The Spine Center

The spine is one of the most complex and important systems in the human body. Treatment requires specialists with the knowledge and expertise to develop an effective treatment plan. At Boston Orthopaedic & Spine, our fellowship-trained, board-certified experts have advanced training and the skills to help you understand and treat your pain.

SPINE ANATOMY

The spine is made up of a column of bones called vertebrae, which extends the length of the back to the neck. The spine plays an important role in posture and movement, and it also protects the spinal cord. Its intricate structure makes the back capable of incredible flexibility and strength.

• Spine consists of 33 vertebrae. There are 7 cervical (neck), 12 thoracic (chest region), 5 lumbar (lower back), 5 sacral (hip region), and 4 coccygeal (tailbone region) vertebrae.
• Vertebrae are held in place by muscles and strong connective tissue called ligaments.
• Most vertebrae have fibrous intervertebral disks between them to absorb shock and enable the spine to bend.

COMMON CAUSES OF BACK AND NECK PAIN TREATED AT BOSTON ORTHOPAEDIC & SPINE

Arthritis

Arthritis, or osteoarthritis, is loss of cartilage within a joint. While there are many other types of arthritis, including rheumatoid, psoriatic, septic, post-traumatic, and lupus, wear and tear osteoarthritis remains by far the most common. Arthritis symptoms can include swelling, tenderness, sharp pain, stiffness, and sometimes fever and chills.

Cervical myelopathy

Cervical myelopathy is caused by compression of the spinal cord through the narrowing of the cervical spinal canal. Symptoms of cervical myelopathy include weakness or clumsiness of the hands, fingers, or arms, stiffness in the neck, pain, and difficulty walking. Many patients will describe a change in their hand writing.

Compression fractures

A compression fracture is damage to the bones of the spine (vertebrae) that cause them to collapse and alter the shape of the spine, often caused by osteoporosis. Gradually worsening pain, increased pain with activity, loss of height, pain relief when lying down, and deformity of the spine can all indicate a compression fracture.

Degenerative disc disease

Degenerative disc disease is the damage or deterioration of the spongy cushions between the bones of the spine (discs), causing chronic pain in the neck (cervical spine) or lower back (lumbar spine). Symptoms of degenerative disc disease include pain that may increase during movement of the neck or back.

Herniated discs (bulging discs)

Herniated disc is the bulging or rupture of an intervertebral disc (the spongy cushion between the vertebrae of the spine). When the outer ring of a disc becomes damaged or slips out of place, the inner portion may bulge out between the vertebrae, which is called a bulging disc.

In the case of a ruptured disc, the inner portion bursts open completely. Symptoms of a herniated disc depend on the location of the disc, but can include pain, numbness, or weakness. Treatment is rest, anti-inflammatory medications, physical therapy, and in come cases, surgery.

Radiculopathy

Radiculopathy occurs when one of the spinal nerve roots is compressed near the vertebrae (bones), causing damage or disturbance of nerve function. The condition is characterized by radiating pain or numbness along the course of the affected nerves.

Sciatica

Sciatica is radiating pain, tingling, or numbness in the back, buttock, back of the leg, and/or foot produced by pressure on the nerve roots that lead to the sciatic nerve. Many patients describe muscle cramping or sharp pains in the buttock and posterior leg. The condition usually heals itself, given sufficient time and rest. Approximately 80% to 90% of patients with sciatica get better over time without surgery, typically within several weeks.

Scoliosis

Scoliosis is a curvature in the spine. Symptoms of scoliosis include uneven shoulders or waist, one hip appearing higher than the other, and/or one shoulder blade appearing more prominent than the other. This is commonly screened in adolescents but may also develop in the aging spine as the bones compress.

Spinal stenosis

Spinal stenosis occurs when the spinal canal narrows, putting pressure on the nerve roots. The symptoms vary depending on which nerves are affected. Mild neck pain may occur, along with numbness or pain in the back, shoulders, arms, or legs. The limbs or hands may feel clumsy or uncoordinated. In more serious cases, bladder or bowel function can become impaired.

Fractures of the spine

Spine trauma occurs when there is severe injury to the spine or spinal cord often due to an accident or fall. Most can be managed with immobilization, pain medications, and rest. In some cases, surgery is required to stabilize the spine.

Spondylolisthesis

Spondylolisthesis is a condition in which one bone (vertebra) slides forward, out of position, over another vertebra in the spine. This commonly occurs in adolescents and can be associated with pain in the lower back and tightness in the hamstrings.

The lower back is made up of five lumbar bones (vertebrae), all of which are separated by spinal discs composed of a gel-like substance and covered with cartilage. These discs act as shock absorbers and help your entire spinal column to move. The vertebrae themselves can be felt when you touch your back, and all the muscles that stabilize the spine attach to these bony points. The spinal canal, which holds the spinal cord and the nerves that branch off, runs the length of the spinal column. Because your lower back supports the majority of your body’s weight, it is very common to experience pain that comes from the muscles, the nerves, or the spine itself.

In fact, low back pain is the second most common reason people visit their doctor (cold and flu are number one).* There are many causes of back pain, and there is no single explanation for each person, although most people experience pain because of injury or trauma. The most common causes of back pain include:

• Injury to a muscle (strain) or ligament (sprain)
• Disc herniation
• Degenerative disc disease
• A pinched nerve (sciatica)
• Hip joint inflammation (sacroiliitis)

Strains and sprains can occur for many reasons, and may not be caused by any single event. Using improper lifting techniques, being overweight, and having poor posture can cause enough strain on the structures of the lower back to cause injury. You are particularly at risk if you have a job that requires heavy lifting, don’t exercise, or have a history of osteoporosis or arthritis.

Most people find that low back pain improves with simple, at-home measures that include rest (limited to two days) and nonsteroidal anti-inflammatory medications (NSAIDs) or acetaminophen to relieve pain. Sometimes, stronger muscle relaxants and narcotics are used for a short period. Prolonged bedrest (longer than two or three days) is not recommended and may actually worsen the problem.

It is important to gradually resume activity after the first couple of days. Other methods of care include applying heat or cold packs, massage therapy, ultrasound, electrical stimulation, and traction and reduction (physically maneuvering the bones). Injection with local anesthetics or corticosteroids is also an option for short-term pain relief. With all causes of low back pain, one of the most important ways to improve your condition is with back strengthening and conditioning. This is done with specific exercises, as well as general aerobic conditioning.

Surgery for low back pain is an option when nonsurgical options have been unsuccessful. The most commonly performed back operation is spinal fusion, which limits movement of the most painful part of your back. Surgery is considered successful when pain is reduced; however, recovery can take longer than a year. Furthermore, it is rare for people to have complete recovery from pain. Surgery is not the right answer for everyone, and your doctor can best discuss the benefits and limitations of surgery for your particular condition.

How to prevent low back pain:

• Use correct lifting techniques.
• Exercise regularly to strengthen back muscles.
• Maintain good posture.
• Maintain a healthy body weight.

Home care for low back pain:

– Stop normal activity and apply ice for first few days.
– Apply heat to lower back.
– Gradually increase activity to normal.
– Take over-the-counter pain relief (ibuprofen or acetaminophen).

Back pain with a loss of bowel or bladder control, leg weakness, weight loss, or fever may suggest a more serious condition. If you experience these symptoms, please seek emergency care for further evaluation.

Brief Evidence – Update: Primary Care Interventions to Prevent Low Back Pain – U.S. Preventive Services Task Force (USPSTF)

DISC DEGENERATION

Disc degeneration and loss of elasticity due to aging are one of the most common causes of herniation, although improper lifting, excessive back strain, and repetitive injury to the back area make the discs weaker and more vulnerable to injury. Because the nerves of the spine exit at every level of the spinal column, symptoms may be felt along the length of the nerve that is affected (e.g., down the length of the leg). The pain that radiates from the herniation can range from mild to severe and can be associated with numbness, tingling, or weakness. Pain may be worsened by movement, straining, coughing, or with leg raises.

