GREG S. KHOUNGANIAN, MD Minimally Invasive Spine Surgery Board Certified Orthopedic Surgeon GENERAL POST-OPERATIVE INSTRUCTIONS

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1 GREG S. KHOUNGANIAN, MD Minimally Invasive Spine Surgery Bard Certified Orthpedic Surgen GENERAL POST-OPERATIVE INSTRUCTIONS These instructins are general pst-perative instructins fr mst spinal prcedures, including: 1. Cervical fusin 2. Cervical decmpressin 3. Cervical disc replacement 4. Lumbar micrdiscectmy 5. Lumbar laminectmy/decmpressin 6. Lumbar fusin 7. Lumbar micrdiscectmy 8. Lumbar disc replacement 9. Thracic prcedures WHILE IN HOSPITAL // Surgery Center A sterile gauze and waterprf dressing (Tegaderm) will be applied t the lwer back. This dressing shuld cver the wund fr abut three days. Shwering is permitted. DO NOT allw the water t spray directly nt yur incisin. Shwer with the gauze and Tegaderm.

2 Remve the dressing after yu shwer if lse. Even thugh the dressing may appear t be dry, misture will still cllect n the dry gauze frm the shwer. After day five pst-p, if there is n drainage frm the wund r any pen area f the wund, yu may shwer withut cvering the wund, but DO NOT submerge the wund in water fr initial 4 weeks. Pat the incisin dry nce yu are dne in the shwer. Yur incisin will heal best when clean and dry. Yu may remve the bandage and leave the wund pen t air nce there is n further drainage frm the incisin site. DO NOT apply any medicatins, intments, ltins, sunblck, etc. until yu have seen yur dctr at yur first pst-p appintment and they indicate it is safe t use these items ver the incisin site. The day after yur surgery yu may be assisted by a physical therapist t regain mbility. After yur physical therapy sessin yu shuld cntinue t walk several mre times during the day as tlerated. If yu had yur prcedure as an utpatient in a surgery center, yu will walk befre being discharged hme. Yur bladder shuld be functining prir t yu leaving the hspital. Please nte that yur bwel functin is typically slwer t return t nrmal. Walking early after surgery is usually the best way t stimulate quick return f bwel functin. Yu will nt be kept vernight if yu have nt had a bwel mvement, but yu will be started n a bwel prgram immediately after surgery. Therefre, yu can expect activity either during yur stay r sn after yu get hme. Yu will be discharged frm the hspital/surgery center when yu achieve a relative level f independence (mderate level f mbility, eating withut nausea, and managing yur pain with ral medicatin nly). Yur gal is t transitin frm injectin pain medicatins t ral narctic pain medicatins (r nn-narctics) as sn as pssible. This shuld be by ne t tw days after surgery.

3 A family member r friend will be able t transprt yu hme with regular transprtatin. A cmfrtable sedan r SUV that allws the passenger seat t recline is usually mre cmfrtable fr patients early pst-p versus a small car r sprts car. If a pain medicatin prescriptin is nt given t yu during yur stay in the hspital, please call ur ffice with yur pharmacy name, phne number, and fax number. Please call during nrmal business hurs, Mn-Fri 9am 5pm. We will make sure t call in a prescriptin fr yu. Please nte any prescriptin with Hydrcdne (Vicdin, Nrc), OxyCntin r Oxycdne (including Perccet) must be filled by the patient with the actual prescriptin in hand and cannt be called int a pharmacy. Anticipate needs fr pain medicatin befre the weekend due t the fact that n narctic pain meds will be called in t yur pharmacy. AT HOME // FIRST SIX T0 EIGHT WEEKS Smebdy respnsible shuld assist yu fr the first several days at hme. If yu need a hme health nurse t assist yu, ur ffice will crdinate this fr yu. Please let us knw prir yur surgery date if yu wuld like this arrangement t be made. NO bending, lifting, r twisting anything heavier than a punds. Shwering is permitted. DO NOT allw the water t spray directly nt yur incisin. Shwer with the gauze and Tegaderm. Remve and change the dressing after yu shwer. Even thugh the dressing may appear t be dry, misture will still cllect n the dry gauze frm the shwer. After day three pst-p, if there is n drainage frm the wund r any pen area f the wund, yu may shwer withut cvering the wund, but DO NOT submerge the wund in water until cleared by Dr. Khunganian. Pat the incisin dry nce yu are dne in the shwer. Yur incisin will heal best when clean and dry.

4 Yu may remve the bandage and leave the wund pen t air nce there is n further drainage frm the incisin site. DO NOT sak yur incisin in a bathtub, pl, etc., fr at least fur weeks r cleared by Dr. Khunganian. DO NOT apply any medicatins, intments, ltins, sunblck, etc. until yu have seen yur dctr at yur first pst-p appintment and they indicate it is safe t use these items ver the incisin site. Yu may start t use an anti-scarring intment/cream (such as Mederma), after the steristrips have been remved and the wund has cmpletely clsed. Use sunblck with high SPF fr the first year after surgery if yur incisin is expsed t sun in rder t reduce scar frmatin. Sunblck shuld NOT be applied t the incisin until the incisin has healed with n drainage Suture remval will nt be necessary, as yu will have a csmetic skin clsure with absrbable suture material. It takes the subcutaneus (belw the skin) sutures abut three mnths t cmpletely resrb. If this is nt the case, the dctr will remve the sutures abut ne week after surgery. DO NOT scratch yur incisin. The itching will subside in time. The bdy resrbs the sutures/stitches by an inflammatry reactin s yu will likely experience sme swelling arund the incisin site this is nrmal. By three mnths pst-surgery the incisin will be flat. PLEASE NOTE, IF YOU HAVE HAD A FUSION SURGERY D NOT take any anti-inflammatries as these medicatins prhibit bne frmatin and may result in a nn-unin (nn-fusin). These medicatins include Aspirin, Advil, Ibuprfen, Mtrin, Naprxen, Mbic, Celebrex, etc. If yu have any questins regarding yur surgery and these medicatins, please speak with yur dctr. If yu were taking bld-thinning agents/anti-inflammatries prir surgery fr medical reasns, yu may cntinue taking these medicatins three t five days pst-p with cnsent frm yur pre-perative internist r surgen.

5 If yu are experiencing a headache during the first few days f being pst-p, this may be an indicatin f a spinal leak. If laying flat and a headache cmes n, try sitting r standing upright and/r vice versa. Yu may take an aspirin if yu cntinue t have headaches but shuld nt take the medicatin fr a prlnged perid f time. Narctics are very cnstipating and ften cause nausea and vmiting. If yu are experiencing nausea yu may need t lessen the pain medicatin r change the pain medicatin all tgether. If nausea results despite reducing verall narctic intake, yu may call and ask fr a prescriptin f Zfran. If yu have nt had a bwel mvement after yu have arrived hme, yu may try an verthe-cunter stl sftener r laxative t help facilitate this prcess (ex. Dulclax, Miralax, r Magnesium Citrate). Yu may start these medicatins as sn as yu wish if cnstipatin is causing discmfrt. These shuld nly be taken nce yu have started t experience flatus (gas). Again, the best way t initiate a bwel mvement after surgery is by walking. It is OKAY t take ver-the-cunter cld, cugh medicatin and/r antibitics at this time. If yu are seeking t have any ther surgeries r prcedures within the first six mnths f yur surgery, please have yur physician prescribe a prphylactic antibitic. Ice is usually best during the first ne t tw weeks pst-surgery. Ice reduces inflammatin and is effective as an analgesic (pain remedy). After inflammatin has subsided, heat can be used alne r with alternating usage f ice. Hwever, please nte that ice tends t cause muscle spasms and may be cntributing t yur pain if yu are experiencing severe muscular spasms. Muscle spasms are typically treated with heat (heating paid r mist heat). By six weeks pst-p yu may begin t use heat if muscle spasms are the main cause f yur pain. Yur gal is t walk 1/2 t 1 mile per day. Yu shuld keep active during yur recvery prcess. Walk fr five t ten minutes every 30 t 40 minutes. Avid activities that cause strain arund yur incisin area.

6 Climbing stairs is permitted (and encuraged), but shuld be dne slwly and carefully. If yu have been given a lumbar brace, wear it at all times when ut f bed, but remve fr sleeping, feeding, and shwering. If yu are given a cervical cllar, please wear it as recmmended by yur surgen except when shwering and feeding. Yu are nt allwed t drive while wearing a cervical cllar. Yu may start driving after yur first pst-p appintment. Please nte, yu shuld NOT drive if yu are taking any narctic medicatin that impairs r affects yur judgment. SPECIFIC INSTRUCTIONS FOR MICRODISCECTOMY/MICRODECOMPRESSION PATIENTS NO heavy impact exercises fr the first six t eight weeks NO heavy bending, lifting, r twisting fr the first six t eight weeks It is nrmal t experience symptms similar t yur pre-p symptms ff and n after surgery due t the decmpressin f the nerve. This recurrence f irritatin t the nerve will fluctuate but shuld decrease in intensity and frequency as the weeks pass. SPECIFIC INSTRUCTIONS FOR FUSION PATIENTS Fusins require three t six mnths t becme stable. D NOT take any bld-thinning agents/anti-inflammatries as these medicatins prhibit bne frmatin and may result in a nn-unin (nn-fusin). These medicatins include Aspirin, Advil, Ibuprfen, Mtrin, Naprxen, Mbic, Celebrex, etc. If yu have any questins regarding yur surgery and these medicatins, please speak with yur dctr.

7 If yu were taking bld-thinning agents/anti-inflammatries prir surgery fr medical reasns, yu may cntinue taking these medicatins three t five days pst-p with cnsent frm yur pre-perative internist r surgen. The bne and tissue rebuilding prcess requires muscle stressrs and gravity t help the fusin becme strnger. Therefre, please d NOT stay in bed (this type f reduced activity is nt indicated). DO NOT smke. Smking will decrease yur fusin rate and may ptentially lead t revisin surgery. FIRST POST-OP APPOINTMENT // ONE - TWO WEEKS AFTER YOUR DATE OF SURGERY Yur incisin site will be examined and new care instructins will be ffered. -Yu may have returned t a relatively nrmal activity level except fr ding impact exercises (running, weight lifting). Any questins regarding exercising, lifting weights, and wrking ut can be addressed at this time. Please ask yur dctr. Physical therapy may be recmmended at this time, but typically starts at 4 weeks after surgery. Swimming (aqua therapy), Pilates, cre cnditining, and ther nn-impact exercise are ideal frms f exercise. Aqua therapy can nly be started after the surgical wund has healed withut signs f infectin. Inquiries regarding ff wrk status, wrk restrictins, etc., can als be addressed at this time. Please ask yur dctr. Bring all wrk-related paperwrk that needs t be cmpleted t yur clinic appintment. Restricted level f sex may be resumed unless therwise instructed by the dctr.

8 While a certain amunt f pain is cmmn in the recvery prcess, yur gal is t wean ff all pain medicatins and muscle relaxants. Ice can still be used, as it is a safe analgesic. A TENS unit and certain psitins may als help reduce yur pain symptms. GENERAL INFORMATION Cmmitment and determinatin t a full recvery is dependent n the patient s willingness t wrk hard with the infrmatin shared by the medical team. Many patients are decnditined befre surgery. Thus, a strng cmmitment t rehabilitatin is vital fr a successful utcme. Physical therapy, lifestyle changes, drinking enugh water, sleeping n a firm mattress, smking cessatin, and maintaining the ideal bdy weight thrugh regular exercise are all imprtant cnsideratins fr pst-p spinal surgery recvery. If yu are verweight, yur results may be adversely affected and may cntribute t further spinal surgery. Identify yur ideal bdy weight and strive t achieve it yu d nt want t g thrugh the surgery and recvery prcess all ver again. This is yur pprtunity t get back in shape. Yu may be required t use a bne grwth stimulatr during the first eight weeks pst-p. If this has nt been crdinated fr yu by yur first pst-p appintment, ask yur surgen if ne is recmmended. If yu have cme frm ut f twn fr yur surgery, r need t travel sn after, we recmmend yu wait until yu have been ambulating fr three days prir t travel. CALL OUR OFFICE IMMEDIATELY IF Yu develp a temperature greater than 101 F.-yu have increased pain r wrsening f symptms-there is any: redness r swelling f the incisin, r draining frm the incisin site -yu are experiencing persistent nausea/vmiting Greg S. Khunganian, MD Orthpedic Spine Surgery 5525 Etiwanda Ave. Suite #311 Tarzana, CA T: F: