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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Orthopedics

A Patient’s Guide to Orthopedic Spine Surgery (7027)

A Patient’s Guide to Orthopedic Spine Surgery (7027) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Orthopedics

7027



A Patient’s Guide to
Orthopedic Spine Surgery


First Day Surgery Unit
(608) 265-8857
1-800-323-8942

Spine Clinic
Monday - Friday, 8:00am – 5:00pm
(608) 265-3207

Nights, Weekends, and Holidays
(608) 262-0486
1-800-323-8942





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Highland Avenue


Valet parking is free. It is open from 7:00 am to 7:00 pm. It is located between the
clinic and hospital doors.

To go to the First Day Surgery Unit, enter at the hospital entrance. Follow the
gray path to the D elevator. Take the D elevator to the 3rd floor and turn left to the
First Day Surgery Unit entrance.

To go to the Outpatient Surgery Center, enter at the clinic entrance. Once inside
the lobby, it’s the 1st door on your left.

To go to the Ambulatory Procedure Center, enter at the hospital entrance.
Follow the gray path past the D elevator. Turn left when you see the APC sign.

This is the 2nd floor…
To get to the …

Cafeteria: H4/1 – H elevator to the 1st floor
ECG: G3/452 – Take Atrium elevators to the 4th floor behind cafeteria
Pulmonary Function: E5/520 – E elevator to the 5th floor
Inpatient X-Ray: E3/3 – E elevators to the 3rd floor
Admissions: 2nd floor behind the information desk

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By law, we need to ask if you would like to complete an advance medical directive
(AMD). This is a Power of Attorney (POA) for Health Care or a Living Will. This
decision is up to you. A POA allows you to name a health care agent who could
speak for you if you were not able to do so. If you choose to complete an AMD,
you must be 18 or older and of sound mind. You have the choice to complete the
form or not.

If you choose to fill one out, complete it and have it signed and witnessed before
coming to surgery. There is not enough time to complete the forms that morning.
The two witnesses cannot be family members or UW Hospital staff. Exceptions are
chaplains, social workers and volunteers. The person you name as your health care
agent may not be a witness. We suggest you choose a neighbor or friend. If you
need help to complete this form or have questions, call our Patient Relations office
at (608) 263-8009.

You may wish to have a member of the Spiritual Care Services visit while you
are in the hospital. We can arrange it for you or you can call (608) 263-8574.



Welcome to University of Wisconsin Hospital and Clinics

Knowing what to expect is part of getting ready for surgery. We hope this booklet
helps you.

Getting Ready .................................................................... 3
Psychosocial Aspects of Surgery……………………….. 4
Planning Ahead ................................................................. 5
Day before Surgery ........................................................... 6
Night before Surgery ........................................................ 6-8
Day of Surgery………………………………………….. 8
Inpatient Unit…………………………………………… 10
Pain Management………………………………………. 11
Activity…………………………………………………... 14
Leaving the Hospital..…………………………………... 15
Phone Numbers…………………………………………. 16


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Getting Ready

Within 30 days before your surgery, you will need to have a pre-surgery work up
visit. This visit will take from 2-6 hours. During this time you may meet with a
member of the anesthesia team and talk with other healthcare staff. The Spine
Clinic nurse will arrange this once the date for surgery has been set. The Spine
Clinic nurse will also help you decide if the complete physical exam should be
done by your primary medical doctor or at the Spine Clinic. This depends on your
health status and insurance plan.

The exam may include
ξ Blood work
ξ ECG (electrocardiogram)
ξ X-rays
ξ Other tests

Your doctor may discuss whether you may donate your own blood in the event you
need to be transfused during or after surgery. The doctor will also discuss any
medicines to stop taking before surgery. These may include
ξ Aspirin, Excedrin , Ascriptin and Ecotrin
ξ Plavix
ξ Vitamins and herbal supplements
ξ Coumadin or warfarin
ξ Ibuprofen, Advil®, Motrin®, Nuprin®, Aleve®, Naproxen®, and Naprosyn®

If your work up is done by your primary doctor, please have the doctor’s office
FAX the forms to the Spine Clinic (608) 263-4995 before your work up day. On
the day of your work up visit, bring any x-ray films or other papers that your
primary doctor or the Spine Clinic has given you.

