Maryland Spine Center - Surgery

Should the patient and surgeon select a surgical treatment, the patient next meets with the Clinical Coordinator to choose a surgery date. The Coordinator will discuss alternatives for blood replacement, any needed pre-operative medical evaluations, pre-operative testing, and hospital and hotel accommodations. Mercy Medical Center has private room accommodations. The Coordinator will explain the hospital admission procedure and what to expect before and after surgery at the end of the visit or in subsequent telephone conversations.

Most patients will arrive early on the morning of surgery. All major spinal cases are scheduled as first cases so all personnel are fresh. You will report to the Surgical Receiving. After you are prepared for surgery, you will meet the surgical nurses and anesthesiologist for your case. Shortly before you enter the operating room, your surgeon will visit you as well and briefly discuss the surgery to be performed. You will be asked to sign the hospital consent from at that time.

As soon as your surgeon leaves the operating room, he will meet with your patient’s family in the family waiting room area. Based on their medical condition after surgery, patients go from the operating room to either the recovery room or Intensive Care Unit. Most patients go to the recovery room for several hours and then back to their hospital room. It is usually possible for a family member to see the patient about one hour after surgery and to spend the night with patients who have private rooms.

Pain is controlled after larger procedures with a Morphine pump for the first 2 – 4 days. Drains are removed 2 – 3 days after surgery. Fusion patients will then receive their brace and begin physical therapy. Patients who had correction of major spine deformities will have their brace mold fabricated after drain removal and generally receive their brace the following day.

Patients are not discharged until they have good pain control, a clean wound, good bowel and bladder function and are free of known medical and surgical problems. Patients destined for home receive physical therapy until they can walk independently. A family member is instructed in brace and skin care for patients with braces. Most patients with cervical spine operations and lumbar spine decompressions are in the hospital 1 – 3 days. Most patients with larger thoracic or lumbar spine operations that include fusion stay 6 – 7 days. Patients with major deformities that require two (2) surgical stages may stay an additional week.

The hospital social worker or case manager will assist patients in obtaining appropriate transportation home. Most patients from the Maryland area are comfortable in a large private vehicle with a reclining seat or mattress. Occasionally ambulances are a better choice. Most airlines will accommodate transportation of post-operative patients, even those wearing braces with a thigh cuff. The Clinical Coordinator will advise on these arrangements.

Some patients are not ready to go home several days after surgery. Rehabilitation needs are assessed by the physical therapists. Each insurance plan has rehabilitation requirements.

At Mercy Medical Center, patients can stay in the 9^th floor of the main tower building.

When patients are discharged directly to their home, there are few restrictions for patients who had either cervical spine surgery or lumbar spine decompressions. Patients who had fusions are frequently protected in a brace. These patients are provided with a Brace Manual that describes daily undershirt changes and other helpful hints. Patients who have extensive surgery down to their sacrum are advised to arrange their living space on one floor for the first month after surgery.

Suture or staple removal is usually performed in the patient’s home by a visiting nurse 10 – 14 days after surgery. Thin resorbable sutures within the skin combined with Steri-strips that adhere to the skin are used for all anterior neck incisions, most posterior neck, and short back incisions. These sutures do not need to be removed.

After larger surgeries, some patients need assistance at home for several weeks. Most insurance plans provide for regular visits by a home health aid to assist patients with brace undershirt changes and baths.

Patients should make an appointment to see their surgeon 3 – 5 weeks after discharge. Patients from out of state are often initially seen by their referring surgeon or a cooperating local surgeon to save an early trip back to Maryland. After decompression operations, uncomplicated patients are generally seen at 2 – 4 month intervals for six months. After fusions and other more complex cases, patients are usually seen at approximately 3 months, six months, one and two years after surgery.

Pain relief occurs very rapidly after cervical (neck) operations and lumbar decompressions. These patients rarely require narcotics more than a week or two. Larger lumbar reconstructions (with fusion) may require narcotics for up to several weeks. Unfortunately, many patients with chronic pain have become addicted to narcotics before referral to the Maryland Spine Center. Our goal is to diagnose and correct disorders causing pain so that long-term narcotics are unnecessary. Therefore, we do not prescribe long-term narcotics for outpatients.

The speed with which patients can return to normal activities varies considerably with the type of spinal surgery. After most decompressions, patients resume normal activities within 4 – 6 weeks. After fusions, the process is much more gradual. Activity levels advance as the fusion matures. Limited activities such as office work are usually possible after a few months. Formal strengthening exercises begin at 5 to 6 months. However, all restrictions are not lifted until the surgeon can demonstrate the fusion is solid about one year after surgery. Our goal following spinal reconstruction is full recovery of normal activity without the need for future activity restrictions.

Maryland Spine Center surgeons believe in a continuing commitment to our patients. The great majority of surgical procedures are successful; however, complications can occur and some disorders may not be initially recognizable. When patients do not obtain the results expected, we continue to pursue remaining problems with additional testing and/or procedures until a reasonable end result is obtained if at all possible.