It is very important to be thoroughly prepared for your surgery.

The Day Before
The medical team will give you personalized instructions regarding preparing for the surgery. In general, most patients are instructed to observe the following directions starting 24 hours before the surgery.

• Do not eat any solid foods after midnight the night before your surgery. We allow drinking clear liquids up to eight (8)AM if your surgery is scheduled for after 3PM that day. If you are a diabetic, talk to your doctor as to when to stop eating prior to surgery.
  
• If you take medications on a daily basis, discuss the timing of when you should stop these prior to surgery with your physician. Especially important are such medications as blood thinners such as coumadin, or medications for high blood pressure, heart arrhythmia or diabetes.
  
• If you become ill prior to your surgery (cold, fever, flu, etc.), it is essential that you call us immediately. If you are scheduled for outpatient surgery, please arrange for your transportation back home. You will not be permitted to drive yourself home.
  
• Please leave your valuables at home (money, credit cards, jewelry, etc.).
  
• Make-up should be kept to a minimum. Avoid mascara or body lotions.
  
• Bring all forms from your physician's office as instructed. This will include your signed consent forms and insurance information.
  
• If you wear glasses, contacts, a hearing aide, or dentures, please bring them with their storage case.
  
• Wear clothing that will be comfortable and easy for you to put on following surgery, including sturdy, flat, shoes.
  
• Visits by family or friends prior to the surgery will be limited in the pre-op holding area.

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The Day of Surgery
When a patient prepares thoroughly for surgery they are increasing their likelihood of a rapid and smooth return to health. The day of surgery will be very busy. It is important you arrive on time. The following directions will help your day to run smoothly and calmly.

Checklist - Items to Bring:

• insurance card(s)
• comfortable clothing
• your back brace (if you wear one)
  
• a list of allergies to medications
  
• signed consent forms
  
• sturdy, flat shoes or sneakers for walking
  
• toiletry items
  
• a CD or tape player with soothing/relaxing music.
  

Do NOT bring: valuables, including jewelry, credit cards, large amounts of cash

Arrival
You will spend time in several areas of the hospital in preparation for your surgery. Please note that from the moment you arrive, you will be asked many of the same questions repeatedly; please be patient! This is done for your safety. Upon arrival at the hospital, report to the admissions desk. Admissions is located in the main lobby.

Preoperative Preparations
Your family will be allowed to stay with you through this process. Your medical and surgical histories, medications, allergies and preoperative process will be reviewed in detail. Vital signs including weight, blood pressure, oxygen levels, heart rate, and temperature are recorded. If your physician has ordered other preoperative tests, they will be performed.

An intravenous catheter will be inserted and fluids administered. Antibiotics and sedatives will be delivered through the catheter.

Meeting the Surgical Team
The patient will meet with the anesthesiologist, the surgeon and a nurse in the preoperative holding area. Surgical risks, complications and questions will be reviewed again and answered. Please bring a list of your questions and your signed consent forms.

Taken to the Operating Room
Only after you have spoken to both the anesthesiologist and your surgeon will you be taken to the Operating Room. At this time, your family will be escorted to the waiting room. The operating room staff will communicate with your family during and after the procedure. The nurse will call your family when the surgery actually starts, every hour and a half thereafter, and when the surgery is over. The surgeon will speak with your family after the surgery as well.

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After Surgery
Having completed your surgery, all of us at COMC now want to see you steadily return to health. To help you understand the recovery process you are beginning, we've outlined below the main steps in this process.

Length of stay
The length of stay in the hospital can vary greatly between procedure types as well as amongst individual patients. In general, a cervical surgery requires a two day hospital stay. A lumbar decompression surgery has a similar length of stay. Fusion surgery can require a four to five day stay in the hospital. Minimally invasive lumbar fusions may require only a one to two day stay. Complex surgery or other revision and reconstruction surgeries may require more time in the hospital. The individual patient's general condition and age may greatly influence the length of stay and each patients situation is unique. This description is therefore a generalization only. Your needs may be different.

During your stay:
DAY 1
The first day after surgery is mostly a day of rest. Pain medications will be adjusted and blood tests will be performed as needed. The therapists will allow you to stand up and walk as tolerated with their help. A (PCA) Personal Analgesia Pump is often used to allow you to control your own pain medication.

DAY 2
Small drainage tubes are often placed in the incisions. These are removed on the second day. The PCA pump is also slowly decreased and replaced with oral pain medications. Dressings are changed. Physical therapy is continued with more walking, sitting and education.

DAY 3 to 5
The priority is more rehabilitation as required. The patient should be working towards a regular diet and voiding normally at about this point in time. The decision as to when you are ready to go home is made during this time. It is based on all of the issues already described as well as clearance by the Physical Therapists. If more rehabilitation is required, we will usually transfer you to the rehabilitative unit at this point. Your surgical team will visit you there, but they are no longer your primary (decision making) doctors for the duration of your rehabilitative stay.

DISCHARGE
The day of discharge brings a flurry of activity. Prescriptions are provided and discharge instructions reviewed. These are all provided in a written format as well. You will need to arrange for transportation home. You are allowed to ride in a regular car but make sure it is one that is easy to get in and out of. You of course, will not be allowed to drive your own vehicle home. At this time, it is a good idea to call the appointment desk at COMC to set up your first office visit which should occur in about 10 days.