HERNIATED DISC

Disc herniation, often referred to as a “slipped” or “ruptured” disc, is a common cause of low back, neck, and even arm or leg pain. The most frequently affected area of the spinal column is the lower back (the lumbar section of the spine), but any disc in the vertebral column can rupture.

Vertebral discs are the shock-absorbing, protective discs found between the bones of the spinal column (vertebrae). These discs are made up of a strong outer shell of cartilage encasing an inner gel-like substance. Although they do not actually “slip,” they may rupture or split, allowing the inner gel-like material to escape into the surrounding tissues. This puts pressure on nearby spinal nerves, which are very sensitive to even the slightest of pressure. Nerve irritation then results in pain, numbness, or weakness in the back and can radiate to one or both legs or arms.

 

GENERAL OVERVIEW

A lumbar laminectomy is a surgical procedure most often performed to alleviate leg pain caused by nerve impingement. The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerves by widening the spinal canal. A laminectomy is typically performed to treat spinal stenosis. Spinal stenosis is simply the narrowing of the spinal canal. Narrowing occurs as people age and is due to thickening of the ligaments of the spine, disc bulging, joint enlargement and bone spur formation.

PROCEDURE

Pinched Nerve Laminectomy An incision is made on the back near or at the midline. The incision is vertical and will vary in length from approximately two to five inches and is dependent on how many vertebrae are involved. Once the spine is exposed, the lamina (roof of bone covering the nerves) is removed (laminectomy) to provide more space for the nerve roots. If only a small portion of the lamina is removed it is called a laminotomy. Bone spurs are then trimmed if necessary. The incision is then closed with sutures or staples.

Risks of spinal fusion surgery include but are not limited to nerve damage, leg pain, blood vessel damage, blood clots, blood loss, dural tear, spinal fluid leak and infection. Rare risks of surgery include weakness of an extremity, bowel or bladder dysfunction or incontinence, paralysis, worsening of neurologic symptoms, worsening of low back pain and possibly death.

PREPARING FOR SURGERY

Please contact the office immediately if should develop any of the following conditions before your surgery date:

• Dental Infections
• Urinary tract infections
• Cuts that will not heal or that appear red
• Open wounds or sores
• Fever
• Any infection requiring antibiotics
• Cold or Flu
• Blood Clot
• Heart condition
• Any significant change to your overall health status
• Skin Rash
• New Allergies

7 Days Prior to Surgery

You MUST discontinue all anti-inflammatory medications and anticoagulation medications seven days prior to the surgical procedure unless told otherwise by your surgeon. This includes, but is not limited to, Aspirin, Naprosyn (Aleve), Ibuprofen (Advil, Motrin), Lovenox, Coumadin, Plavix, etc. If you are taking Plavix, Lovenox, Coumadin or other anticoagulation medication please contact the surgical coordinator immediately.

Prescreening

Pre-operative testing and any other necessary arrangements for your surgery are managed by the Surgical Coordinator. Please contact the Surgical Coordinator with any surgical questions you may have.

All patients that undergo surgery at the New England Baptist Hospital are required to go to the New England Baptist for a prescreening appointment prior to the date of surgery. At that visit you will undergo a complete physical examination by the anesthesia department. Blood work, special x-rays and an EKG will be taken. If you are required to see a specialist for surgical clearance (i.e. cardiologist), arrangements will be made to see that physician during your prescreening appointment. Please plan on spending a full day at the hospital.

Please report to the hospital 30 minutes prior to your appointment to register. Bring your insurance card(s) or workers compensation information with you to your prescreening appointment. Please bring a small snack and any medications (including pain medications) that you will need to take during the day to your prescreening appointment, as this may be a long day. There is a cafeteria and vending machines on site for your use.

You are required to bring all medications that you take on a regular basis to your pre-screening appointment at the New England Baptist Hospital in their original containers. This helps eliminate any confusion regarding your medications and will ensure that you will receive the appropriate medications during your stay at the hospital.

On occasion, the pre-screening staff will detect a medical issue that needs to be either treated or further tested prior to the surgery date. If you are informed that additional testing and/or treatment is needed before surgery, please contact the surgical coordinator immediately. If the pre-screening staff has told you that you have not been cleared for surgery please alert the surgical coordinator immediately.

You cannot have surgery without this pre-screening evaluation. If you cannot make your pre-screening appointment, you must call 617-754-5498 to reschedule as soon as possible.

If you miss your prescreening appointment your surgery will be canceled. Contact the office immediately if you have any difficulty rescheduling this appointment.

To minimize time spent at prescreening, you may pre-register at www.onemedicalpassport.com. Your surgical coordinator will provide you will you surgeon’s ID number.

Other Suggestions for Pre-Operative Planning

* Place items in your home that you use on a daily basis between waist and shoulder height. That way you can safely avoid reaching or bending.

* Make small meals or grocery shop before your surgical date so you will have little need to do so post-operatively.

• Find someone to help with chores or errands.
• If you live alone it may be helpful to stop mail for a period of time while you are in the hospital.
• Buy a pair of slip on shoes so that you will not have to bend to put them on post-operatively.
• Make arrangements for your pets to be fed or cared for.

Hospital Guest Hotel Services

New England Baptist Hospital offers hotel services on the hospital grounds exclusively to patients and their family or friends. This program was put in place to help eliminate the stress of traveling to and from the hospital for appointments or surgery.

Guests have the option of a twin, double or queen bed. Some rooms include a sleep chair for an additional person.

All guest rooms have:

• A private bath with shower
• Cable TV
• Telephone
• Clock radio
• Daily housekeeping

Other amenities include:

• Complimentary parking
• Use of the common room, with complimentary coffee service, microwave, refrigerator and sitting area
• Discounts at the hospital cafeteria

Room rates range from $75 to $105 per night

For reservations, please call Guest Services at 617-754-5173 between 8 am and 4 pm Monday through Friday. It is recommended that you call for reservations as soon as possible to ensure availability.

7 Days Prior to Surgery

**You MUST discontinue all anti-inflammatory medications and anticoagulation medications seven days prior to the surgical procedure unless told otherwise by your surgeon. This includes, but is not limited to, Aspirin, Naprosyn (Aleve), Ibuprofen (Advil, Motrin), Lovenox, Coumadin, Plavix, etc. If you are taking Plavix, Lovenox, Coumadin or other anticoagulation medication please contact the surgical coordinator immediately.

Your Operative Day

Please do NOT eat any food or drink after midnight the night before your surgery. Do NOT eat candy or gum. You may have your morning medications with a sip of water. If you use insulin, do not administer your morning injection. Bring your insulin with you to the hospital.

Hospital Arrival

You will arrive at the hospital at the time provided to you by the surgical coordinator. This will be approximately 1 ½ to 2 hours prior to your surgical time. Please report to the admitting office immediately to check in. Please bring your insurance card with you. Once you are admitted, you will be escorted to the Bond Center.

Bond Center

Once you arrive at the Bond Center, your will meet the nurse who will be taking care of you that morning. You will be asked to change into a hospital gown. The anesthesiologist will put in an IV in your arm for medications. Your surgeon will see you before surgery.

LENGTH OF SURGERY

The length of your surgery is dependent on how many vertebrae are involved. The average length of surgery is 1-2 hours. You will be transferred to the recovery room after the surgery is completed. Once you are awake and alert, you will then be transferred to your hospital room.

In Patient Post-Operative Care

Pain: Your low back will be sore following this procedure. This is managed with pain medications.

Bowel Discomfort: Your bowels may not work normally for a few days following the procedure. You will be slowly introduced to food as tolerated. We recommend small meals for the first few days, gradually increasing to your normal portions.

Breathing: Breathing exercises are incorporated into your post-operative program to help prevent pneumonia from developing. You will be given a device called an incentive spirometer, to assist you with these exercises.

Bladder Care: Following surgery, it may be difficult to urinate due to the affects of anesthesia. You may have a catheter placed temporarily to help you to urinate, though this is uncommon.

Clot Prevention: When you are inactive, precautions are taken to avoid the development of blood clots. You may be required to wear elastic stockings post-operatively.

