Thank you for choosing Saint Joseph s Hospital Health Center for your spine surgery. Updated Jan 2017

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Kristian Scott
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3 Thank you for choosing Saint Joseph s Hospital Health Center for your spine surgery Updated Jan 2017

This class is designed to give you some basic, important information about spine surgery We will cover what to expect before, during, and after your

4 This class is designed to give you some basic, important information about spine surgery We will cover what to expect before, during, and after your surgery You will be given a booklet in Pre-Admission Testing The booklet contains information about some of your care and how to prepare for your hospital stay

5 To answer any questions you may have about your upcoming spine surgery To inform you of what to expect so you are comfortable with your surgery and your stay at St. Joseph s Hospital To be discharged from the hospital to home

6 Work? Walking? Playing with your children and/or grandchildren? Reducing pain? Vacationing with your family? We will work with you to help you to achieve the goals that you set for yourself.

7 Whether it be your arms, legs or back that are bothering you; whether your pain is present occasionally or throughout your day, all patients have options to reduce these symptoms and get back to life. -Dr. Aaron Bianco, Spine Surgeon

8 Cervical Thoracic Lumbar Close up showing Vertebrae and Discs Your S P Discs I N E

9 Cortical rim Body Cancellous Transverse process Pedicle Superior articular process Lamina Vertebral foramen Spinous process

10 Degenerative Disc Disease Herniated Disc Spinal Stenosis Vertebral Fracture Arthritis

11 Cause Degenerative changes Misuse Smoking Symptoms Pain and aching in the back Normal Disc Degenerated Disc Can radiate to low back, buttocks or legs Numbness or tingling Bladder or bowel dysfunction Immediate MD notification needed Groin or leg weakness or severe symptoms (lasting for > 2-3 days seek medical assistance) Treatment NSAIDS Physical Therapy

12 Cause o Trauma o Repetitive stress o Degeneration of the discs Symptoms o Gradual to sudden o Low back pain o Radiculopathy Treatment o Conservative Pharmaceutical: NSAIDS, muscle relaxants, steroids Physical Therapy Pain management o Surgical Discectomy Laminectomy Spinal Fusion

Cause o Non specific o Aging process Symptoms o Gradual onset o Low back or leg pain o Positional o Radiating pain Treatment o Conservative Activity

13 Cause o Non specific o Aging process Symptoms o Gradual onset o Low back or leg pain o Positional o Radiating pain Treatment o Conservative Activity should be maintained for comfort Avoid extension activities Epidural steroids Physical/Aquatic therapy o Surgical Last resort Decompressive Laminectomy

14 Laminectomy Discectomy Fusions o Lumbar o Cervical

15 Definition o Removal or trimming the lamina (roof) of the vertebrae to create more space for the nerves Indications o Narrowing of the spinal canal, resulting in crowding of the nerve roots in the canal Goal of Surgery o To relieve pressure on the spinal cord or spinal nerve by removing the arthritic bone and ligaments causing the stenosis and make room for the nerve roots

18 Definition o Removing the herniation and freeing the nerves o Opening created in the lamina Indications o The herniation is the part of the disc that has leaked and placed pressure on the nerve causing back pain Goal o Remove the herniated part of the disc to reduce pain

19 Complex procedure allowing the surgeon to stabilize spinal ligaments and correct deformities Usually involves fusing one or more spinal segments together Often involves placement of hardware in the spine to provide correction of deformity and initial stability Pedicle Screw

23 Surgeon Physician Assistant Anesthesia Care Group Nurses o Registered Nurse o Licensed Practical Nurse Physical Medicine and Rehabilitation o Physical Therapist o Physical Therapist Assistant o Occupational Therapist Case Manager / Discharge Planner Pharmacist

24 Also playing a vital role in your recovery is YOU!

25 Inside your home and outside Good lighting No trip hazards Handrails Frequently used items within reach

26 TO PROMOTE HEALING, FOLLOW THESE STEPS Eat as healthy as possible including the recommended servings of fruits, vegetables, protein, whole grains, and low fat dairy Stop smoking at least two weeks before surgery Keep blood sugar under control Limit alcohol intake

the business day before surgery after 5 pm If you

27 A phone call from the hospital about your expected arrival time (please arrive on time) This will occur the business day before surgery after 5 pm If you have not received a call by 7 pm, please call