Stop at Admissions the day of your clinic visit. If you cannot do this, you may call
them. Please call them as soon as you can to get your paperwork started. Your
family will get one parking pass for the length of your stay. It can be picked up the
day of your surgery by your family. Admission’s is open 7:00 am to 9:00 pm. The
phone number is (608) 263-8770.



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Psychosocial Aspects of Surgery

Your surgery may have an impact on you and your loved ones. The impact may be
both mental and physical. Finding out what to expect, what is normal and what is
not, provides a chance to adjust to the changes caused by surgery. Patients with
strong emotional support network tend to recover more quickly. It is best to talk
with someone about your thoughts and feelings.

Setting goals and having a rehabilitation plan before surgery will give you sense of
control. You will be able to measure your progress. Try to focus on positive
thoughts. Remind yourself the goal is to improve your movement and quality of
life. Our staff is here to support you during this time. If you are having problems
coping or need support, please talk with your doctor or nurse.

Smoking Cessation

We strongly suggest you quit smoking before surgery. Smoking will impair and
delay healing time. We also recommend that you avoid second hand smoke. You
should talk with your doctor or nurse if you need help to quit. The Smoking Quit
Line number is 1-800-QUITNOW (784-8669).




















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Planning Ahead

People who have spine surgery find it useful to plan ahead and prepare the home
before surgery.

To prevent falls at home, watch out for
ξ Loose throw rugs or carpets
ξ Pets that may run in your path
ξ Water spills
ξ Bare slippery floors
ξ Long cords across the floor, such as phone or fan cords
ξ Ice on steps and porches, etc

You may want to make plans for help with
ξ Meals
ξ Child and pet care
ξ Household chores
ξ Yard work

Transportation

You will need to arrange for transportation home. A four-door car works best.
We can help you arrange transportation, but there may be a cost to you. The cost
depends on your insurance.

You must also arrange for someone 16 years or older to stay with you the first
night at home. If these plans cannot be made, your surgery will need to be
rescheduled.

Length of Stay

The length of time you spend in the hospital depends on the type of surgery you
have. You should plan to go home after spending 1 to 3 nights in the hospital.
Most spine surgery patients are discharged home. In rare cases, transfer to a
rehabilitation facility may be needed. Your doctor will discuss this with you
before surgery.

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Day before Surgery

A nurse will call you the day before surgery (or on the Friday before a Monday
surgery) to review your instructions, tell you what time to arrive at the hospital,
and where you should go. If you have questions about how to prepare for surgery,
please be sure to ask the nurse when they call.

Before this call, please review details your clinic or anesthesia staff gave you
during your clinic visit. If you do not hear from us by 3:00 pm, please call (608)
265-8857. Tell us where you will be staying the night before surgery.

If you have a cold, fever, or illness before surgery, call the Spine Clinic. After
hours or on weekends ask for the Orthopedic doctor on call.

Night before Surgery

1. Do not drink alcohol after 8 pm, the night before surgery. If mixed with
anesthesia, it can cause problems.

2. Do not eat solid food after midnight. This includes gum and candy.

3. Do not use tobacco after midnight.

4. Do not drink milk or juice with pulp after midnight.

5. Stop drinking clear liquids four hours before your surgery.
Clear liquids include
 Water
 Popsicles
 Carbonated beverages
 Juices without pulp or solid material
 Coffee or tea without milk or creamer
 Jello without fruit, and only if it is home-made
 Clear protein drinks
 Bullion cube broth or consommé with no fat


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6. If you are taking pills, we will tell you during your clinic visit whether you
should take them the day of surgery. If you are told to take them, swallow
with a small sip of water.

7. If you have diabetes, you will be given details about your insulin or oral
pills at your clinic visit.

8. Your doctor may want you to take laxatives to empty stool from your bowel
before surgery. You will get details on the bowel preparation at your clinic
visit.

9. