you know, you'll be using your CHG wipes that you were given at pre-testing. You will also have the mupiricin ointment that you swab into your nose and you'll have IV antibiotics when you're in the OR. Any time that you're taking a lot of pain medications, you're at high risk for constipation or ileus, which happens whenever your digestive process slows down. It's very important that you're up walking frequently and early. We want to make sure that you're properly hydrated, and we will also use stool softeners to prevent any constipation or ileus from occurring post-operatively. It is very important that you not smoke in the post-operative period. drastically increases the risk of post-operative complications, including poor bone fusion, which means that the fusion just doesn't heal. It's called a non-union. Infection, the risk of infection is much higher when you smoke, and problems with adjacent levels at the fusion site, meaning the levels above or below the hardware are at risk for failing due to smoking. So it's very important that you not smoke or use any kind of nicotine in the post-operative period. If you need patches, please let us know. We will be glad to prescribe those for you in order to make you have an opportunity to be more successful. The Transition to Home. The discharge plan is discussed daily beginning the day of surgery by the surgeon, the physical therapist, the occupational therapist, nurses, case manager, the spine care coordinator. The discharge needs are determined on the PT and OT evaluation. Some of the discharge planning options may include home with your family or home with home health PT and/or OT, depending on what's recommended by the therapist. At discharge, you'll be given a list of medications to take. The list may include new medications. It may include changes to some medications that you took prior to surgery, including stopping or changing the doses. We ask that you take any pain medication you receive exactly as prescribed. In some cases, if your pain medication exceeds a certain amount, Narcan will be offered. It is not required that you fill it, but it is mandated by our state law that we offer you the prescription for it. You will avoid all NSAIDs. NSAIDs are your anti-inflammatory drugs, including Motrin, Advil, Aleve, BC powders, Goody powders, naproxen, a lot of arthritis medication, and aspirin. You will not be able to take those medications until your surgeon clears you to do so somewhere between the six month and one year mark after surgery. We do not want to do anything that could slow down the healing process after a fusion. If you need medication refills, we ask that you call the office. Calls received after 3:00 will not be called into the following day. Please call in any refill request at least 24 to 48 hours before you run out of medication to prevent any lapse in your medication. Caring for yourself at home. It's very important that you change your position hourly. You need to be up walking frequently inside your home, wear your braces instructed, which is anytime you are out of bed. No bending, lifting, or twisting. We want you walking daily and steadily increasing your distance. We do ask that you limit your stay or use the first week at home. I know in many cases it may be unavoidable to some point, but we recommend that you not do it any more than what you absolutely have to that first week. In the mail, you will receive a bone growth stimulator. This is what that device will look like. It will be mailed to your home sometime after surgery. You will not use this until around the one month mark, so don't be alarmed if you don't have it already. You'll be contacted by the DJO Global Sales Representative, who will schedule a demonstration. You'll use the device 30 minutes a day for the first four months after your surgery, beginning at the one month mark. We want to ensure that you're successful by encouraging you to have coaches, a family or a friend that can help you at home. Prior to discharge we'll review with that person how to change your dressing, signs and symptoms of a wound infection, the do's and don'ts of pain medication, signs and symptoms of a blood clot or pulmonary embolism, spinal precautions meaning no bending lifting or twisting, and then the application of the brace. We'll discuss how to assist the patient in and out of bed, up and down stairs, in and out of the chair, and then we'll also discuss the exercise program that you'll follow. We want to make sure that you guys understand exactly what care is needed at home and that you're set up for success. At any point during the process, if you have any questions, we ask that you contact the spine care coordinator at 864-725-5872. If you get a voicemail, we ask that you leave a detailed message including your name, date of birth, and the best contact number so that we can return your call and answer any questions that you may have. Once again, we'd like to thank you for choosing the South Carolina Spine Center for your upcoming surgery and we look forward to providing you with excellent care in the future and exceeding all of your expectations.