Follow the specific instructions about food and liquid restrictions provided at your Pre-Admission Testing appointment Take morning medications as directed in Pre-Admission Testing instructions Limit

28 Follow the specific instructions about food and liquid restrictions provided at your Pre-Admission Testing appointment Take morning medications as directed in Pre-Admission Testing instructions Limit belongings and leave all valuables at home. Your family will be responsible for carrying your personal items, a credit card will be needed for the TV You are expected to arrive on time, do not wait for the valet with your family. You will be directed to unit 1-1 You should be on standby the morning of surgery

medications for pain, nausea, and antibiotics You will be transferred to the

29 Nurses will review your medical/surgical history Medications will be reviewed An IV will be inserted You will receive multiple pre-op medications that include medications for pain, nausea, and antibiotics You will be transferred to the operating room and here you will have oxygen applied and general anesthesia administered.

30 You will receive general anesthesia for your spine surgery You will be asleep while in the OR You will not feel any pain during your spine surgery Please refer to your surgeon for any questions that you may have regarding anesthesia

Arrive in Post Anesthesia Care Unit (PACU), you will be there for

nurses You may have oxygen, a catheter and a drain Frequent vital

as you can tolerate You will be out of bed the night of surgery

31 Arrive in Post Anesthesia Care Unit (PACU), you will be there for approximately 1 3 hours Arrive to floor, be greeted by your nurses You may have oxygen, a catheter and a drain Frequent vital signs and assessments Clear liquid diet, advanced to regular food as you can tolerate You will be out of bed the night of surgery You may have activity precautions which the nurse will explain to you

32 Pain Scale o 0 = no pain o 10 = the worst pain you could imagine We use various oral medications o You will have an individualized pain management plan Ask your nurse! Pain medication is administered on an as needed basis If you have spasms, can t sleep, uncontrolled pain: Ask! There are more therapies/orders that may be used

33 Any drains and catheters are removed by your nurse or PA You will order your meals when you would like them with Room Service Physical Therapy will see you You can ask for pain medicines when you need them Use your call bell and wait for your nurse before getting out bed! Call Don t Fall!

34 Located on the wall across from your bed A way to keep you connected with your care Names of your nurses, unit manager When you received your last dose of pain medicine When you are due for your next dose The phone number in your room

35 You will be expected to walk the unit You are encouraged to dress in comfortable clothes Each day hygiene products will be available You will continue to be monitored and assessed You may be discharged, depending on your progress and physician/pt recommendations With collaboration of your discharge planner, MD and PT you may need homecare or a nursing home

36 In the morning, your PA will see you and assess if you are able to be discharged You will not be discharged immediately. You may need to see PT before discharge and paperwork needs to be filled out and gone over with you Discharge time varies Transport will be called in accordance with the pick-up time you have discussed with family and your nurse Family can wait in the front circle and transport will bring you right out We do our best to coordinate a timely discharge

37 To keep your follow-up appointment 7 14 days after surgery

38 We wash our hands frequently We use hand sanitizer in between hand washing We clean our equipment & workstations frequently How can you help

39 Do not shave the surgical site prior to surgery Wash your hands before meals and after using the bathroom. Wash your hands often! It s just as important for family members to wash their hands often, too! See your dentist on a regular basis

40 Foot pumps & ted stockings o Prevent post-op blood clots o Wear the foot pumps when you are in bed or in the chair Incentive Spirometry and deep-breathing o Prevent pneumonia after surgery, 10 times every hour while awake o Antibiotics

41 Pain medications can cause constipation We will start you on a bowel regime postoperatively with various stool softeners Return to activity get out of bed and walk the unit! Good hydration

any questions that you may have as you recover from your surgery We

42 Again, we want to thank you for choosing SJHHC for your spine surgery Do not hesitate to ask our knowledgeable team of nurses and physicians any questions that you may have as you recover from your surgery We look forward to caring for you and hope we exceed all of your expectations

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If you have a condition that compresses your nerves, causing debilitating back pain or numbness along the back of your leg.

If you have a condition that compresses your nerves, causing debilitating back pain or numbness along the back of your leg. Below, we have provided some basic information for your benefit. Please use this information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk