Preparing For, Going Into and Getting Home from a Spinal Operation
My perspective is as caregiver for my mother when she went through this. I should add that the hip joint on the same side affected by her stenosis was disintegrating around the time she underwent her back surgery. The bad hip greatly impaired her recovery from her lumbar operation.
I am not a medical professional and am not trying to give you medical advice. I am passing along advice based on personal experience as a carer for someone who had a laminectomy and some vertebral fusion in the lower back.
There is no substitute for the help of a doctor you trust. Please feel free to take the recommendations I quoted to your doctor if you are facing surgery. If this helps you get through your surgery better, or helps get your doctor to do some extra thinking about special difficulties of your situation and make adjustments in the surgery plan to make it easier on you, then this lens will have done what I wanted.
Prescriptions can Get a Break on Expenses
(This particular note is specific to the USA)
For anything you need, try to get the doctor to write a prescription that says you need it. Your health insurance might reimburse you for some of these things. If it doesn’t, having the prescription allows you to include the item as a deductible medical expense when you itemize tax deductions on Schedule A. Such things as a wheelchair, shower chair, walker, gadgets to help you dress yourself without bending your back… all of these count as medical expenses when your doctor prescribes them. Medical expenses not reimbursed by insurance are deductible only to the extent that they exceed 7.5% of your adjusted gross income–but for tax purposes, medical expenses include travel costs and parking. It all adds up quickly.
Pre-Operative Preparations Involving Medical People
For the Doctor and Hospital
- Make a list of all the medications, vitamins and supplements you take. Be specific about what they are, what dosages you take, at what times of day, with food or without food (and whether there are particular foods you must avoid). If any are occasional pills, specify that too.
- Take a few copies with you each time you go for a medical appointment related to the upcoming operation, and take a few when you go in for surgery. Give a copy to each medical person who asks what you take.
- If anyone will accompany you to the hospital and be with you there after the surgery, make sure they have your drug list. They can help keep an eye on what you are given by nurses.
- When you check into the hospital, bring the medications themselves in a small bag. Make sure all the bottles are properly labeled, including your name.
Some Things the Doctor May Order Beforehand
- The surgeon will need a fresh MRI to study closely before operating on you. At a pre-op visit, the surgeon will tell you what s/he expects to need to do. You may need laminectomy (chipping away of the excess bone that causes stenosis)–that’s very common.
- Often people who need laminectomy turn out to need one or more pairs of vertebrae fused. My mother needed fusion of L4 to L5 and L5 to S1. (Those are vertebrae at the bottom of the lower back.)
- Talk deeply with the doctor about whether stabilizing hardware will be used for any fusions. Have this talk even if the doctor does not expect to do any. Sometimes after making the incision, the surgeon finds that what really needs to be done is not exactly what the MRI suggested. You and the surgeon should be in agreement about how to handle a fusion in case that has to be done.
Pre-operative scans tell the doctor a lot, but they are no substitute for seeing your actual spine. The doctor can tell you what is definitely going to be done, and what is likely or possible as additions after the surgeon is able to see exactly what is happening in your back.
If You Need Vertebrae Fused
If you might need a fusion, you have a choice to make. Extra bone will be taken from somewhere, usually from your hip, to do the fusion. The fusion can be done with or without supporting hardware. The hardware consists of metal plates and screws to hold the newly fused vertebrae in the right position as the fusion heals.
For hardware, you may need to sign a consent form that emphasizes the hardware is not approved by the FDA for this purpose. There is considerable time lag between the development of new hardware and the granting of approval by the FDA, but if your surgeon has used the new hardware a lot with good results, you may want it. Here are the high points of what else the doctor will tell you about it.
- With hardware, the success rate of fusion operations is much higher because the new bone put in place for the fusion is protected from strain while it grows.
- With hardware, you don’t have to wear the back brace as long.
- If the hardware is poorly placed, it can leave the patient with lifelong pain that is highly resistant to treatment. (This is one of the reasons for choosing the best “back specialist” you can find. Someone who does “nothing but backs” has lots of experience.)
The doctor probably will not think to offer you a wallet card about the metal in your body because it will seem like not enough to set off airport metal detectors. I would ask for a wallet card anyway. I have encountered metal detectors at European airports that were sensitive enough to pick up that small amount of metal, and who knows how much more sensitive detectors might become?
Getting Fitted for a Back Brace
If a fusion is anticipated, you will be fitted for a custom-made back brace. For the fitting, you strip to your underwear. The technicians will either have you put on sort of a snug-fitting cotton torso stocking or wrap your torso with gauze.
Then one will stand in front of you and the other behind you. They’ll have a bucket of water handy. They’ll dip a roll of plaster-saturated gauze in the bucket, then they will wrap your torso with it, handing it from one technician to the other as it goes around and around you so they can finish before the plaster hardens.
After a few minutes, when the plaster is hard, they will use snips to remove the plaster mold. When you check into the hospital, your brace will be waiting for you–about 3/8 inch of foam on the inside, a hard white plastic shell on the outside, and three wide Velcro closure straps in the front. You will wear that practically all the time except when you are in the shower or asleep for months until the fusion heals enough not to be snapped by a single inadvertent twist of your body.
Pre-Operative Preparation on Your Own
Bring prunes or fruit cubes to the hospital.
You’ll need to take heavy duty pain medication for a good while after your surgery. It’s important not to let pain get the upper hand, because the muscle tightness (even spasms) caused by pain interferes with healing and can even damage the delicate work done by the surgeon on your back. But the pain medications slow down the work done by your digestive tract. You can’t leave the hospital until after you’ve had a post-surgical bowel movement, yet the pain medications make your insides tend to plug up. For some reason, I have never seen a doctor do anything proactive to keep that from happening. You have to plan ahead for it.
Four to six prunes a day or one fruit cube containing fig and senna in its ingredients will help keep everything moving so you can go home sooner (not to mention avoiding certain kinds of extra discomfort). If you prefer prunes, you can eat them right out of the container, but they are most effective when stewed and served hot. All that takes is a little water in a microwave-safe dish with them and thirty seconds or so in the microwave.
Make sure you will be able to take showers.
You take showers, not baths, for quite a while after this surgery. If you don’t have a shower, get something set up so you will be able to shower. Whether it is a regular shower stall or a make-do arrangement, you will want a lightweight shower head on a hose that you can hold in one hand to spray yourself at any angle. You won’t be able to move around under a fixed shower head to wash yourself. You may be able to step over the side of a normal bathtub to use a shower or shower hose there, but an extra-deep tub or a raised or clawfoot tub might have higher sides than you can manage.
Before your surgery, get grab bars installed everywhere you might need them.
They are especially helpful for using the toilet and taking a shower. A professional will know how to anchor them to studs so they will not rip off the wall when you put weight on them. Recovery will be easier and safer if you have grab bars installed at strategic locations before you go for surgery.
Make sure you have at least one comfortable chair that you will be able to get into and out of easily.
Sturdy arms that you can use to lower yourself and push yourself up out of the chair are great. A seat height that allows your thighs to be parallel to the floor when you sit is also good.
You should also have:
- Most importantly of all, lots of help at home for at least two weeks after you are released from the hospital. At a minimum, you need help to bring you meals and water and meds, help you shower, change your dressings, help you change nightgowns or clothes, and maybe steady you when you walk until the incision has closed and dressings are no longer needed. You should have some household chores done for you for a month or more, too, because you cannot bend, lift, shove, or otherwise do anything that puts extra strain on your back. This includes doing laundry, changing sheets, taking out the garbage, vacuuming and mopping.
- A shower seat to sit on while taking your shower. If it has a back, remove the back so it will not bump your incision.
- A back washer (sponge on a long handle), which you can get from a medical supply store or maybe from a store that carries bathing luxuries. You won’t want anything rougher than a sponge on it.
- A walker (walking frame) if your doctor says you will need one.
- A grabber because for months you cannot bend over at all to pick up things that you drop. I’ve seen two styles, and my mother has found different uses for each. One is held sort of like a long pistol, and swings a single curved end piece against the long straight portion when you squeeze the trigger. The other is a Golden Grabber which we got at Walgreen’s.
- Sterile dressings so someone can change the dressings for you at least once a day (right after your shower) for about two weeks. The doctor will say overlapping 4″x4″ dressings is fine. We preferred dressings that were 8 or 9 inches long, and that were wide enough so that if folded in half longways, they covered the entire incision with just the right extra amount to spare.
- Plenty of wide medical tape to put the dressings on. The whole dressing will need to be covered with lots of overlap onto your skin, because that dressing will get stressed every time you roll over or stand or sit or shower. The hospital had a flexible cloth tape with ventilation holes in it and easy-tear places every so often on the roll. I wish I could have found more like that.
- Sterile non-latex medical gloves for whoever changes your dressing.
- A quad cane (has four tips in contact with the ground, not just one) to steady yourself when walking.
