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.

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

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: (617) 738-8642
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.