Physical Therapy: Physical therapy begins the day after your surgery. The therapists will assist you in getting out of bed and walking. They will help you to regain your strength and motion so that you may be discharged to home safely.

DISCHARGE PLANNING

Your hospital case manager will review your post-operative plan with you before you are discharged. The hospital case manager is responsible for arranging the following services for you if needed:

• Home Physical Therapy
• Inpatient Rehabilitation Transfers
• Home Nursing
• Transportation to Home or a Rehab Center
• Home Health Aides

Rehabilitation Hospital Transfer: This is not generally necessary following a laminectomy, however, if it is necessary, this will be arranged by the hospital case manager.

Home Services: If you have been told that you are having home care and you are not contacted within two days of your discharge from the hospital by the home care agency, call the agency’s number that is listed on your discharge papers. If they do not respond, contact the office immediately at 617-730-9814.

Length of Stay: You will be expected to spend 1-3 days in the hospital.

Medications: You will receive prescriptions for pain medications upon discharge. The prescriptions are provided to you by the hospital. You will need to contact the office for refills. Please keep in mind that many medications cannot be called in and must be mailed. It is important to call the office several days in advance so that you can receive your medications on time.

Pain medications are designed to make your pain more tolerable. Do not expect to be pain free.

Medical Equipment: Medical equipment such as a cane, commode, walker, shower chair, etc. is arranged for by the hospital if needed.

Please contact the office immediately if you develop any of the FOLLOWING SYMPTOMS after discharge from the hospital:

• A significant increase in pain
• New numbness, tingling or weakness of legs
• Fever over 100°F
• New back or leg pain
• Severe headaches
• Redness or discharge from the incision site

Office Phone Number: (857) 575-5089

RECOVERING FROM LAMINECTOMY

Please contact the office immediately if you develop any of the FOLLOWING SYMPTOMS after discharge from the hospital:

• a significant increase in pain
• new numbness, tingling or weakness of legs
• fever over 100°F
• new back or leg pain
• severe headaches
• redness or discharge from the incision site

Office Phone Number: (857) 575-5089

Post Op Visits

1st Post-Op visit: Your first post-operative visit will be scheduled by the surgical coordinator. You must be seen in the office between the 10th and 14th post-operative day for suture/staple removal and a wound check. If you are unable to come to the office for this visit, please contact our office as soon as possible.

2nd Post-Op visit: Your second post-op visit will be scheduled by the surgical coordinator. This will be approximately 6 weeks from the date of surgery. You will see your surgeon on this date and x-rays will be taken.

IMMEDIATELY AFTER SURGERY

Incision Care

Dressing: A dressing will be applied to your incision following surgery. This dressing should be left on until your first office visit unless otherwise specified by your physician or physician assistant. Your visiting nurse may receive instructions to remove or change this bandage before your first post-operative visit. Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area continues to bleed, you should call the office immediately.

Wound Care: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower unless otherwise specified by your physician.

Incision: Initially the incision appears pink. Over time, with proper care, it will heal into a fine white line. This may take up to one year. For best results, put vitamin E directly onto the incision once it has healed. Keep the incisionout of the sun or cover with sunscreen.

Exercise and Precautions

You are expected to walk daily for exercise. Begin with short distances and try to walk two times per day. Avoid prolonged sitting. Avoid bending or twisting at the waist. Do not lift anything greater than 5 pounds. 3-6 Weeks after Surgery

Intercourse: You should avoid sexual activity for 3-4 four weeks following surgery. Before you resume sexual activity, make your partner aware of your pain and any concerns that you may have. Limit activity and positions that cause pain. The dependent (supine) position is recommended. Avoid twisting and excessive bending of the hips and sudden movements.

Work: You are expected to be out of work for a minimum of 4 to 6 weeks. This of course varies from person to person and is dependent upon the rate of healing, symptoms, work demands, etc. If you need disability paperwork completed, please contact the office at the earliest possible date.

Physical Activity Limitations: Avoid any lifting with the surgical limb for six weeks following surgery unless advised otherwise by your physician. You are restricted from household chores such as laundry, vacuuming, cleaning, raking, shoveling, etc. If you have a question regarding a certain activity, contact the office.

Driving: You should not drive for 6 weeks unless told otherwise by the physician

A lumbar microdiscectomy is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. This is performed to alleviate pain, numbness, tingling or weakness of the leg(s) that is caused by nerve impingement. A lumbar microdiscectomy is typically performed to treat a herniated disc.

A microdiscectomy is often combined with other surgical procedures such as a laminectomy or a lumbar fusion.

An incision is made on the back near or at the midline. The incision is vertical and will vary in length from approximately one to three inches and is dependent on how many vertebrae are involved. Once the spine is exposed, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve nerve impingement and to provide more room for the nerve to heal. The incision is then closed.

Risks

Risks of spinal fusion surgery include but are not limited to nerve damage, leg pain, blood vessel damage, blood clots, blood loss, dural tear, spinal fluid leak and infection. Rare risks of surgery include weakness of an extremity, bowel or bladder dysfunction or incontinence, paralysis, worsening of neurologic symptoms, worsening of low back pain and possibly death.

PREPAIRING FOR SURGERY

Prescreening

Pre-operative testing and any other necessary arrangements for your surgery are managed by the Surgical Coordinator. Please contact the Surgical Coordinator with any surgical questions you may have.

All patients that undergo surgery at the New England Baptist Hospital are required to go to the New England Baptist for a prescreening appointment prior to the date of surgery. At that visit you will undergo a complete physical examination by the anesthesia department. Blood work, special x-rays and an EKG will be taken. If you are required to see a specialist for surgical clearance (i.e. cardiologist), arrangements will be made to see that physician during your prescreening appointment. Please plan on spending a full day at the hospital.

Please report to the hospital 30 minutes prior to your appointment to register. Bring your insurance card(s) or workers compensation information with you to your prescreening appointment. Please bring a small snack and any medications (including pain medications) that you will need to take during the day to your prescreening appointment, as this may be a long day. There is a cafeteria and vending machines on site for your use.

You are required to bring all medications that you take on a regular basis to your pre-screening appointment at the New England Baptist Hospital in their original containers.

This helps eliminate any confusion regarding your medications and will ensure that you will receive the appropriate medications during your stay at the hospital.

** On occasion, the pre-screening staff will detect a medical issue that needs to be either treated or further tested prior to the surgery date. If you are informed that additional testing and/or treatment is needed before surgery, please contact the surgical coordinator immediately. If the pre-screening staff has told you that you have not been cleared for surgery please alert the surgical coordinator immediately.

**You cannot have surgery without this pre-screening evaluation. If you cannot make your pre-screening appointment, you must call 617-754-5498 to reschedule as soon as possible. If you miss your prescreening appointment your surgery will be canceled. Contact the office immediately if you have any difficulty rescheduling this appointment.

To minimize time spent at prescreening, you may pre-register at www.onemedicalpassport.com. Your surgical coordinator will provide you will you surgeon’s ID number.

Conditions of Concern

Please contact the office immediately if should develop any of the following conditions before your surgery date:

• Dental Infections
• Urinary tract infections
• Cuts that will not heal or that appear red
• Open wounds or sores
• Fever
• Any infection requiring antibiotics
• Cold or Flu
• Blood Clot
• Heart condition
• Any significant change in your overall health status
• Skin Rash
• New Allergies

Other Suggestions for Pre-Operative Planning

• Place items in your home that you use on a daily basis between waist and shoulder height. That way you can safely avoid reaching or bending.
• Make small meals or grocery shop before your surgical date so you will have little need to do so post-operatively.
• Find someone to help with chores or errands.
• If you live alone it may be helpful to stop mail for a period of time while you are in the hospital.
• Buy a pair of slip on shoes so that you will not have to bend to put them on post-operatively.
• Make arrangements for your pets to be fed or cared for.

Hospital Guest Hotel Services

New England Baptist Hospital offers hotel services on the hospital grounds exclusively to patients and their family or friends. This program was put in place to help eliminate the stress of traveling to and from the hospital for appointments or surgery.

Guests have the option of a twin, double or queen bed. Some rooms include a sleep chair for an additional person.

All guest rooms have:

• A private bath with shower
• Cable TV
• Telephone
• Clock radio
• Daily housekeeping

Other amenities include:

• Complimentary parking
• Use of the common room, with complimentary coffee service, microwave, refrigerator and sitting area
• Discounts at the hospital cafeteria

Room rates range from $75 to $105 per night

For reservations, please call Guest Services at 617-754-5173 between 8 am and 4 pm Monday through Friday. It is recommended that you call for reservations as soon as possible to ensure availability

YOUR OPERATIVE DAY

At Home

You MUST discontinue all anti-inflammatory medications and anticoagulation medications seven days prior to the surgical procedure unless told otherwise by your surgeon. This includes, but is not limited to, Aspirin, Naprosyn (Aleve), Ibuprofen (Advil, Motrin), Lovenox, Coumadin, Plavix, etc. If you are taking Plavix, Lovenox, Coumadin or other anticoagulation medication please contact the surgical coordinator immediately.

Please do NOT eat any food or drink after midnight the night before your surgery. Do NOT eat candy or gum. You may have your morning medications with a sip of water. If you use insulin, do not administer your morning injection. Bring your insulin with you to the hospital.

Hospital Arrival

You will arrive at the hospital at the time provided to you by the surgical coordinator. This will be approximately 1 ½ to 2 hours prior to your surgical time. Please report to the admitting office immediately to check in. Please bring your insurance card with you. Once you are admitted, you will be escorted to the Bond Center.

Bond Center

Once you arrive at the Bond Center, your will meet the nurse who will be taking care of you that morning. You will be asked to change into a hospital gown. The anesthesiologist will put in an IV in your arm for medications. Your surgeon will see you before surgery.

Length of Surgery

The length of your surgery is dependent on how many vertebrae are involved. The average length of surgery is 60 to 90 minutes. You will be transferred to the recovery room after the surgery is completed.

DISCHARGE PLANNING

Medications

You will receive prescriptions for pain medications upon discharge. The prescriptions are provided to you by the hospital. You will need to contact the office for refills. Please keep in mind that many medications cannot be called in and must be mailed. It is important to call the office several days in advance so that you can receive your medications on time.

Pain medications are designed to make your pain more tolerable. Do not expect to be pain free.

Medical Equipment

Medical equipment such as a cane, commode, walker, shower chair, etc. is arranged for by the hospital if needed.

Recovering from Microdiscectomy

Please contact the office immediately if you develop any of the FOLLOWING SYMPTOMS after discharge from the hospital:

• A significant increase in pain
• New numbness, tingling or weakness of legs
• Fever over 100°F
• New back or leg pain
• Severe headaches
• Redness or discharge from the incision site

Office Phone Number: (857) 575-5089

Post Op Visits

1st Post-Op visit (10-14 days after surgery)

Your first post-operative visit will be scheduled by the surgical coordinator. You must be seen in the office between the 10th and 14th post-operative day for suture/staple removal and a wound check. If you are unable to come to the office for this visit, please contact our office as soon as possible.

2nd Post-Op visit (6 weeks after surgery)

Your second post-op visit will be scheduled by the surgical coordinator. This will be approximately 6 weeks from the date of surgery. You will see your surgeon on this date and x-rays will be taken.

IMMEDIATELY AFTER SURGERY

Incision Care

Dressing: A dressing will be applied to your incision following surgery. This dressing should be left on until your first office visit unless otherwise specified by your physician or physician assistant. Your visiting nurse may receive instructions to remove or change this bandage before your first post-operative visit.

Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area continues to bleed, you should call the office immediately.

Wound Care: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower unless otherwise specified by your physician.

Incision: Initially the incision appears pink. Over time, with proper care, it will heal into a fine white line. This may take up to one year. For best results, put vitamin E directly onto the incision once it has healed. Keep the incision out of the sun or cover with sunscreen.

EXERCISE, PRECAUTIONS AND LIMITATIONS

You are expected to walk daily for exercise. Begin with short distances and try to walk two times per day.

Avoid prolonged sitting.

Avoid bending or twisting at the waist.

Do not lift anything greater than 5 pounds.

Avoid any lifting with the surgical limb for six weeks following surgery unless advised otherwise by your physician.

You are restricted from household chores such as laundry, vacuuming, cleaning, raking, shoveling, etc. If you have a question regarding a certain activity, contact the office.

Pain: Post-operative pain is normal and to be expected. Be sure to take your medications as prescribed. Contact the office with any significant increase in your pain.

Bracing: Bracing is not generally necessary following a microdiscectomy. However, if needed, a low back brace will be issued to you by the hospital and you will receive before discharge.2-6 Weeks After Surgery

Rehabilitation: You will begin an outpatient physical therapy approximately six week after the surgery unless advised otherwise by your surgeon. This allows time for healing.

Work: You are expected to be out of work for a minimum of 2 to 6 weeks. This of course varies from person to person and is dependent upon the rate of healing, symptoms, work demands, etc. If you need disability paperwork completed, please contact the office at the earliest possible date.

Driving: You should not drive for 6 weeks unless told otherwise by the physician.

Intercourse: You should avoid sexual activity for 3-4 four weeks following surgery. Before you resume sexual activity, make your partner aware of your pain and any concerns that you may have. Limit activity and positions that cause pain. The dependent (supine) position is recommended. Avoid twisting and excessive bending of the hips and sudden movements

A lumbar fusion is a type of back operation where two or more vertebrae, usually separated by a disc, are allowed to grow together or “fuse” into one long bone. The purpose of a fusion is to reduce the pain created by motion of the vertebrae.

Indications: Conditions commonly treated by lumbar fusion include degenerative disc disease, abnormal slippage and motion of the vertebrae, vertebral fracture and other degenerative conditions.

THE PROCEDURE

The incision for a posterior lumbar fusion is made through the back. The incision is vertical. The length of the incision is dependent on the number of vertebrae involved. Once the incision is made, the spine is then exposed. Any bone or disc material compressing a nervewill be removed at this time if discussed prior to surgery. Next a screw is placed on either side of each vertebra involved. The screws are then connected by a rod on each side. Bone graft is then taken from your pelvis and placed alongside the hardware to promote fusion. Bone graft substitute may also be used. (see diagram)

A screw is then placed on either side of each vertebra involved. The screws are connected by a rod on each side. Bone graft is then taken from your pelvis and placed alongside the spine to promote fusion. Bone graft substitute may also be used.

The spine fusion is not actually completed at the time of surgery. Instead, the conditions for the spine to fuse are created. The hardware is put in place to temporarily stabilize the vertebrae until your own body has made enough bone to stabilize the vertebrae itself. As you heal, the graft and vertebrae will grow together to become one sold unit. It will take 6 to 12 months for the fusion to become solid. X-rays will be taken periodically to monitor healing

WARNING: Patient’s who smoke or use other tobacco products DO NOT fuse. You must discontinue using all tobacco products before undergoing fusion surgery. Contact the office immediately if you need assistance to quit smoking.

PREPARING FOR SURGERY

Arrangements for your surgery and any pre-operative testing are coordinated by the Surgical Coordinator Patricia Wilkerson. Please contact her with any surgical questions you may have at 617-730-9814.

Prescreening

All patients that undergo surgery at the New England Baptist Hospital are required to go to the hospital for a prescreening appointment prior to the date of surgery. At that visit you will undergo a complete physical examination by the anesthesia department. Blood work, special x-rays and an EKG will be taken. If you are required to see a specialist for surgical clearance (i.e. cardiologist), arrangements will be made for you to see that physician at your prescreening appointment. If other arrangements need to be made, you will be notified. Blood donations, if necessary, may also be scheduled for that day. Please plan on spending a full day at the hospital.

Please bring a small snack and any medications (including pain medications) that you will need to take during the day to your prescreening appointment, as this will be a long day. There is a cafeteria and vending machines on site for your use.

You cannot have surgery without this pre-screening evaluation. If you cannot make your pre-screening appointment, you must call 617-754-5223 to reschedule as soon as possible. You must notify the office as well. If you miss your prescreening appointment your surgery will be canceled. Contact the office immediately if you have any difficulty rescheduling this appointment.

To minimize time spent at prescreening, you are encouraged to pre-register at www.onemedicalpassport.com. Dr. Masons ID number is 0001610056. See the enclosed pamphlet for more information.

Blood Donation

Most patients receive two blood transfusions following an anterior posterior fusion. Therefore, you will be asked to donate two units of your own blood preoperatively to be used for transfusion during or following surgery. One unit is generally donated at your prescreening visit.

Blood donations may also be scheduled at designated American Red Cross facilities. This will be coordinated by the surgical coordinator. Be aware that most Red Cross locations do not provide this service. Family members may also donate blood for the surgery if their blood type is exactly the same. “Universal donors” are not acceptable.

Any blood donated on your behalf is disposed of if not used for your surgical procedure.

YOUR OPERATIVE DAY

At Home

Please do NOT eat any food or drink after midnight the night before your surgery. Do NOT eat candy or gum. You may have your morning medications with a sip of water. If you use insulin, do not administer your morning injection. Bring your insulin with you to the hospital.

Hospital Arrival

You must arrive at the hospital at the time provided to you by the surgical coordinator. This will be approximately 1 ½ to 2 hours prior to your surgical time.

Please report to the admitting office immediately to check in. Please bring your insurance card with you. Once you are admitted, you will be escorted to the Bond Center.

Bond Center

Once you arrive at the Bond Center, your will meet the nurse who will be taking care of you that morning. You will be asked to change into a hospital gown. The anesthesiologist will put in an IV in your arm for medications. Your surgeon will see you before surgery.

Length of Surgery

The length of your surgery is dependent on how many vertebrae are involved. The average length of surgery is 4-5 hours. You will be transferred to the recovery room after the surgery is completed. Once you are awake and alert, you will then be transferred to your hospital room.

IN PATIENT POST-OPERATIVE CARE

Pain

Your low back and abdomen will be very sore following this procedure. Initially your pain will managed with IV medications. Pain medication will be utilized to keep you comfortable. Do not expect to be pain free.

Bowel Discomfort

Your bowels will be manipulated during the anterior portion of your surgery to allow for good exposure of the spine. Therefore, your bowels may not work normally for a few days following surgery. You will be slowly introduced to food as tolerated. We recommend small meals for the first few days, gradually increasing to your normal portions.

Breathing

Breathing exercises are incorporated into your post-operative program to help prevent pneumonia from developing. You will be given a device called an incentive spirometer, to assist you with these exercises.

Bladder Care

Following surgery, it may be difficult to urinate due to the affects of anesthesia. You may have a catheter placed temporarily to help you to urinate.

Clot Prevention

When you are inactive, precautions are taken to avoid the development of blood clots. You may be required to wear elastic stockings post-operatively.

Physical Therapy

Physical therapy begins the day after your surgery. The therapists will assist you in getting out of bed and walking. They will help you to regain your strength and motion so that you may be discharged to home safely.

DISCHARGE PLANNING

Your hospital case manager will review your post-operative plan with you before you are discharged. The hospital case manager is responsible for arranging the following services for you if needed:

• Home Physical Therapy
• Inpatient Rehabilitation Transfers
• Home Nursing
• Transportation to Home or a Rehab Center
• Home Health Aides
• Rehabilitation Hospital Transfer

You may be transferred to an inpatient rehabilitation center for a short period of time following surgery if you are not ready to go home. If inpatient rehabilitation is needed, this is arranged by the hospital case manager. If you would like to go to a specific rehabilitation hospital, please inform your case worker as soon as possible.

Home Services

If you have been told that you are having home care and you are not contacted within two days of your discharge from the hospital by the home care agency, call the agency’s number that is listed on your discharge papers. If they do not respond, contact the office immediately at 617-730-9814.

Length of Stay

You will be expected to spend 4-5 days in the hospital.

Medications

You will receive prescriptions for pain medications upon discharge. The prescriptions are provided to you by the hospital. You will need to contact the office during office hours for refills. Pain medications cannot be called in or written after office hours or on weekends.

Please keep in mind that many narcotic medications cannot be called in and must be mailed. It is important to call the office several days in advance so that you can receive your medications on time.

Pain medications are designed to make your pain more tolerable. Do not expect to be pain free.

Medical Equipment

Medical equipment such as a cane, commode, walker, shower chair, etc. is arranged for by the hospital if needed.

RECOVERING FROM LUMBAR FUSION

Please contact the office immediately if you develop any of the following symptoms after discharge from the hospital:

• A significant increase in pain
• New numbness, tingling or weakness of legs
• Fever over 100°F
• New back or leg pain
• Severe headaches
• Redness or discharge from the incision site
• POST OPERATIVE VISITS

1st Post Op Visit (10-14 days)

You must be seen in the office between the 10th and 14th post-operative day. This is for suture or staple removal, a wound check and pain medication refills. If you are unable to come to this appointment, please contact our office.

2nd Post-Op visit

You will be seen by your surgeon approximately 6 weeks following the date of surgery. You will have x-rays taken that day.

IMMEDIATELY AFTER SURGERY

Incision Care

Dressing: A dressing will be applied to your incision following surgery. This dressing should be left on until your first office visit unless otherwise specified by your physician or physician assistant. Your visiting nurse may receive instructions to remove or change this bandage before your first post-operative visit.

Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area continues to bleed, you should call the office immediately.

Wound Care: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower unless otherwise specified by your surgeon.

Incision: Initially the incision appears pink. Over time, with proper care, it will heal into a fine white line. This may take up to one year. For best results, put vitamin E directly onto the incision once it has healed. Keep the incision out of the sun or cover with sunscreen.

Exercise and Precautions

You are expected to walk daily for exercise. Begin with short distances and try to walk two times per day. Do not lift anything greater than 5 pounds.

Pain: Post-operative pain is normal and to be expected. Be sure to take your medications as prescribed. Contact the office with any significant increase in your pain.

Body Mechanics: Maintain proper posture with all activities. Avoid bending, twisting or slouching. Avoid prolonged sitting.

Bone Stimulators: If indicated, you will be provided with an external bone stimulator to be worn with your brace. This may increase the rate of fusion and decrease healing time. You will be notified by your physician if you are a candidate. Please note that some insurance companies will not approve this product.

3-6 Weeks After Surgery

Housework: Do not do any household chores such as bed making, sweeping, dishes, laundry, etc.

Driving: You should not drive for 6 weeks unless told otherwise by the physician.

Intercourse: You should avoid sexual activity for 3-4 four weeks following surgery. Before you resume sexual activity, make your partner aware of your pain and any concerns that you may have. Limit activity and positions that cause pain. The dependent (supine) position is recommended. Avoid twisting and excessive bending of the hips and sudden movements.

12 WEEKS AFTER SURGERY

Rehabilitation: You will begin outpatient physical therapy approximately three months after the surgery unless advised otherwise by your surgeon.

Bracing: All patients will require a low back brace to be worn post-operatively for a minimum of three months. Patients are usually measured pre-operatively for this brace. On occasion, measurements are taken during your hospital stay.

Work: You are expected to be out of work for a minimum of 12 weeks. This of course varies from person to person. Return to work is dependent upon the rate of healing, symptoms, work demands, etc. If you need disability paperwork completed, please contact the office at the earliest possible date.

The incision for a posterior lumbar fusion is made through the back. The incision is vertical. The length of the incision is dependent on the number of vertebrae involved. Once the incision is made, the spine is then exposed. Any bone or disc material compressing a nerve will be removed at this time if discussed prior to surgery. Next a screw is placed on either side of each vertebra involved. The screws are then connected by a rod on each side. Bone graft is then taken from your pelvis and placed alongside the hardware to promote fusion. Bone graft substitute may also be used. (see diagram)

A screw is then placed on either side of each vertebra involved. The screws are connected by a rod on each side. Bone graft is then taken from your pelvis and placed alongside the spine to promote fusion. Bone graft substitute may also be used.

The spine fusion is not actually completed at the time of surgery. Instead, the conditions for the spine to fuse are created. The hardware is put in place to temporarily stabilize the vertebrae until your own body has made enough bone to stabilize the vertebrae itself. As you heal, the graft and vertebrae will grow together to become one sold unit. It will take 6 to 12 months for the fusion to become solid. X-rays will be taken periodically to monitor healing

WARNING: Patient’s who smoke or use other tobacco products DO NOT fuse. You must discontinue using all tobacco products before undergoing fusion surgery. Contact the office immediately if you need assistance to quit smoking.

Preparing for Surgery

Arrangements for your surgery and any pre-operative testing are coordinated by the Surgical Coordinator. Please contact your assigned surgical scheduler with any surgical questions you may have.

Prescreening

All patients that undergo surgery at the New England Baptist Hospital are required to go to the hospital for a prescreening appointment prior to the date of surgery. At that visit you will undergo a complete physical examination by the anesthesia department. Blood work, special x-rays and an EKG will be taken. If you are required to see a specialist for surgical clearance (i.e. cardiologist), arrangements will be made for you to see that physician at your prescreening appointment. If other arrangements need to be made, you will be notified. Blood donations, if necessary, may also be scheduled for that day. Please plan on spending a full day at the hospital.

Please bring a small snack and any medications (including pain medications) that you will need to take during the day to your prescreening appointment, as this will be a long day. There is a cafeteria and vending machines on site for your use.

You cannot have surgery without this pre-screening evaluation. If you cannot make your pre-screening appointment, you must call 617-754-5223 to reschedule as soon as possible. You must notify the office as well. If you miss your prescreening appointment your surgery will be canceled. Contact the office immediately if you have any difficulty rescheduling this appointment.

To minimize time spent at prescreening, you are encouraged to pre-register at www.onemedicalpassport.com. Dr. Masons ID number is 0001610056. See the enclosed pamphlet for more information.

Blood Donation

Most patients receive two blood transfusions following an anterior posterior fusion. Therefore, you will be asked to donate two units of your own blood preoperatively to be used for transfusion during or following surgery. One unit is generally donated at your prescreening visit.

Blood donations may also be scheduled at designated American Red Cross facilities. This will be coordinated by the surgical coordinator. Be aware that most Red Cross locations do not provide this service. Family members may also donate blood for the surgery if their blood type is exactly the same. “Universal donors” are not acceptable.

Any blood donated on your behalf is disposed of if not used for your surgical procedure.

Your Operative Day

At Home

Please do NOT eat any food or drink after midnight the night before your surgery. Do NOT eat candy or gum. You may have your morning medications with a sip of water. If you use insulin, do not administer your morning injection. Bring your insulin with you to the hospital.

Length of Surgery

The length of your surgery is dependent on how many vertebrae are involved. The average length of surgery is 4-5 hours. You will be transferred to the recovery room after the surgery is completed. Once you are awake and alert, you will then be transferred to your hospital room.

In Patient Post-Operative Care

Pain

Your low back and abdomen will be very sore following this procedure. Initially your pain will managed with IV medications. Pain medication will be utilized to keep you comfortable. Do not expect to be pain free.

Bowel Discomfort

Your bowels will be manipulated during the anterior portion of your surgery to allow for good exposure of the spine. Therefore, your bowels may not work normally for a few days following surgery. You will be slowly introduced to food as tolerated. We recommend small meals for the first few days, gradually increasing to your normal portions.

Breathing

Breathing exercises are incorporated into your post-operative program to help prevent pneumonia from developing. You will be given a device called an incentive spirometer, to assist you with these exercises.

Bladder Care

Following surgery, it may be difficult to urinate due to the affects of anesthesia. You may have a catheter placed temporarily to help you to urinate.

Clot Prevention

When you are inactive, precautions are taken to avoid the development of blood clots. You may be required to wear elastic stockings post-operatively.

Physical Therapy

Physical therapy begins the day after your surgery. The therapists will assist you in getting out of bed and walking. They will help you to regain your strength and motion so that you may be discharged to home safely.

Discharge Planning

Your hospital case manager will review your post-operative plan with you before you are discharged. The hospital case manager is responsible for arranging the following services for you if needed:

• Home Physical Therapy
• Inpatient Rehabilitation Transfers
• Home Nursing
• Transportation to Home or a Rehab Center
• Home Health Aides

Rehabilitation Hospital Transfer

You may be transferred to an inpatient rehabilitation center for a short period of time following surgery if you are not ready to go home. If inpatient rehabilitation is needed, this is arranged by the hospital case manager. If you would like to go to a specific rehabilitation hospital, please inform your case worker as soon as possible.

Home Services

If you have been told that you are having home care and you are not contacted within two days of your discharge from the hospital by the home care agency, call the agency’s number that is listed on your discharge papers. If they do not respond, contact the office immediately at 617-730-9814.

Length of Stay

You will be expected to spend 4-5 days in the hospital.

Medications

You will receive prescriptions for pain medications upon discharge. The prescriptions are provided to you by the hospital. You will need to contact the office during office hours for refills. Pain medications cannot be called in or written after office hours or on weekends.

Please keep in mind that many narcotic medications cannot be called in and must be mailed. It is important to call the office several days in advance so that you can receive your medications on time.

Pain medications are designed to make your pain more tolerable. Do not expect to be pain free.

Medical Equipment

Medical equipment such as a cane, commode, walker, shower chair, etc. is arranged for by the hospital if needed.

Recovering from Lumbar Fusion

Please contact the office immediately if you develop any of the following symptoms after discharge from the hospital:

• A significant increase in pain
• New numbness, tingling or weakness of legs
• Fever over 100°F
• New back or leg pain
• Severe headaches
• Redness or discharge from the incision site

Post Operative Visits
1st Post Op Visit (10-14 days)

You must be seen in the office between the 10th and 14th post-operative day. This is for suture or staple removal, a wound check and pain medication refills. If you are unable to come to this appointment, please contact our office.

2nd Post-Op visit

You will be seen by your surgeon approximately 6 weeks following the date of surgery. You will have x-rays taken that day.

Immediately After Surgery

Incision Care

Dressing: A dressing will be applied to your incision following surgery. This dressing should be left on until your first office visit unless otherwise specified by your physician or physician assistant. Your visiting nurse may receive instructions to remove or change this bandage before your first post-operative visit.

Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area continues to bleed, you should call the office immediately.

Wound Care: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower unless otherwise specified by your surgeon.

Incision: Initially the incision appears pink. Over time, with proper care, it will heal into a fine white line. This may take up to one year. For best results, put vitamin E directly onto the incision once it has healed. Keep the incision out of the sun or cover with sunscreen. Exercise and Precautions

You are expected to walk daily for exercise. Begin with short distances and try to walk two times per day. Do not lift anything greater than 5 pounds.

Pain: Post-operative pain is normal and to be expected. Be sure to take your medications as prescribed. Contact the office with any significant increase in your pain.

Body Mechanics: Maintain proper posture with all activities. Avoid bending, twisting or slouching. Avoid prolonged sitting.

Bone Stimulators: If indicated, you will be provided with an external bone stimulator to be worn with your brace. This may increase the rate of fusion and decrease healing time. You will be notified by your physician if you are a candidate. Please note that some insurance companies will not approve this product. 3-6 Weeks After Surgery

Housework: Do not do any household chores such as bed making, sweeping, dishes, laundry, etc.

Driving: You should not drive for 6 weeks unless told otherwise by the physician.

Intercourse: You should avoid sexual activity for 3-4 four weeks following surgery. Before you resume sexual activity, make your partner aware of your pain and any concerns that you may have. Limit activity and positions that cause pain. The dependent (supine) position is recommended. Avoid twisting and excessive bending of the hips and sudden movements.

12 Weeks After Surgery

Rehabilitation: You will begin outpatient physical therapy approximately three months after the surgery unless advised otherwise by your surgeon.

Bracing: All patients will require a low back brace to be worn post-operatively for a minimum of three months. Patients are usually measured pre-operatively for this brace. On occasion, measurements are taken during your hospital stay.

Work: You are expected to be out of work for a minimum of 12 weeks. This of course varies from person to person. Return to work is dependent upon the rate of healing, symptoms, work demands, etc. If you need disability paperwork completed, please contact the office at the earliest possible date.

A lumbar fusion is a type of back operation where two or more vertebrae, which are usually separated by a disc, are allowed to grow together or “fuse” into one long bone. The purpose of a fusion is to reduce the pain created by motion of the vertebrae.

An anterior posterior fusion is performed through two incisions, one on the front (anterior) and one on the back (posterior). The front incision is made first. This is generally vertical and extends from the belly button to just above the hairline. A vascular surgeon will make the incision and perform the exposure for your spine surgeon. Once the spine is exposed, the diseased disc material is removed and replaced by one or twocages. These cages are filled with bone graft taken from your pelvis and/or bone graft substitute. The cages provide stability to the spine. The bone graft helps to stimulate the growth of bone from the vertebrae above to the vertebrae below. Once this process is completed, the wound is closed and you are turned onto your stomach.

The back incision is then made. The incision is vertical and varies in length. Once the spine is exposed, any bone or disc material compressing a nerve will be removed at this time if discussed prior to surgery. A screw is then placed on either side of each vertebra involved. The screws are connected by a rod on each side. Bone graft is then taken from your pelvis and placed alongside the hardware to promote fusion. Bone graft substitute may also be used.

The spine fusion is not actually completed at the time of surgery. Instead, the conditions for the spine to fuse are created. The hardware is put in place to temporarily stabilize the vertebrae until your own body has made enough bone to stabilize the vertebrae itself. As you heal, the bone graft and vertebrae will grow together to become one solid unit. It will take 6 to 12 months for the fusion to become solid. X-rays will be taken periodically to monitor healing.

WARNING: Patient’s who smoke or use other tobacco products DO NOT fuse. You must discontinue all tobacco products (including but not limited to chewing tobacco, cigarettes, cigars and the nicotine patch) prior to undergoing fusion surgery. Contact the office immediately if you need assistance to quit smoking.

Risks

Risks of spinal fusion surgery include but are not limited to nerve damage, blood vessel damage, blood clots, blood loss, dural tear, spinal fluid leak, infection, movement of the interbody cage and failure to fuse. Rare risks of surgery include weakness of an extremity, bowel or bladder dysfunction or incontinence, worsening of neurologic symptoms, worsening of low back pain and possible death. For males, there is a (rare) risk of retrograde ejaculation.

PREPARING FOR SURGERY

Pre-operative testing and any other necessary arrangements for your surgery are managed by the Surgical Coordinator. Please contact the Surgical Coordinator with any surgical questions you may have.

Prescreening

All patients that undergo surgery at the New England Baptist Hospital are required to go to the New England Baptist for a prescreening appointment prior to the date of surgery. At that visit you will undergo a complete physical examination by the anesthesia department. Blood work, special x-rays and an EKG will be taken. If you are required to see a specialist for surgical clearance (i.e. cardiologist), arrangements will be made to see that physician during your prescreening appointment. Please plan on spending a full day at the hospital.

Please report to the hospital 30 minutes prior to your appointment to register. Bring your insurance card(s) or workers compensation information with you to your prescreening appointment. Please bring a small snack and any medications (including pain medications) that you will need to take during the day to your prescreening appointment, as this may be a long day. There is a cafeteria and vending machines on site for your use.

You are required to bring all medications that you take on a regular basis to your pre-screening appointment at the New England Baptist Hospital in their original containers. This helps eliminate any confusion regarding your medications and will ensure that you will receive the appropriate medications during your stay at the hospital.

** On occasion, the pre-screening staff will detect a medical issue that needs to be either treated or further tested prior to the surgery date. If you are informed that additional testing and treatment is needed before surgery, please contact the surgical coordinator immediately. If the pre-screening staff has told you that you have not been cleared for surgery please alert the surgical coordinator immediately.

**You cannot have surgery without this pre-screening evaluation. If you miss your prescreening appointment your surgery will be canceled. If you cannot make your pre-screening appointment, you must call 617-754-5498 to reschedule as soon as possible. Contact the office immediately if you have any difficulty rescheduling this appointment.

To minimize time spent at prescreening, you may pre-register at www.onemedicalpassport.com. Your surgical coordinator will provide you will you surgeon’s ID number.

Conditions of Concern

**Please contact the office immediately if should develop any of the following conditions before your surgery date:

• Dental Infections
• Urinary tract infections
• Cuts that will not heal or that appear red
• Open wounds or sores
• Fever
• Any infection requiring antibiotics
• Cold or Flu
• Blood Clot
• Heart condition
• Any significant change in your overall health status
• Skin Rash
• New Allergies

Blood Donation

Most patients receive two blood transfusions following an anterior posterior fusion. Therefore, you will be asked to donate two units of your own blood preoperatively to be used for transfusion during or following surgery. One unit is generally donated at your prescreening visit. The Surgical Coordinator will make these arrangements.

Blood donations may also be scheduled at designated American Red Cross facilities. Most Red Cross locations do not provide this service.

Family members may donate blood for your surgery if their blood type is exactly the same. “Universal donors” are not acceptable.

The blood donated for your surgery may only be used by you. Any blood products not utilized will be discarded.

** If you have any religious beliefs or medical issues that that prohibit you from receiving blood or blood products, please notify your surgeon or the surgical coordinator immediately.

Bowel Prep

The prescreening unit may give you a prescription for bowel medication take prior to surgery to help reduce post-operative bowel discomfort.

Medications

You must discontinue all anti-inflammatory medications (other than Celebrex), aspirin products and other anticoagulation medication one week prior to surgery. If you are currently taking Plavix, Coumadin, Warfarin or any other blood thinners, please contact the office immediately.

Bracing

All patients undergoing spine fusion surgery are required to wear a back brace post-operatively for a minimum of three months. The brace helps to stabilize the spine while it is healing. You will be measured pre-operatively for this brace. If a custom brace is needed arrangements will be made for a fitting before your surgery date.

Bone Stimulators

An external electrical bone stimulator is a lightweight, battery powered, portable device that is used as an adjunctive therapy to enhance the chances of obtaining a solid spinal fusion. It is recommended for use in patients undergoing a multi-level or revision fusion. Bone stimulators are also recommended for patients who smoke, patients who are diabetic and for those with severe instability in the spine.

On occasion, the surgeon recommends that an implantable bone stimulator device be used. This is placed at the time of surgery.

Our office, with your permission, will attempt to obtain insurance approval for the bone external stimulator if needed. Insurance approval and the amount covered by the insurance company will vary from plan to plan.

** The use of bone stimulators is contraindicated in patients with implantable pace-makers or defibrillators.

Hospital Guest Hotel Services

New England Baptist Hospital offers hotel services on the hospital grounds exclusively to patients and their family or friends. This program was put in place to help eliminate the stress of traveling to and from the hospital for appointments or surgery.

Guests have the option of a twin, double or queen bed. Some rooms include a sleep chair for an additional person.

All guest rooms have:

• A private bath with shower
• Cable TV
• Telephone
• Clock radio
• Daily housekeeping

Other amenities include:

• Complimentary parking
• Use of the common room, with complimentary coffee service, microwave, refrigerator and sitting area
• Discounts at the hospital cafeteria

Room rates range from $75 to $105 per night

For reservations, please call Guest Services at 617-754-5173 between 8 am and 4 pm Monday through Friday. It is recommended that you call for reservations as soon as possible to ensure availability.

