Patient information. Information for Patients Undergoing Lumbar Spine Surgery. Trauma and Orthopaedic Directorate PIF 1357/V3

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1 Patient information Information for Patients Undergoing Lumbar Spine Surgery Trauma and Orthopaedic Directorate PIF 1357/V3

2 Your Consultant / Doctor has advised you to have Lumbar Spine Surgery. How is the spine constructed? The spine is constructed in two parts, your spinal column which consists of the bones, (your back bone) and your spinal cord which consists of the nerves of your spinal cord that pass messages through from your brain to your body and back again. Spinal column The spine is made up of small bones called vertebrae which all sit on top of each other to form your spinal column. The vertebrae get larger as they go down your spinal column, with the largest being in your lumbar (lower back) area.

3 To stop these bones from rubbing on each other you have intervertebral discs. These are soft cushions of tissue, which sit in between each of the bones in your spinal column and act as shock absorbers, stopping your bones from rubbing on each other. Your spinal column is very strong and flexible, it is held in place by many structures. Your cervical (neck) and Lumbar (lower back) areas are more prone to problems as these are the areas that move the most to allow us to move our head and bend and stretch. Spinal Cord Your spinal cord consists of millions of nerve fibres which run through the middle of your spinal column. Your spinal cord, and the nerves it is made of, act in a similar way to a telephone exchange passing information from your brain to your body and back again. At the level of each bone (vertebra) your spinal cord sends out one nerve on the right side and one on the left side. These nerves contain hundreds of nerve fibres that transmit messages between your body and brain. The cervical vertebrae are in your neck, thoracic are in your trunk and the lumbar and sacral are in your lower back. Any problems with your spinal column that causes pressure on your spinal cord or nerves can cause problems with feeling and/or movement. The nerves in the lower back are responsible for the feeling and/or movement from below your waist, and so any problems in the lower back may result in symptoms in this area. What are the benefits of having Lumbar spine surgery? The aim of surgery for problems with your spinal column or spinal cord and/or nerves, can be performed for many reasons. Your doctor will explain these to you and the risks/complications involved. It is important that you understand, that spinal surgery is often performed in order to prevent any further deterioration in movement or sensation if nerves and/or spinal cord have sustained damage, quite often over a long period of time. The damage already caused to the nerves or spinal cord may not be reversible, despite surgery to remove the problem. This is why surgery is often offered in order to prevent any further deterioration rather than to guarantee any improvement. What are the risks of having spinal surgery? All the risks will be discussed with you prior to your surgery and although they are not common you should be aware that there is the potential for them to occur. Risk from anaesthetic. Small risk of increased pain in back or leg. Risk of injury to the nerves causing weakness or numbness in the legs, including the nerves to the bladder, bowel and sex organs. Leak of spinal fluid. Infection. Haematoma (DVT, PE) Blood Clot. Are there any alternative treatments available? It is your decision if you wish to have surgery and surgery will only have been offered to you if your consultant feels that it may be of benefit to you. If you do not wish to have surgery then your consultant will discuss the individual implications this will have for you.

4 Here are some alternatives that may be suggested to you: Wait to see if your condition remains unchanged without surgery. Manage your pain with analgesia (pain killers). Try conservative measures, for example physiotherapy and/or exercise such as Pilates or Thai Chi. Spinal injections. The alternatives will be explained to you if necessary. If you are worried about any of these risks, please speak to your Consultant or a member of their team. Getting ready for your Lumbar spine surgery Most people will be assessed in a pre-operative assessment clinic. An appointment will be sent to you if you are required to attend for this. If you are unable to attend the pre-operative assessment clinic you must inform them of this. This assessment is important in helping us to ensure you are safe to undergo your surgery. Preoperative assessment will vary dependent upon your individual requirements, but can include being assessed by the anaesthetist, he/she will have a chat with you, discuss any relevant medical history and explain what having a general anaesthetic will involve. You may have some blood tests performed, a member of the medical or nursing team will discuss your medical history with you and you will be examined. If any X-rays or a heart trace (ECG) are required these will also be done. If you are on medication that thins the blood you will be asked to omit this medication as follows before your surgery: Aspirin -seven to ten days. Clopidrogrel -seven to ten days. HRT - one month. Warfarin - four days. This will all be explained to you in pre- operative assessment clinic. Admission to hospital In most cases you will be admitted the morning of your operation fasting. In some cases you will be admitted the day before your surgery. If this is going to happen it will be discussed with you and any instructions given to you in advance. Most patients will be admitted the day of surgery. You will be able to eat and drink up to midnight the night before your surgery and in some cases up to 6am on the morning of your surgery. This varies depending on what time you are due to go for your surgery, and the ward staff will be able to explain this for you, the evening before your surgery which is when the operation lists are finalised. Operations may be delayed, postponed or cancelled depending on your suitability of anaesthetic or availability of high dependency beds for this operation if it is indicated you may require one.