I'd like to welcome you to the informational session for the cervical spine surgery. We would like to thank you for choosing the South Carolina Spine Center and appreciate you entrusting us with your care. Our goals for today will include discussing what to do at home prior to your surgery, talk about your day of surgery instructions, what to expect while you're in the hospital, reduce any pre-surgical anxiety, talk about physical and occupational therapy's role in your care, and how you'll care for yourself once you're at home. I want to begin by discussing some of the terminology that you may have heard when you scheduled your procedure. A laminectomy is the removal of the bone that causes pressure on a nerve. The discectomy is removal of the disc. Fusion is permanently connecting two or more vertebrae to eliminate motion in the spine. The instrumentation refers to the titanium plates and screws that are used. And bone grafts are made of the bone and tissue that's used to fill the space. It can be harvested during surgery or in some cases may be cadaver bone. In the images that you see on the screen, on the left side you'll see is a normal disc. On the right side you'll see that the disc is herniated, meaning that the membrane is ruptured and the contents of the disc are spilling out, and they're compressing down on the nerve root on the right side. That is what causes the pain in your back, your arms, and your legs, depending on where the disc is herniated at. A laminectomy is when we go in and remove the lamina. The lamina you'll see on the left-hand side is labeled, and it is that horn-shaped piece of bone that sticks out at the bottom. If you notice, it's causing some pressure on the nerve. On the right side, if you look and see where the lamina has been removed, the circle in the center, which is the spinal cord, is now opened back up and that nerve root on the right side that comes off of the spinal cord is now freed up and that should relieve the pain that is occurring. If you notice the image down at the bottom of your screen. That is what the laminectomy looks like from a different angle. It is common to have laminectomies or some sort of decompression in this procedure. In some cases, you may be a candidate to have an artificial disc placed. If that is the case, this is what the artificial disc looks like. The recovery process for an artificial disc replacement is just a little bit different. We do not use cervical collars for the procedure once you're in the post-operative period. The next image is of the cervical fusion. This shows actually what the hardware that's placed in your neck looks like. This is plates and titanium plates and screws that are used to eliminate any mobility or instability in the spine once the pressure is taken off of the nerves in the spinal cord. Preoperatively, it's very important that you prepare your home for surgery you want to make sure that you have groceries in your home that you've prepared and stored meals that are going to be easy for you to warm up particularly if you're going to be spending a lot of time by yourself some patients may have a lot of family who's going to be around other people may be by themselves a little bit more so you want to make sure you have the things that you need prior to surgery we do suggest that you move regularly used items to counter our table height we do not want you reaching up overhead and working and doing things after surgery nor do we want you bending down and retrieving things from low cabinets as well. You need to remove any throw rugs or electrical cords that could cause you to trip. We want to make sure that your hallways and rooms are clutter free and well lit. We do suggest that you place non-skid mats in the shower or bathtub. Have a comfortable chair with high back rest and good arm rest. It's important that the chair that you choose for your recovery is stationary. We don't recommend anything with wheels or something that could easily slide out from under you and make you fall. You want to make sure that you have clean linen on your bed throughout the process. This just further reduces the possibility of your surgical site becoming contaminated. We do recommend that you have someone to care for your pets. Large dogs can often bump you or knock you down. Smaller dogs tend to get underfoot, and we certainly do not want you cleaning any litter boxes for the first few months after surgery. The last thing that you want to do when you have a back surgery is to risk getting a surgical site infection, and pets, if they're exposed to your incision site or if you're sharing beds with them, things like that, you can certainly increase your risk for infection. Infection prevention will begin at home prior to surgery. time you have surgery, the biggest risk of getting a surgical site infection comes from the bacteria that resides on the skin. So during pre-testing, you were given three packets of the CHG wipes. You'll start using those wipes two full days before surgery, and you'll use your last pack the morning of your surgery. If you'll look on page 16 in your surgical guidebook, you'll see a diagram that outlines how to use those wipes. There are six wipes in each packet. Once you wet the wipes, you go according to the numbers. It tells you exactly where to use those on your body. If you're having neck surgery, you need to pay particularly close attention to your neck, front and back, depending on where your incision is to make sure that you've really cleaned that area well. You will not apply the wipes to your face or your growing area. So you'll shower like you normally do. When you get out, you'll dry off, you'll wet your CHG wipes, and then you'll apply those to your skin. Do not wash them off once you've used them. If for some reason you have a rash, we do suggest that you wash it off with normal soap and water and discontinue using the wipes. And you can just let us know that you cannot use them. It's very uncommon that we have patients complain about any kind of reaction to the wipes, but if it's a problem, just let us know. Do not flush your wipes. They will cause pretty major plumbing problems. You need to discard them into the wastebasket. The second thing that we'll do will be to send in a prescription for mupiricin ointment to your pharmacy. We'll do that once you're scheduled for surgery. You'll use this ointment five days before surgery and you'll use it twice a day. So for application of the mupiricin ointment, you'll apply a pea-sized amount to a cotton swab and you'll swab both sides of the nose twice daily. This is to prevent any kind of MRSA, or as some people call it, MRSA infection postoperatively. MRSA is colonized in the nose, and you can often have it and not even realize it. So this will be to prevent any of those infections and cut down on any bacteria that might be colonized in your nose. So if you've not already been, you'll go to the Ready for Surgery Clinic, which is formally known as pre-testing. That is located right at the street from the hospital at the tower point office 105 van crest court If for some reason you need to change your appointment, you can call eight six four seven two five four zero zero two We do ask that you arrive five to ten minutes prior to your scheduled time You'll need to bring any insurance cards that you have including private insurance Medicare Medicaid and a photo ID We recommend a state issued ID if for some reason you do not have that bring your social security card and some sort of photo ID Bring all your current medications in the original container. No pill boxes. We do ask that you include any over-the-counter medications that you regularly take vitamins and herbal remedies You may be instructed to stop or change some of your medications before surgery such as blood thinners insulin or over-the-counter medications They will also instruct you on what medications to take the morning of surgery. The nurse will review your full health history. Your surgeon or anesthesiologist will order lab work and other tests to ensure that you're healthy enough for surgery. Some of the commonly ordered tests might include blood and urine tests, a chest x-ray, and an EKG. Please be sure and inform your surgeon of any infection, dental issues, fevers, rashes, or anything that occurs prior to surgery. Not doing so can often lead to surgery being canceled. This is an elective surgery, so we do not want to set you up for failure or risk any unnecessary complications, so any of these problems will need to be treated prior to having surgery. Your arrival time to the hospital. The day before surgery, you'll call 864-725-4001 or 725-4002 between the hours of 12 and 5. will be the day before surgery. They will give you your arrival time to the hospital the following day. If your surgery is scheduled on Monday, you'll call on Friday between 12:00 and 5:00 and they will give you your arrival time. On the day of surgery, when you get up, you're going to use your last pack of your CHG wipes. You'll need to make sure that you have loose-fitting clothes, such as shorts, t-shirts, lounge pants, something that's going to be comfortable and easy to move in. We do ask that you bring walking shoes, no flip-flops or sandals. They may increase your risk of falling. Your brace that was given to you prior to surgery, you will wake up in the recovery room with that brace already in place, so it's very important that it be with you. We also ask that you bring your spine surgery guidebook with you. We will often refer you to the information in the book, and it also has a lot of your follow-up appointment information. On the day of surgery, you'll report to the childbirth and surgery center entrance on the Spring Street side of the hospital. It is right down from the B entrance. If you notice on the diagram, it's coated with the circle that has the yellow, red, and blue on that side of the building. The glass panes on the side of the building are in those colors, yellow, red, and blue, So it's easy to recognize. You can bring one family member with you the day of surgery to wait in the surgical waiting area. Once your surgery is complete, the physician will come out and update your family on how everything went and where you can wait. Our visitation policy is subject to change, particularly due to the current state of COVID. We ask that you clarify any visitation related policies with the surgery scheduler. For the procedure, you will have general anesthesia. The anesthesiologist will review your health and medication history, discuss any nausea or pain management concerns that you have. This is a really good time for you to discuss any history you have with a prior anesthetic so that they can make sure that they customize your anesthetic so that you have the best outcome with the least likelihood for any complications. This is a image of the operating room. If you notice at the back of that image, there's a CT scanner that allows the surgeon to precisely place the screws within about a millimeter of accuracy. They use real-time imaging, and this ensures that your hardware is in correct placement so that you don't have any pressure on the nerves or the