Spine

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For information on spine conditions, please visit the Spine Center's web site. The West Michigan Spine Center is a division of Orthopaedic Associates of Muskegon.

West Michigan Spine Center

Procedures

Spine/Back Surgery

Spine/Back Surgery

Introduction

Your doctor has completed a thorough diagnostic evaluation of your back/leg pain and has recommended surgery. The following information will answer many of your questions about what will happen before, during, and after your surgery.

If after reading this information you or your family still have questions, please feel free to call our office. There is never a silly question, and we hope that by asking questions now, you will understand what is happening at each step in the recovery process. The more you know, the better your recovery period will be.

 

Types of Back Surgery

There are different types of back surgery depending on your problem; therefore, some of the following information may not pertain to your specific case.

  1. Decompression/Laminectomy is removing the bone that is causing pressure on nerves, usually resulting in leg symptoms.
  2. Microscopic Disectomy is done to remove the herniated portion of the disc from the spinal column.
  3. Fusion immobilizes a segment of your spine due to spondylolisthesis, spondylolysis and/or degenerative disc disease (DDD).
    a. Transforaminal Lumbar Interbody Fusion (TLIF) is done through an incision on the low back, immobilizing the vertebral disc space(s) in question from any further movement.
    b. Posterior Spinal Fusion is done through an incision on the back, immobilizing the vertebral disc space(s) in question from any further movement.
    c. Anterior Lumbar Interbody Fusion (ALIF) is done through an incision in the front of the abdomen, immobilizing the vertebral disc space(s) in question from any further movement.
  4. Disc Arthroplasty replaces the disc between two vertebral bodies to maintain motion at that segment.
  5. Kyphoplasty is a minimally invasive procedure done to treat a fracture of the vertebral body. A bone cement is used to restore the strength and height of the vertebral body.
  6. X-Stop is a minimally-invasive surgical procedure designed to alleviate painful symptoms of lumbar stenosis. This procedure is reversible.
Preparing for Surgery

The doctor may request medical clearance from your family doctor in order to make sure any medical conditions you have will not affect your ability to tolerate surgery. If you take insulin, ask your family doctor how to take this medicine on the day of surgery.

All medicines having blood thinning tendencies, prescribed or over-the-counter, must be stopped five days prior to surgery. Medicines with blood thinning tendencies include:

  • Aspirin
  • Vitamin E Fish oil/Omega 3/Lovaza
  • Celebrex
  • Plaquenil
  • Relafen/Nabumetone
  • Lodine/Etodolac
  • Motrin/Ibuprofen
  • Daypro/Oxaprozin
  • Mobic/Meloxicam
  • Naproxen/Naprosyn/Aleve
  • Disalcid/Salsalate
  • Feldene/Piroxicam
  • Arthrotec/Voltaren/Cataflam
  • Dicolfenac
  • Tordol/ketorolac tromethamine
  • Vimovo

 

If you take any of the following prescription medicines you must check with the doctor monitoring this medicine to be sure it is okay to stop:

  • Plavix/Clopidogrel
  • Coumadin/Warfarin
  • Pradaxa/Dabigatran
  • Xarelto/Rivaroxaban
  • Eliquis/Apixabin
  • Pletal/Cilostazol
  • Persantine/Dipyridamole
  • Ticlid/Ticlopidine
  • Aggrenox/Asprin/Dipyridamole
  • Lovenox
  • Arixtra/Fondaparinux
  • Effient/Prasugrel

 

Notify us immediately if at any time before your surgery you have any symptoms of an infection (for example, a urinary tract or sinus infection), especially the week before your surgery.

If you smoke, your doctor may require you to stop 4-6 weeks before doing your surgery and for 12 weeks after your surgery. The nicotine dramatically slows and/or hinders the healing process by 40% per level fused. The doctor may order a blood draw to test for your nicotine level.

A back brace is usually not necessary unless you have severe osteoporosis or you ignore your restrictions after surgery.