5 Please leave all cash and valuables at home. If you need to bring valuables into hospital, these can be sent to General Office for safekeeping. General Office is open between 08.30am and 4.30pm Monday to Friday. Therefore, if you are discharged outside these times we will not be able to return your property until General Office is open. The Trust does not accept responsibility for items not handed in for safekeeping. The day of your Lumbar spinal surgery You will be asked to attend 11Z on the day of your admission. You will be kept fasted (nothing to eat or drink). You will also be given a theatre gown to wear following your morning bath or shower. Your details will be checked with you on the ward, before you go to theatre. You will be wearing a wrist band and have to answer a list of questions, for example, your name, date of birth. You will be collected for theatre and taken to the theatre reception area where the nurse will check your details again, this can appear repetitive but it is all done to ensure your safety. You will then be taken to the anaesthetic room. Here the anaesthetist will give you your anaesthetic medication through a needle in your hand and once you are asleep you will be taken into theatre. Your surgery will be performed and what this involves varies depending upon your individual requirements. This will have been explained to you when you discussed it with your doctor and signed your consent form. Surgery is performed by either the consultant, or one of his team under the supervision of the consultant. Recovery Room and Return to the Ward After surgery you will be taken into the recovery room where you will be monitored whilst you wake up from your anaesthetic. You will be transferred back to the ward after spending time in Recovery. In the recovery room and on return to the ward your observations, e.g. blood pressure and pulse will be checked regularly, as will your wound and your limb power and movement. An intravenous infusion (drip) will be in your hand/arm until you are awake enough to eat and drink again, and you will have an oxygen mask over your nose and mouth until you are fully awake from the anaesthetic, this is usually removed when you have been back on the ward a few hours. You will receive two doses of post- operative antibiotics, and you can get up to go to the toilet with assistance after surgery. Your pain will be controlled with injections initially, and then the following day you will be able to have tablets. Some patients may have a PCA (patient controlled analgesia) but this varies depending upon the procedure you are having performed. For more information, please ask for a copy of the leaflet Patient Controlled Analgesia PCA ( PIF 113). You will be encouraged to move around the bed as much as possible and the nursing staff will inform you when you are able to get out of bed. This is most often the evening of your surgery or the day following your surgery. Your individual operation will determine your management, however, in most cases, the day following surgery your drip will be removed and your wound will be checked. You will be encouraged to get out of bed and move around the ward.

6 If you have any problems the physiotherapist will see you to explain correct posture and the exercises that you will need to do. Going Home The Spinal Team will see you and check that you are recovering well and for routine uncomplicated spinal operations you will be able to return home the day after surgery in the afternoon. For most spinal operations it is quite normal practice to go home the day after your operation. You are advised to arrange your own transport home before admission. If you are travelling home by car sit in the front passenger seat and recline the seat back to make you more comfortable whilst travelling. Discharge Information Pain relief and medication Pain killing medication will be organised for you to take home if you do not already have any; however if you can get some from your family doctor (GP) before your admission this will prevent you needing to wait., for the hospital pharmacy to dispense medication. Your wound Your sutures (stitches)/clips will need to be removed or trimmed, in most cases ten days after your operation. Most patients can go to their local GP Practice Nurse or drop in centre to have this done. The nursing staff will be able to arrange this for you. Please make sure that if you are not going home to your usual address, you inform the nursing staff. The nursing staff will inform you of the date your stitches need to be removed which is usually ten days, and this can be documented in the relevant page of your patient and visitor information. You will have waterproof dressings which are not to be removed and if there are any concerns regarding this please contact one of the staff on the ward. Getting back to normal Remember that you have just had an operation. It is normal to feel more tired than usual for a few days afterwards. The evidence shows that the faster you return to normal activity the better you will be. Pace yourself and gradually build up your level of activity. Doing small things often, rather than all in one go is more sensible. It is important that you are up and moving and do not go home and spend too long lying in bed. Further Appointments You will be sent an outpatient appointment by post to return for a check-up about two to three months after your discharge from hospital. Here you will be seen by either a doctor or a nurse specialist, so we can check you are making good progress and discuss any concerns you may have.

7 Further Information The Spinal Team The consultants are: Mr Marcus DeMatas Mr Sathya Thambiraj Mr Prokopis Annis Mr Radu Popa Mr George Ampat Spinal Specialist Nurse Mark McGowan Tel: Bleep 4099 Textphone Number: Bleep 4099 Spinal secretaries Jackie Landry Collette Rowan Julie Melia Barbara Mills Tel: Textphone Number: Author: Trauma and Orthopaedic Directorate Review Date: October 2018

8 All Trust approved information is available on request in alternative formats, including other languages, easy read, large print, audio, Braille, moon and electronically.