- Try to find a swimming pool near you that has a hydraulic lift chair for getting you into and out of the water. The best exercise you can do during recovery is water-walking and eventually swimming, but you will not be able to safely use the steps in and out of the pool for quite a while. With a hydraulic chair, you can start water-walking as soon as your incision closes over. Finding a chair may not be easy. The YMCA has one in my mother’s town of 50,000 people and any lifeguard can operate it for someone at any time. On the other hand, the entire city of Houston (4th largest city in the country) had only one at the time, and only certain people could operate it, and those people were only available at certain times.
- If you found a pool with a lift chair, get a snorkel and swimming mask. If your surgery involves a fusion, you will be wearing a back brace even while you swim, and you will be forbidden to twist your body. When you become able to swim a little instead of just water-walking, you’ll be limited to something like a crawl stroke, yet you won’t easily be able to turn your head to breathe without inadvertently twisting your torso. Use the mask and snorkel to eliminate the need to turn for breathing. My mother was not able to practice with this beforehand and was okay using the mask and snorkel.
- If you will be able to swim and will have a back brace, also get lots of rubbing alcohol (surgical spirit). You will need it to clean your back brace after every dip in the pool, because otherwise the pool’s chlorine will degrade the brace.
- You may want a shoehorn with a loonnngggg handle. With that and a grabber, you can put on slippers or loose slip-on shoes even while you aren’t allowed to lean over. (You won’t be able to reach your shoes to tie shoelaces for a while. Make sure you have some slip-on footwear that is easy to get onto your feet.)
- At least one Velcro cable strap from an office supply or computer supply store. Get the kind with a slot cut crosswise near one end, so you can attach it around the very thing you need to strap things to and won’t have to keep track of it. You can use this to carry your grabber around. It’s especially handy if you need to use a walker for a while after the surgery. Many patients don’t need a walker any more when they leave the hospital, but my mother needed one until after she got her bad hip replaced a few months later.
- If you wind up with a walker, you will want something on it to help you tote things. We got a $2 carpenter’s apron at a builder’s supply store and tied it across the front.
- If you will be using a walker, get cheap tennis balls. For each of the two ends of the walker that do not have wheels, cut an X in a tennis ball and fit the ball onto the end of the walker. This will give it a good combination of sliding over nice wood floors without marring them, but gripping enough not to slip out from under you on tile or carpet. The tennis balls wear out quickly, so keep a good stock on hand.
- A toilet seat extender or riser. Several designs are available. Some are on a metal frame that goes over the toilet–you can use the bars on those to push on when you need to stand up if there is not a good way to install grab bars. Some clamp to the toilet, and some just rest on the toilet. The doctor seemed to feel it was not necessary and sent us home without one, but I don’t know how my mother would have managed without it. I got one at Walgreen’s that just rests on/in the normal toilet seat for about $25, and it has been enough with grab bars on the adjacent wall.
- Get a temporary table that can be set up so you can eat meals sitting on the side of your bed, or get trays, or both. Set up a TV you can view and operate by remote control from bed. You’ll be in bed a lot for a little while and probably won’t feel like doing much.
Packing to Go to the Hospital
If you come down with a cold or flu, the surgery has to be postponed until you’ve gotten over the bug. Don’t be heroic and hide it. Going into surgery when already ill puts you at risk for dangerous complications.
- Pack a mid-length robe that has snap closures all the way down the front. When you are out of bed, you can wear this over your hospital gown, draped over your shoulders and snapped in one or two places, even while you have IVs in your arms. They will have you on your feet and walking a few steps soon after your surgery. (They had my mother walking 4 1/2 hours after she came out of the recovery room.) As a general rule, people who are most diligent about walking and maybe swimming have the best recoveries, so about 3-4 times a day you will be wobbling around the hospital hallways with your IV pole and a nurse. Without that robe, your backside will be in the breeze the whole way.
- Pack some slippers that go on your feet easily and comfortably even when your feet are swollen.
- If you are female, you may want to pack a few short to mid-length nightgowns. However, chances are that you will choose to stay in hospital gowns until you are released.
- Bring something that will not put pressure on your incision (no tight or elastic waistband) to wear when you check in, and wear it again when you are sent home. Bring your toiletries (toothbrush, toothpaste, comb, reading glasses, etc.) in something along the lines of a small zippered bag, or have your companion bring it when you come out of the recovery room. Do not bring valuables to the hospital, but do bring (or have your companion bring) your insurance cards for final verification.
- Be prepared in case your stay turns out to be a little longer than what the doctor tells you to expect. That might require stopping newspaper delivery at home or a few other little things like that. (This may affect where you want your hospital companion to stay if surgery is done in a city away from home.)
