Preparing for Surgery

Your well being, comfort, and recovery are our primary concerns. You can help to make things go smoothly by making a few preparations before surgery.

When you go to the hospital, make sure that you bring along any X-rays or scans you were given, and your cervical collar (if one was fitted for you). Follow the anesthesiologist's instructions regarding your medications, and abstaining from eating food on the day of surgery. If you smoke, consider this an opportunity to quit. Smoking interferes with wound healing, and with recovery from anesthesia.

Bring some loose fitting clothes to wear home form the hospital. A shirt or blouse that buttons is much easier to put on and take off than a pull-over garment.

Because you will change your dressing every day for at least two weeks, you will need sterile dressing pads (4 inch by 4 inch size) and paper type to redress your incision. Two dozen dressings should be enough for an anterior discectomy. You will need about three dozen for a laminectomy.

If time permits, we will schedule a pre-operative visit shortly before your operation so that we can discuss your preparations, hospital stay, and post-operative course. Dr. Nehls or Dr. Mohit will answer all of your questions at that time. If you have any additional questions about your surgery, please do not hesitate to call us at (253) 426-4420.

What to Expect After Surgery

You will probably notice a significant improvement in your condition very shortly after surgery. Many patients have relief in arm pain in the recovery room. However, if there was long-standing compression of the nerves or spinal cord, it may take longer for your condition to improve.

For the first several days after surgery, it is normal for you neck to be sore and to have some pain while swallowing. If a graft was taken from your hip, that area will be sore for several weeks. In the hospital, you will have a narcotic pump that you control to keep you comfortable. Studies have shown that this is extremely effective, and that people actually use less medicine with the pump, than when it is given on a schedule. The pump limits the total dose per hour so that it is not possible to give yourself too much medication.

In most cases, you will be up and walking on the day of surgery, and will be ready to go home the next day.

When you go home you will be given pain pills. Even when the pain has been completely relieved by surgery, you may get occasional aches or twinges or spasms. Weakness will take time to improve, generally several months. Numbness can take the longest to improve, in some cases up to a year.

Medications

Pain medication will be prescribed before surgery, or when you leave the hospital. Due to the addictive potential of long-term use, it is important to limit narcotic use to the post-operative period. Try to use less and less of the narcotic pain medication as soon as possible. Use non-narcotic medications such as Tylenol or ibuprofen (Motrin), if you can take them.

Questions/Refills

If you are having problems or concerns, there is someone available to help you, 24 hours a day. You can reach us by calling our office number, (253) 426-4420. After office hours, the message will instruct you how to reach the on-call neurosurgeon. If you have any questions about your condition, or about your treatment, please do not hesitate to call during our regular office hours. Please be certain to call for medication refills during office hours, as we will not be able to refill prescriptions after office hours or on weekends.

Activities

For the first week after surgery, try to take it easy. You will probably be most comfortable standing fully upright or sitting upright in a chair. For the first weeks you should limit your activities. You should not lift anything over 5 pounds, and should not do any reaching or overhead work. Limit riding in a car to your travel home from the hospital. Walk as much as you like, but don't overdo it.

During the second week after your surgery, gradually increase your activities as tolerated. You should still limit lifting to less than 5 pounds. You may ride in a car for short trips, but should not drive. Two weeks after surgery you can resume driving, but keep in mind that you may have some minor difficulties, so take appropriate precautions.

Follow-up Appointment

As soon as you are home from the hospital, please call us at (253) 426-4420 to schedule a follow-up appointment for three weeks after surgery. During your visit, we will discuss your progress, your return to work, and the need for physical therapy. Make a list of questions so that they can be answered at that time. If you have any questions before your follow-up appointment, please call the office between 8:30 and 5:00. For emergencies, you can reach Dr. Nehls, Dr. Mohit, or a colleague twenty-four hours a day by calling the office number.

Cervical Collar Use

The use of your cervical collar will depend upon how extensive an operation you have had.

• For single level simple anterior cervical discectomies and most laminectomies, you will need to wear your collar for several weeks. However, you may remove the collar to shower, when seated quietly, and to eat. Over the two weeks following surgery, you should use the collar less and less so that by 14-21 days you are not using it. The use of your collar is primarily for comfort. If you feel better with the collar, wear it, although you should still try to gradually reduce your use of it. If the collar is uncomfortable and you feel better without it, take it off.
• For more extensive surgery, the collar will need to be worn for stability and to promote fusion. You should keep your collar on at all times, except to shower and shave. You may also remove it when seated quietly for brief periods. At your follow-up visit we will assess your situation and decide about further use of the collar.

Care of Your Incision

Depending upon the size of the incision, and the nature of the surgery, your incision was closed in one of two ways. For single level discectomies and some laminectomies, absorbable sutures are used beneath the skin. For larger operations, external sutures or staples are used. Staples and external sutures are visible. Wounds closed with absorbable sutures are supplemented by small amounts of tape.

• Your incision was closed with sutures under the skin. These sutures will dissolve on their own, and do not need to be removed. Small tapes are applied to achieve the best cosmetic results possible. These will loosen and begin to peel in about five to seven days. When they begin to loosen, you can gently peel them off.
• Your incision was closed with external sutures or staples. It will be necessary for you come in to the office to have them removed. Please call the office to schedule an appointment seven days after your surgery.

Unless instructed to do so, you may shower once you leave the hospital. Remove the dressing and allow water to run over the incision while you take a standard shower. Do not rub the incision and do not immerse the incision in a bath. Pat the incision dry and apply a fresh dressing. Your collar tends to rub across the incision, so keep a dressing in place until the incision has completely healed, usually 1-2 weeks.

Call the office at (253) 426.4420 if you have any questions about your post-operative course or instructions. You should call if you run a fever greater than 101.0 degrees Fahrenheit, if your incision drains any substance, or if it becomes red, hot, swollen, or painful. Also call for new pain, weakness or numbness in your arm, or for difficulties urinating.