Preoperative Information

Someone from pre-admission testing (PAT) will call you to schedule your lab work, an EKG, a chest x-ray and a consultation with the anesthesiologist.

You must not eat or drink anything after midnight the night before your surgery!

What to Expect After Surgery/Recovery Period

A disectomy, laminectomy, X-stop procedure, permanent DCS placement and kyphoplasty may involve an overnight stay. A lumbar fusion involves a 3-5 day stay.

Pain management during your hospital stay will be by intravenous patient-controlled anesthesia

(PCA), injections or by oral pain medications. We recommend you switch to oral pain medications as soon as you are comfortable.

After a fusion surgery, you will find a drain coming from your back lying next to you in bed. This will relieve any fluid accumulation from the surgical area. If you are sent home with a drain you will have to return to our office the following day to have it removed.

You may have a Foley catheter in place when you wake up following a lumbar fusion until you are safe to get up. This will save you from having to get up to use the bathroom.

Do not be discouraged if you have some of the same pain as before your surgery. You have had pressure on the nerves for some time and it can take 12-18 months for the nerves to recover. You may find that your energy level is quite low after surgery (even the trip home from the hospital may wear you out).

The hospital discharge planner or the social services department will help you arrange for assistance or assistive devices at home.

Once You Return Home

Call our office as soon as you return home to arrange for your follow-up appointment in 10-14 days. We will need to check your incision and remove any visible sutures. If you have had previous back surgery, you will have sutures to be removed instead of dissolvable sutures.

Most patients can expect to experience some emotional highs and lows, which is normal. It is better to pace yourself when you feel tired and rest. Ask for help when you need it, and be sure to follow the instructions given to you. Remember, no lifting, twisting, bending or carrying anything heavier than 5 lbs. A gallon of milk is too heavy!

WALK! WALK! WALK!

You may take a shower, but not a bath when you get home. DO NOT apply any lotions, ointments or Neosporin to your surgical incision.

Avoid sitting for any prolonged periods, and avoid long car rides. You may climb stairs when you are steady on your feet.

You may renew prescriptions by calling our office, but please do not wait until you are on your last pill. Call the office before 11:00 am with at least 2-3 days worth of your prescriptions left.

You may have driving restrictions for the first 2-6 weeks after surgery or until your doctor says you may drive.

You MUST call the office as soon as possible if any of the following symptoms occur:

  • pain in your calf or excessive swelling in feet or legs
  • an increasing pain in your back that does not go away with your pain medicine
  • foul-smelling discharge coming from your incision
  • a red, hot, or swollen incision
  • chills or fever over 100°F
  • chest congestion, coughing, or problems breathing while at rest
  • chest pain
  • problems passing urine, moving your bowels or lack of control

 

If you have any questions, please call the office at (231) 733-1326.

SNRI

SNRI

What is a Selective Nerve Root Injection?

We have 24 levels of vertebrae in our spine: 7 cervical (neck), 12 thoracic (mid-back), 5 lumbar (low back). At each vertebral level, nerves exit from the spinal cord on the right and left sides. These are called nerve roots. These nerve roots form nerves that travel throughout our arms, chest wall and legs. These nerves become painful due to irritation and inflammation at the nerve root. These nerve roots become irritated and inflamed due to stenosis (narrowing) at the opening where the nerve root exits the spinal cord. A selective nerve root injection is an injection of a steroid medication and a local anesthetic medication near the irritated nerve root. This combination of medications work to decrease the inflammation in the nerve root to relieve pain.

What is an Epidural Injection?

An epidural injection is the delivery of a local anesthetic and steroid medication into the space outside of the sac of fluid around your spinal cord. This area is called the epidural space. This combination of medications work to decrease the inflammation in the nerve root to relieve pain. When the irritated nerve root cannot be specifically identified, an epidural injection can provide a more broad area of pain relief than the selective nerve root injection.

How and where are these injections performed?

These injections are performed in our office in a procedure room which is equipped with a fluoroscopy machine. This machine provides real-time x-ray images allowing the physician accurate placement of the needle for the injection. Your blood pressure will be taken prior to the injection. The procedure requires that you lie face-down on the injection table. Your skin will be cleansed with a betadine solution at the injection site. Please inform the staff if you are allergic to betadine. Just prior to injecting the pain medication, and through the same needle, the physician will inject a small amount of contrast dye to allow him to see the nerve root better. It is important that you notify our staff if you have an allergy to injectable contrast dye.

After the injection, band aids will be placed over the injection site(s) and you will be wheeled into the recovery area where your blood pressure will be taken and you will be provided with a snack and drink. The nurse will review your discharge instructions with you and you will be transported to your vehicle in a wheel-chair. Use extreme caution when standing/walking for the first 12 hours after the injection as you may experience numbness in your legs. You may resume normal activities the following day.

What do I need to do prior to having this injection?

There are several medications that increase bleeding which will need to be stopped temporarily before the injection:

The following medications need to be stopped 5 days prior to the injection:

  • Aspirin
  • BC packets
  • Vitamin E
  • Fish Oil/Omega3
  • Lovaza
  • Celebrex (celecoxib)
  • Plaquenil (hydroxychloroquine)
  • Relafen (nabumetone)
  • Lodine (etodolac)
  • Motrin (ibuprofen)
  • Daypro (oxaprozin)
  • Mobic (meloxicam)
  • Aleve/Naprosyn/Anaprox (naproxen)
  • Disalcid (salsalate)
  • Feldene (piroxicam)
  • Arthrotec/Voltaren/Cataflam (diclofenac)
  • Toradol (ketorolac)
  • Vimovo

The following medications need to be stopped prior to your injection only with the approval of the physician who is prescribing this medication:

  • 5 days  Plavix (clopidogrel)
  • 5 days  Coumadin (warfarin)
  • 3 days  Pradaxa (dabigatran)
  • 3 days  Eliquis (apixaban)
  • 3 days  Xarelto (rivaroxaban)
  • 5 days  Pletal (cilostazol)
  • 5 days  Persantine (dipyridamole)
  • 5 days  Ticlid (ticlopidine)
  • 5 days  Aggrenox (aspirin ER)
  • 5 days  Lovenox (enoxaparin)
  • 5 days  Arixtra (fondaparinux)
  • 5 days  Effient (prasugrel)

If your physician will not let you stop any of these medications, you need to inform our office.

If you are diabetic and take Glucophage or Metformin, do not take these medications the day of the injection.

Please do not stop taking all other prescription medications.

You may not have anything to eat 4 hours prior to the injection. You may have clear liquids up to 2 hours prior to the injection. We will fax a prescription to your pharmacy for a sedative. Please take this tablet of medication 1 hour before your scheduled injection time. This will help to relax you and allow you to be still during the injection. You will need a driver to and from our office on the day of the injection and the driver must remain at our office while you are here. Arrive to our office thirty minutes prior to your scheduled injection. Please be aware that vehicles that are high off the ground are difficult for patients to get into after the injection due to possible weakness in their legs.

When will the injection take effect?

Pain may increase in the first day or two following the injection. If this occurs, apply ice to the injection site(s) intermittently. Please avoid the use of heat at the injection site(s). It may take 14 days for the injection to have its full effect. Please be sure to schedule a follow-up appointment with your physician 3 weeks after the injection to discuss its effectiveness.

What are the possible risks?

These injections have been utilized for decades with remarkably low complications when performed correctly. However, there exists rare but serious complications and the FDA has recently offered warnings and cautions regarding these medications and procedures. It is important to note that OAM does not use a compounding pharmacy and uses only medications that are produced by FDA approved pharmaceutical companies with appropriate monitoring programs to ensure the highest quality product.

Complications and risks associated with these procedures include:

  • Infection
  • Nerve damage
  • Bleeding
  • Allergic reaction to the medications
  • Flushing of the face and chest that can last several days and can be accompanied by a feeling of warmth
  • Increased blood sugar levels
  • Dural tear and paralysis

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