Soon After Arrival at the Hospital
- Have your companion (or somebody) bring a generous order of bagels and cream cheese for each nursing shift, delivering them compliments of you. My sister used to be a med tech. She suggested this, and it makes a huge difference in how attentive the staff is to you as a patient. I bought 2 dozen assorted bagels and a few containers of cream cheese at Einstein Bagel Bros. for each of the three shifts. I had to deliver each set to each shift as it came on duty–otherwise the shift that got delivery would eat them all!
- As I mentioned, a few hours after you are in your room, the nurses will help you get out of bed and walk a few steps. You will go for progressively longer little walks at least 3 to 4 times daily, although you’ll be shaky at first. I suggest walking right around the time that a fresh dose of pain meds begins to take effect. You are to continue walking and increasing your distances after you go home. If you don’t have access to a pool with a lift chair, walking is the only exercise you can do to build your strength up again.
- Physical therapists will teach you how to sit up, lie down and roll over without twisting your torso. They may also help you do some exercises and teach you some other skills.
- When you go home, you will probably have a soft foam back brace with pockets to hold large gelpacks against your lower back. You can use this occasionally during your earliest days at home, mostly when you are in bed or sitting in a chair, taking the gelpacks out of your freezer and putting them into the brace to help ease any pain. But after the worst of the post-op pain is over, you’ll be wearing the hard plastic brace whenever you are up and about, except in the shower.
- Under the hard brace, always wear a cotton tee shirt or other comfortable cotton shirt. Otherwise the brace would be awfully uncomfortable. Whatever else you are wearing can be under or over the brace.
- You’ll be on prednisone for a few days after surgery to reduce inflammation. If you are borderline diabetic, this can kick you over into insulin dependent diabetes. Talk with your doctor ahead of time about that possibility if your blood sugar is not entirely normal.
- For several days after the surgery, your blood sugar, electrolyte balance and hormone balance may be out of kilter. The hospital should run blood tests from time to time in order to keep an eye on that.
Going Home from the Hospital
- You’ll want to be able to ride home in a nearly-reclining position in a car with a comfortable ride. If you don’t have to do deep knee bends to get into it, that will be nice too. Remember, you are not allowed to twist your back for months after the surgery. You will need to be able to sit sideways on the passenger seat, then rotate your entire body to swing your legs into the car.
- Have the doctor call your pain medication prescriptions in to your pharmacy before you leave the hospital. You are likely to be on pain pills that only last about 4 hours before you are due for another dose. It is important not to be stoic about the pain meds. Pain makes nearby muscles spasm, which puts strain on the work the surgeon just did to your back. Take the pain meds when you are supposed to and try not to let the pain get ahead of the pills. By the time you go through bureaucratic checkout procedures and go home, you will be close to time for your next dose, and you will want to be able to just pick up your meds at the drive-through window instead of waiting for them.
- Do not take pain meds that have not been explicitly approved by a doctor. This is especially important as your pain gets better and you begin to feel like you don’t need such strong meds. If you switch yourself to something milder, it is likely to be something that interferes with the healing of bone, and that means it could jeopardize your healing from the surgery! This is particularly crucial if your surgery includes a fusion.
- My mother had a complication. It doesn’t happen to all that many patients, but here it is so you can recognize it. You have a sciatic nerve for each leg. Let’s say your stenosis is hurting the nerve for one leg, but (as with my mother) not the other. After the surgery, if you start having pain down the leg that was *not* having problems, it may be that the other sciatic nerve got irritated by having all that surgery done so close to it. Remember what I said about the importance of keeping your pain treated–report this type of symptom as soon as it starts. You might need stronger pain meds, or another round or two of prednisone, or both until the irritated nerve calms down.
- You’re going to want to sleep a lot for a few weeks. Go ahead and sleep that much. It will help your body heal. You may be sleeping in relatively short snatches (sleep 3 hours, take pain med, go for a walk, rest again). That’s normal during the post-op weeks and will get better.
- When you are ready to go out into the world again, you may need a few clothes that are a size larger than your usual size, if you want to hide your brace under your clothes.
- If you’re swimming, always use your walker or quad cane around the edge of the pool. It’s wet and slippery there, and you must not fall!
- Try not to expect miracles. If you do not have a fusion, you should be able to walk a mile and a half a day after a few months. If you have a fusion, recovery will be considerably slower, and you may not feel quite like you are yourself again until maybe a year after the operation.
Some Things We Found Useful
In some instances I have shown a device that is not the exact make and model we used, but the same type of device. If you cannot easily get these locally, you can order them through these links.