spinal cord from the hardware itself. This is something that improves the outcome and decreases the likelihood of any kind of complications. Postoperatively, you will wake up in the PACU. You will already have your neck brace on if one is needed. You'll be there for about one to two hours. They will stabilize your vital signs. They'll do a neuromuscular assessment. They'll ask you to squeeze their hands, press your feet up and down, just to make sure that you don't have any weakness. And they'll also provide any comfort measures you may need, such as pain medication, treatment of nausea, that kind of thing. During your hospitalization, you're going to be asked to rate your pain on a scale of 0 to 10. The pain medication is prescribed based on how you rate the pain on the pain scale. From 0 to 3, you're going to get the mildest medication. From 4 to 7, you're going to get something that's stronger. That's considered the moderate range. From 8 to 10, we consider severe pain, so you'll get the strongest medication. It's very important that you accurately rate your pain so that we can make sure you get the medication that's appropriate for you. Your oxygen levels, alertness, and blood pressure are factors in determining if pain medications can be safely given. Some of the types of pain that you may experience after spinal surgery would include incisional pain, which is exactly what it sounds like. That's the soreness or pressure at the incision site. It responds very well to the pain medications. Muscle spasms are the tight grabbing sensation. Typically, after neck surgery, it's down the back of the neck and across the tops of the shoulders. We treat that with muscle relaxers three times a day. The nerve pain is kind of a tough one. In many cases, that's what brought you to us to consider surgery as an option. The nerve pain is the shooting, stabbing, or burning sensation that's in your arms or legs. The nerve pain can persist after surgery and may even be slightly worse due to the manipulation of the nerves during surgery. This will get better over time. In some cases, you may wake up and be pain-free in your arms or legs, but that is not always the case. Don't be discouraged if you had that persistent pain in the first few days, weeks, or even sometimes months post-operatively. Some of the treatment options for the nerve pain would include gabapentin, Lyrica, or even steroids at the surgeon's discretion. Remember, the pain medication will not make the pain go away completely. We aim to manage the discomfort so that you can eat, sleep, and participate in therapy. The pain medications are not scheduled. They must be requested. We do ask that you let your nurse know if the medication is not effective. Ask questions and be sure that you understand the pain management efforts that are in place. Some of the possible side effects of pain medications would include constipation, drowsiness, dizziness, nausea, vomiting, and dry mouth or itching. If for some reason you have any of those side effects please let us know and we will certainly try to treat those as much as possible. It may be that we can add a different medication or change what we have ordered for you to try to make those side effects be improved or eliminated. An island dressing will be applied at the operative site at the time of discharge. The dressing should remain in place for the first seven days unless it becomes wet or soiled we will provide you with extra dressings in case you do need to change it at the seven-day mark you can remove that dressing there will be some little strips up under that dressing those strips need to remain on until they fall off by themselves that typically takes up to about two weeks but do not pull at those if you do pull at them you risk opening up your incision or even getting a surgical site infection you will commonly have what we call a hemovac drain after surgery. The drain is inserted near the operative site. It drains out any blood that could collect up under the skin. The drain normally is removed the day after surgery prior to going home. Your neck brace will be worn at all times except for in showering. The image on the left shows you the soft cervical collar, which is our most common collar that we use on the right for the more extensive neck surgeries we use an Aspen collar we do advise you to uphold your spinal precautions the BLTs as we call it your therapist and your nurses will be educating you on the BLTs that means no bending lifting or twisting the head and neck should be kept in a neutral position with a focus on turning the body not the head you cannot perform activities and involve working with your arms above your head during the post-operative period. Physical therapy will begin the day of surgery if you're in your room by 4 o'clock. They'll work with you on getting in and out of bed, in and out of a chair, walking, and climbing stairs. Occupational therapy will evaluate and assist with bathing, dressing, and hygiene. Assisted devices including a reacher, shoehorn, bath sponge, and sock aid can be provided if needed prevent bending lifting or twisting some of the possible equipment needs could include a rolling walker a bedside commode or a shower chair insurance will normally cover a walker every five years but it will likely not cover a bedside commode or a shower chair if you feel like you need those items we will certainly provide you with a prescription for those but