Other Suggestions for Pre-Operative Planning

• Place items in your home that you use on a daily basis between waist and shoulder height. That way you can safely avoid reaching or bending.
• Make small meals or grocery shop before your surgical date so you will have little need to do so post-operatively.
• Find someone to help with chores or errands.
• If you live alone it may be helpful to stop mail for a period of time while you are in the hospital.
• Buy a pair of slip on shoes so that you will not have to bend to put them on post-operatively.
• Make arrangements for your pets to be fed or cared for.

YOUR OPERATIVE DAY

At Home

Please do NOT eat any food or drink after midnight the night before your surgery. Do NOT eat candy or gum. You may have your morning medications with a sip of water. If you use insulin, do not administer your morning injection. Bring your insulin with you to the hospital.

Hospital Arrival

You are expected to arrive at the hospital at the time provided to you by the surgical coordinator. This will be approximately 1 ½ to 2 hours prior to your surgical time.

Please leave early to allow time for any traffic delays.

Please report to the admitting office immediately to check in. Bring your insurance card(s) with you. Once you are admitted, you will be escorted to the Bond Center.

Bond Center

Once you arrive at the Bond Center, your will meet the nurse who will be taking care of you that morning. You will be asked to change into a hospital gown. The anesthesiologist will put in an IV in your arm for medications. Your surgeon will see you before surgery.

Length of Surgery

The length of your surgery is dependent on how many vertebrae are involved. The average length of surgery is 5-7 hours. You will be transferred to the recovery room after the surgery is completed. Once you are awake and alert, you will then be transferred to your hospital room. The surgeon will speak to your family once surgery is completed at your request.

IN-PATIENT POST-OPERATIVE CARE

Pain

Your low back and abdomen will be very sore post-operatively. Pain medication will be utilized to keep you as comfortable as possible. Do NOT expect to be pain free.

Bowel Discomfort

Your intestines will be manipulated during the anterior portion of your surgery to allow for good exposure of the spine. As a result, your bowels may not work normally for a few days following your surgery. You will be slowly introduced to food as tolerated. We recommend small meals for the first few days, gradually increasing to your normal portions.

Breathing

Breathing exercises are incorporated into your post-operative program to help prevent pneumonia from developing. You will be given a device called an incentive spirometer to assist you with these exercises.

Bladder Care

You may have a catheter placed during your surgery to help you to urinate pos-operatively.

Clot Prevention

When you are inactive, precautions are taken to avoid the development of blood clots. You may be required to wear elastic stockings post-operatively.

Physical Therapy

Physical therapy begins the day after your surgery. The therapists will assist you in getting out of bed and walking. They will help you to regain your strength so that you may be discharged to home safely.

DISCHARGE PLANNING

Your hospital case manager will review your post-operative plan with you before you are discharged. The hospital case manager is responsible for arranging the following services for you if needed:

• Home Physical Therapy
• Inpatient Rehabilitation Transfers
• Home Nursing
• Transportation to Home or a Rehab Center
• Home Health Aides;

Rehabilitation Hospital Transfer

You may be transferred to an inpatient rehabilitation center for a short period of time following surgery if you are not ready to go home. If inpatient rehabilitation is needed, the necessary arrangements are made by the hospital case manager. If you would like to go to a specific rehabilitation hospital, please inform your case worker as soon as possible.

Home Services

If you have been told you will receive home care services post-operatively and you are not contacted by the home care agency within two days of your discharge, call the agency’s number that is listed on your discharge papers. If they do not respond, contact the office immediately.

Medications

You will receive prescriptions for pain medications upon discharge. The prescriptions are provided to you by the hospital. Please review your medication instructions prior to leaving the hospital.

You will need to contact the office for medication refills. Please keep in mind that many medications cannot be called in to your pharmacy and must be mailed to your home. It is important to call the office several days in advance so that you can receive your medications on time. Pain medications will NOT be refilled after business hours or on the weekends.

Pain medications are designed to make your pain more tolerable. Do NOT expect to be pain free.

Medical Equipment

Arrangements for medical equipment such as a cane, commode, walker, shower chair, etc. are made by the hospital if needed.

Length of Stay

You will be expected to spend 4-5 days in the hospital.

Questions?

** If you do not understand your discharge instructions, ASK QUESTIONS before you leave the hospital.

RECOVERING FROM ANTERIOR POSTERIOR LUMBAR FUSION

Please contact the office immediately if you develop any of the following symptoms after discharge from the hospital:

• A significant increase in pain
• New numbness, tingling or weakness of legs
• Fever over 100°F
• New back or leg pain
• Severe headaches

Redness or discharge from the incision site

Office Phone Number: 617-730-9814

After 4 pm on weekdays and on the weekends, the on-call physician will be paged.

POST OP VISITS

1st Post-Op visit

Your first post-operative visit will be scheduled by the surgical coordinator. You must be seen in the office between the 10th and 14th post-operative day for suture/staple removal and a wound check. If you are unable to come to the office for this visit, please contact our office as soon as possible.

2nd Post-Op visit

Your second post-op visit will be scheduled by the surgical coordinator. This will be approximately 6 weeks after the date of surgery. You will see your surgeon on this date and x-rays will be taken.

IMMEDIATELY AFTER SURGERY

Pain

Post-operative pain is normal and to be expected. Be sure to take your medications as prescribed. Contact the office with any significant increase in your pain.

Incision Care

Dressing: A dressing will be applied to your incision following surgery. This dressing should be left on until your first office visit unless otherwise specified by your physician or physician assistant. Your visiting nurse may receive instructions to remove or change this bandage before your first post-operative visit.

Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area continues to bleed, you should call the office immediately.

Wound Care: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower unless otherwise specified by your physician.

Incision: Initially the incision appears pink. Over time, with proper care, it will heal into a fine white line. This may take up to one year. For best results, put vitamin E directly onto the incision once it has healed. Keep the incision out of the sun or cover with sunscreen.

Exercise

You are expected to walk daily for exercise. Begin with short distances and try to walk two times per day.

Precautions/Limitations

Avoid prolonged sitting. Avoid bending or twisting at the waist. Do not lift anything greater than 5 pounds. You are restricted from household chores such as laundry, vacuuming, cleaning, raking, shoveling, etc. If you have a question regarding a certain activity, contact the office beforehand.

3-6 WEEKS AFTER SURGERY

Driving: You should not drive for 6 weeks unless told otherwise by your surgeon.

Intercourse: You should avoid sexual activity for 3-4 four weeks following surgery. Before you resume sexual activity, make your partner aware of your pain and any concerns that you may have. Limit activity and positions that cause pain. The dependent (supine) position is recommended. Avoid twisting and excessive bending of the hips and sudden movements.

3 MONTHS AFTER SURGERY

Work: You are expected to be out of work for a minimum of 12 weeks. This of course varies from person to person. Return to work is dependent upon the rate of healing, symptoms, work demands, etc. If you need disability paperwork completed, please contact the office at the earliest possible date.

Rehabilitation: You will begin an outpatient physical therapy approximately three months after the surgery unless advised otherwise by your surgeon. This allows for healing.

Bracing: You are expected to wear your low back brace at all times (except when sleeping) for a minimum of three months.

Bone Stimulators: You should wear your stimulator post-operatively as advised. Please call the office with questions.

A cervical fusion is a type of neck operation where two or more vertebrae, which are usually separated by a disc, are allowed to grow together or “fuse” into one long bone. The purpose of a fusion is to reduce the pain created by motion of the vertebrae and to remove any disc material and or bone impinging upon a nerve root.

The incision is made through the front of the neck. It is horizontal and is approximately 1-2 inches long. During this procedure, a large portion of the disc is removed and a bone graft either from your own hip or from a donor is positioned in its place. A plate is secured to the vertebra above and below the involved disc with small screws. The hardware is put in place to stabilize the vertebrae until your own body has made enough bone to stabilize the vertebrae itself. As you heal, the graft and vertebrae will grow together to become one sold unit. The graft should be almost completely healed at 3 to 6 months. X-rays will be taken periodically to see how the graft is healing.

WARNING: Patient’s who smoke or use other tobacco products DO NOT fuse. Contact the office immediately if you need assistance to quit smoking