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Dr. Roger Hartl
Dr. Roger Hartl

Q: What happens next when I find out I need spine surgery? How should I prepare?

A: Coming to the decision to have surgery is very difficult for patients. We want to make sure our patients feel comfortable that we are taking really good care of them. Once it has been determined that surgery will benefit the patient and it has been agreed upon that surgery is going to happen, we want them to feel comfortable that we can guide them through the entire process. We want the patient to know what to expect before, during, and after surgery, so they are happy and comfortable afterward.

One of the most important considerations is the urgency of the surgery. The timing depends on how severe the pain is, whether symptoms get in the way of daily life activities and what will work best for the patient. You don’t want to wait too long, but you also don’t want to rush into surgery. Timing the surgery can be challenging because the patient may have other medical conditions that need to be considered.

Patients also need to be medically cleared for surgery. Medical clearance is important because it means the patient can safely undergo the type of surgery planned. The length of surgery is not as much of a concern as the impact the surgery will have on the patient’s body, such as their heart, lungs, and blood pressure.

Part of preparing patients for surgery includes talking about pain management and recovery. We want to talk about the whole process of surgery including post-operative pain (pain after surgery) and what to expect. Pain experienced after surgery is different than the pain before surgery. A lot of surgeries that we do require only a small incision (cut), which generally have less pain than more invasive surgeries with large incisions.

Depending on the surgery, the pain may not be completely gone afterward but may take some time. We help the patient understand what to expect in terms of immediate pain relief and pain that may take time to relieve. Muscle spasms (involuntary tightening of muscles) usually occur two or three days after surgery. These spasms may cause mild discomfort or more intense pain. When patients know what to expect, they are not surprised.

We use a protocol called ERAS (enhanced recovery after surgery), which is based on scientific evidence that minimizes the pain throughout the surgical experience. ERAS helps the recovery go as smoothly and comfortably as possible. We explain what the patient can expect to happen after surgery. Pain is managed during the recovery period with medication and physical therapy.

The type of pain medication is based on the pain and the type of surgical procedure. We usually use several kinds of medication. Patients who go home the same day may only need high-dose ibuprofen or acetaminophen. Usually, they will also have medication for muscle spasms. Patients may also need a neuropathic medication, which is for nerve pain. If needed, we will order low-dose narcotics for more severe pain. After surgery, the patient will be encouraged to sit up, get out of bed and go for a short walk in the hallway with one of the nurses or doctors. Again, depending on the surgery, outpatient physical therapy may be recommended to increase strength and endurance. Patients will receive instructions about activity restrictions, any equipment needed, such as a brace, and when to contact the doctor or surgeon after they are discharged. The goal is to adapt the surgical experience to the patient’s needs based on their individual situation.

When patients are preparing for spine surgery, we will help them learn what to expect from a physical as well as an emotional standpoint, so they are well prepared, and their questions and concerns have been addressed.

Dr. Roger Härtl, chief of spine surgery, and Dr. Mohammad Piracha, inpatient pain management program director

This question was answered during the episode of Spine Time called “Preparing for Surgery (and Recovering from It.” A recording of this webinar held on September 30, 2020, is available on YouTube. To sign up for future episodes of Spine Time, where you can ask questions of our spine specialists, subscribe here.