they will likely include an out-of-pocket expense we're going to talk a little bit about preventing post-operative complications. Anytime you have surgery, blood clots is an increased risk. While you're in the hospital, you'll have antithrombic pumps, which will be applied to your legs. They pump up and give a gentle squeeze every few seconds to prevent the blood from pulling in your legs. We do ask that you leave them on at all times unless you're walking. We also will encourage you to walk early and frequently. When you're sitting watching television or resting in your chair, we ask that you do foot and ankle pumps every few minutes throughout the day while you're awake. A good time to remember to do those is during commercials. Anytime you have surgery, you're also at higher risk of having pneumonia. So on the day of surgery, a respiratory therapist will bring this device to your room. It's called an incentive spirometer. This is used to exercise your lungs and to really expand them so that you're not at a higher risk of having pneumonia. We do like for you to use this several times each hour while you're awake during the day. Your risk of infection will be prevented by using the CHG wipes that you began at home. We'll also use the mupurasin ointment in your nose twice a day, and you'll receive IV antibiotics and the OR. Anytime that you have surgery and you're immobile, you are taking pain medications, you're going to be at risk for constipation and an ileus, which just means that your digestive track really slows down. We encourage early ambulation, meaning walking. We want you to be properly hydrated and we'll also use stool softeners to prevent any problems for you. It is very important that you not smoke or use any type of nicotine. People who smoke have a drastically higher risk of having post-operative complications, including poor bone fusion or what we call a non-union, the risk of surgical site infection, and problems with the spine above or below the level of the fusion. Transition to home. The discharge plan is discussed daily beginning the day of surgery by the surgeon, the therapist, the nurses, the case manager, and of course the spine care coordinator. The discharge needs are determined through the occupational therapy and the physical therapy evaluations. Your discharge planning options might include home with your family or home with PT and OT home health. At discharge, you'll be given a list of medications to take. The list may include new medications, and some of the medications taken prior to surgery may be changed or stopped until a later date. You need to take your pain medication exactly as prescribed. In some cases, if your prescription exceeds a certain amount of pain medication per day, you'll be offered a Narcan prescription. It is not required that you have it filled, but it is required through state law that we offer that prescription to you. You will avoid all NSAIDs, that is the anti-inflammatory drugs, Motrin, Advil, Aleve, Naproxen, BC Goody Powders, arthritis medicines, and aspirin until cleared by your surgeon around six months to a year after surgery. Anytime you need medication refills, we ask that you call the office. Calls received after three o'clock will not be called in until the following day. We ask that you give us at least a 24 to 48 hour advance notice before you run out of your medication to ensure that we can get your refills sent in in time. Caring for yourself at home. You need to change your position hourly. You should be up walking frequently. We want you to wear your neck braces instructed. No bending, lifting, or twisting. We don't want you to lift anything heavier than a gallon of milk. You need to be walking daily and steadily increasing your distance. We do ask that you limit your stair use the first week at home. I know in some cases it may be unavoidable, but you want to limit it as much as possible those first few days. After your surgery, you will receive a bone growth stimulator in the mail. This will be shipped to you by DJO Global Sales. The representative will contact you and come out and do a demo for you. This is just something to help the bone heal faster and to be stronger. You won't begin using that until about the one month mark. Once you do start using it, you'll use it 30 minutes a day for four months, just to help ensure that you have the best bone growth. We wanna make sure that you have a family or a friend who works as your coach. They need to know how to change your dressing, signs and symptoms of wound infection, pain medication do's and don'ts, signs and symptoms of blood clots and pulmonary embolism, spinal precautions, meaning no bending, lifting, or twisting, how to properly apply your brace, how to assist the patient in and out of bed, how to assist the patient up and down stairs, and then also be familiar with the exercise program that you'll be following. If your family or friends have questions, then we are certainly willing to perform any education that is needed to make sure that they are able to assist you with your care once you get home. At any point during the process, if you have questions regarding your care, please contact the Spine Care Coordinator. The number's 864-725-5872. We'll be more than happy to help you in any way. We would like to thank you for joining us today. We appreciate you entrusting the South Carolina Spine Center with your care and look forward to serving you.