Spine Surgery

There are 33 vertebrae in the spine placed at top of each other. The cervical, thoracic, and lumbar are three segments of the spine. Spine Surgery is done to treat any disorder caused in the spine. The doctor will only advise the surgery if the medicines and other non-invasive therapies cannot alleviate the symptoms. However, in many cases, surgery is the only method for managing and reducing the symptoms. Several types of spine surgeries are performed depending upon the type of spinal disease.

1. Better physical fitness
2. Less need for pain medicines with fewer drug side effects
3. Increased productivity at work
4. Relief from pain and hence improved mood
5. Less risk of complications
6. Reduced risk of muscle damage

Spinal disorders that require surgical interventions are:

1. Degenerative disc disease
2. Herniated disc
3. Scoliosis and spinal deformities
4. Sciatica
5. Spinal stenosis
6. Vertebral Compression Fracture
7. Spondylolisthesis
8. Spinal Tumours
9. Spinal Infections
10. Bone spurs or overgrowth

There are several types of spinal surgeries. Some common types of spinal surgeries are:

1. Vertebroplasty and kyphoplasty: These techniques are used for repairing the compression fractures in the vertebrae. In vertebroplasty, a cement mixture is injected into a fractured vertebra with the help of a hollow needle. The procedure is done under fluoroscopy guidance. In kyphoplasty, the surgeon initially inserts a balloon in the fractured bone to create a hollow space. Once the balloon is removed, the cement mixture is injected into the hollow space to seal the fracture.   
2. Discectomy: When the inner nucleus of the vertebra is pushed out and compresses a nerve, the condition is known as a herniated disc. Discectomy is a surgical procedure that the surgeon performs to remove the damaged part of a herniated disc. It is an effective method to treat the pain that radiates down to the legs.  
3. Foraminotomy: It is a surgical pressure that the surgeon performs to provide relief from symptoms caused due to compressed nerves. It is done when there is a blockage that narrows or obstructs the spinal column. Such conditions include Spondylolisthesis tumours, disc degeneration, and skeletal disease, such as Paget’s disease. 
4. Spinal fusion: It is a type of spinal surgery in which the surgeon permanently connects the two vertebrae. After connection, the motion between the two vertebrae is eliminated. The surgeon holds the vertebrae together by using a screw, metal plates, and rods during this process. It is performed when the patient suffers from a herniated disc, spine deformities, and spinal instability or weakness.
5. Artificial disc replacement: This surgical intervention is an alternative to spinal fusion. During this procedure, the doctor replaced the damaged disc with a prosthetic implant. However, only a few disc diseases can be treated with this procedure, and spinal fusion is relatively more prevalent. 

What to expect before surgery?

You may expect the following before the surgery:

1. Once your doctor decides that medication and other non-invasive treatments may not manage your spine disease, he may advise you to undergo spine surgery. 
2. You may be sent for a pre-anaesthesia check-up to determine your eligibility for receiving anaesthesia.
3. The doctor may recommend some tests. These tests are usually done not more than seven days before the surgery.
4. The doctor may make a medical file for you and record your medical history and allergy to any medicine.
5. The doctor may also give you a tentative surgery date subject to your pre-anaesthesia check-up results.
6. The doctor may also discuss the surgery and type of anaesthesia that needs to be given.
7. You are advised to avoid medications that increase the risk of bleeding, during and after the surgery, such as NSAIDs, warfarin, and aspirin. 
8. The doctor may instruct you to not eat or drink anything, at least from the night before the surgery.
9. You should take only those medications which are prescribed by your doctor. 
10. Your doctor will also explain to you in detail the types of spinal surgery and its outcome, preparation for recovery at home, cost of the procedure and recovery period. 
11. Your doctor will ask you to quit smoking (if you smoke).

What to expect on the day of surgery?

You may expect the following on the day of surgery:

1. Always reach the hospital at least 2 hours before the scheduled time given by the doctor. It will help you to get accustomed to the hospital environment.
2. Accompany your friend or relative to complete the formalities, such as paying the surgery fee and filling out the informed consent form. 
3. You can take a bath on the day of surgery but avoid using creams, lotions, and deodorants.
4. Leave jewellery, watch, and other valuable items at home.
5. Do not forget to wear  non-slippery footwear.
6. You will also receive the PAC clearance before the surgery.
7. The staff will evaluate your overall health and monitor your vitals, such as respiratory rate, heart rate, and blood pressure.
8. You will then be shifted to the surgery room.

What to expect during surgery?

1. You may expect the following during the surgery:
2. Once you are shifted to the surgery room, the surgeon will advise you to lie on your abdomen.
3. The staff then inserts an IV line for administering the medications.
4. You will be under the effect of general anaesthesia during the whole procedure to prevent the feeling of pain or discomfort.
5. The technique used by the surgeon during surgery will depend upon the type of surgery you are undergoing.
6. The surgeon makes a small incision to expose the diseased part of the spine.
7. After the surgery, the doctor stitches the incision and places a bandage on the wound.
8. The staff then shifts the patient to the recovery room.

1. You may expect the following after the spine surgery:
2. The surgeon will discuss the surgery with the family members and provide the required instructions.
3. You may wake up after some time once the effect of anaesthesia subsides.
4. You will be attaché to certain machines that will display your vital parameters on the monitor.
5. Once your vital parameters are fine, you are shifted to the general room.
6. The nurse may frequently ask questions about the pain, nausea, muscle spasm, tingling sensation, numbness or muscle weakness. It is done for the early identification of surgery complications.
7. Your surgeon will provide you with details about further activities depending upon the type of surgery. For example, it may include complete bed rest, moving only to the bathroom, or can walk as tolerated. 
8. You may be discharged from the hospital depending upon the type of your surgery. For example, in some spine surgeries, such as minimally invasive laminectomy, the patients are discharged on the day of surgery, while in some, patients have to stay at the hospital for a few days.
9. On the day of your discharge, the doctor will provide detailed instructions about your recovery at home. The surgeon may ask you to avoid lifting or pushing objects, avoid p[erforming strenuous activities, not twist the spine, and take good care of the incision site. 
10. You must always follow the instructions to achieve an optimal surgical outcome.

First follow-up appointment

1. Your doctor will provide you with a follow-up date on which you need to visit the hospital.
2. Never miss the follow-up visit as it may lead to delayed diagnosis of post-surgical complications.
3. During the follow-up visit, the doctor will ask you about the pain and any other symptoms of concern.
4. The doctor also recommends you undergo an x-ray to evaluate the success of the surgery.
5. You may expect discontinuation of some medications, such as antibiotics, during the follow-up visit.
6. You may also ask questions about the recovery and resuming your activities, such as driving, playing or going to the office or school.

Immediately consult your doctor without waiting for the follow-up appointment date if you experience the following:

1. Chills and swelling at the site of surgery
2. Weakness and numbness
3. Pain
4. Sudden chest pain
5. Discharge of pus from the wound
6. Recurrence of symptoms