THE FIRST WEEKS AT HOME
During these first few weeks, you will find yourself to be very tired. As such, you will be spending half of your time resting in bed and the other half, up and around. You will certainly be able to go to the bathroom and manage your surroundings without additional help. You will most likely be using pain medications on a routine basis. It is a good idea to have someone available to help you for the first two weeks or so at home.

Activities at this point should include a progressive walking program. Use of a stationary bicycle or treadmills are also allowed, although it may be too early to begin this program as of yet. Do what you feel you can do, but be conservative and safe. In any event, no lifting of greater than 10 pounds is allowed. Also, no stooping, twisting, lifting, housework, or yard work are allowed at this time. A return to sexual activity may occur when you feel ready.

During this period of time, the wound must be kept clean and dry. It is recommended to keep a dry 4x4 inch gauze over the incision at all times. This dressing should be changed on a daily basis. Cover the wound with a cut piece of Saran wrap, secured with tape, for showering purposes. This will keep the incision dry during this process. Change this to a dry gauze once again after the shower. Place no lotions, powders, or ointments on the incision unless instructed to do so.

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Keep track of your prescription medications. Write down a schedule as to when they may need to be taken. Please remember, narcotic pain medications usually require the actual written prescription. Do not wait until you are entirely out of medication to call the office for a refill. A 3 to 4 day warning to our office of your refill needs will make the whole process run more smoothly.

As the weeks progress, you can gradually increase your amount of activity however, your restrictions do not change at this point. Returning to work is based on your type of surgery, type of work, level of energy, and general comfort. In general, a laminectomy surgery allows you to return to a sedentary type of job within two weeks. A more involved fusion surgery combined with more physical types of work may require up to two or three months of recovery prior to returning to work. Discuss the specifics of your situation with your doctor for a better prediction of your particular needs.

ONE MONTH AFTER SURGERY
Your next visit in the office will occur at about six weeks after surgery. We will now begin to increase your level of activity. This may include progression towards a basic exercise program. Again, the magnitude of your particular surgery will influence this time frame. For instance, laminectomy surgeries allow for rapid return to abdominal and back strengthening exercises. Fusion surgery requires a longer period of time. In any event, with exercise, excessive motion of the lumbar spine and pelvis is to be avoided. Physical therapy may or may not be initiated at this point.

THREE MONTHS AFTER SURGERY
An office visit at three months after surgery is the norm. At this time, a more vigorous physical therapy exercise regimen will be initiated. X-rays will usually be obtained as needed. This is done to check the healing of the fusion, if performed. If you're surgery was a straightforward laminectomy, a full release to all activities may well be provided at this time. Fusion surgery however, will require the same restrictions for another three months.

SIX MONTHS AFTER FUSION SURGERY
The office visit at this time will again focus on your rehabilitative agenda. X-rays will also be obtained to further assess the fusion process. It is expected, that most fusion's will be approaching maturity at this point. As such, most all restrictions will be lifted at this time. Understand however, the fusion is not as strong as it will ever be until closer to one year after surgery. It is therefore one year before it is expected that your recovery is totally complete.

ONE YEAR AND BEYOND
A routine check in the office after a major spine surgery is recommended on a yearly basis. At this time, your exercise program will be reviewed and recommendations made to maximize your strength, agility and endurance. X-rays will also be obtained as needed to monitor the fusion and adjacent areas of the spine. Tips on lifestyle improvements to further help your spine throughout the years will be a major focus as well. The medical staff at COMC have a strong commitment and dedication to the long-term health of your back.

The Recovery Process from a Laminectomy or Discectomy
A laminectomy or discectomy surgery is one of the least involved surgical procedures that we routinely perform on the spine. The typical surgery is a one to two hour operation. Hospital stays range from an outpatient based procedure to those requiring one to two days in the hospital.

Before you go home, you must be able to perform certain basic activities. These activities include walking up and down stairs, getting in and out of bed, and maneuvering safely. Without these basic skills, we will not allow you to return home.

Once at home, you may gradually spend more time out of bed as your energy level tolerates. A gentle exercise program is advocated. This includes gentle walking of progressively longer distances, use of a treadmill, or a stationary bike. Lifting more than 10 pounds is to be avoided. No stooping, crawling, or twisting. Housework or yard work is not suggested. You can begin to drive whenever you feel prepared. If narcotic pain medication has been prescribed, do not drive or operate machinery. Return to a regular diet but beware of constipation. Return to sexual activities when you feel comfortable.
Your first office visit should be 10 to 14 days from the date of surgery. Please contact our office as soon as possible to set up this appointment (telephone number: (303) 762-0808, option three). Up to that time, you should change your surgical dressing once a day with dry gauze and tape.

At approximately three weeks after surgery, the previously described basic exercise program will be advanced. Returning to the physical therapist may also be suggested at that time.

By six weeks after surgery a more vigorous exercise routine should be in progress. By this time, most patients are off strong pain medications and many restrictions will be lifted. Heavy or impact activities are still to be avoided.

By three months after surgery, you will be allowed to return to full and unrestricted activities. Common sense and good body mechanics are to be observed. It will take approximately six months for your recovery to reach maximum improvement. After this point, there are no permanent restrictions. Go out and enjoy life again!

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