Spinal fusion surgery is performed when it is necessary to stop movement at a spinal motion segment – two adjacent vertebrae and the connecting tissue that binds them together. When would it be necessary to stop movement at a spinal motion segment? The answer is when movement at that segment is causing neck or back pain.
Planning is always better
Planned surgery of any kind is always preferred over unplanned or emergency surgery. Physically and mentally preparing yourself often eases the healing process. If you are considering spinal fusion surgery, this pre- and post-surgery planning list will help you optimize resources and efficiently get back to normal activity.
Take all the needed tests
Your orthopedic surgeon may order additional tests or studies prior to spinal fusion surgery in order to more precisely plan your surgery. Potential tests may include:
- Radiographs (X-rays) to identify spinal instability
- Myelogram, MRI or CAT scan to determine what, if any, nerve compression exists
- Electromyogram and nerve conduction studies to assess nerve function
Get a clean bill of health
Your surgeon needs to know that you are in general healthy before performing surgery. Is your heart strong enough for surgery? Are your lungs healthy? Is your blood pressure and blood sugar normal or reasonably close to normal? A trip to your primary care physician and/or specialist that you see regularly is usually part of pre-operative planning for spinal fusion surgery.
Discuss over-the-counter (OTC) and prescription drugs
Chances are, you are take several prescribed and OTC drugs. Some of these need to be temporarily stopped prior to surgery, some need to be avoided the day of surgery, and the rest should be taken as usual. Ask your doctor how to manage your medications.
Aspirin and NSAIDs like ibuprofen and naproxen can increase blood loss. Most people should temporarily stop taking these drugs 1 to 2 weeks prior to surgery. If you take Coumadin (warfarin), talk to your orthopedic surgeon and PCP about when to stop the medication and how to manage anticoagulation. Surgery cannot be done safely if your blood does not clot.
Make a deposit in the blood bank
Your surgeon may order an autologous blood donation where you “bank” your own blood to be used, if necessary, while you are in the hospital. Blood loss during spinal surgery is minimal, so this is usually not needed. However, it doesn’t hurt to ask.
Kick the habit
There is a risk that the bone graft that is part of your spinal fusion surgery will not heal (called pseudarthrosis). Factors that increase the possibility of pseudarthrosis include:
- Poor nutrition
- Certain medications (including NSAIDs, cortisone and chemotherapy)
- Previous back surgeries
- Multiple level spinal fusion surgery
When it comes to smoking – surgery or no surgery – the best thing to do is quit. Nicotine inhibits bone-growing cells that are required for a successful spinal fusion. At the bare minimum, you should not smoke for at least three months after spinal fusion surgery. You are investing many resources into this surgery. Don’t waste that investment.
In many cases, one of the reasons you are having spinal fusion surgery is because pain and or factors are limiting your movement. That is why this recommendation is so hard to follow: stay active. It is very important to stay as active as possible prior to surgery. Get your body ready for post-operative life by adding daily aerobic exercise to your schedule. Aerobic exercise in this case doesn’t mean running a marathon; a brisk walk, swimming, and biking are all low-impact ways to improve circulation and heart health. Aerobic exercise also boosts mood so you will head into surgery with a more positive outlook.
You cannot do it alone
Recovering from any surgery takes time. Even if you’re walking or stretching the evening after your surgery, there will still be a lot you can’t do as your body heals. Arrange for help at home and discuss with your surgeon and PCP how much time you’ll need off work. In some cases, resuming normal work activities helps healing, but your priority should be healing, not returning to work too soon.
Taking the time to develop a pre- and post-operative plan for your spinal fusion surgery will ease your mind and allow you to focus your energies on healing. Speak candidly with your surgeon and doctor about any concerns and make sure they are addressed to your satisfaction. Follow your plan and make healing your top priority!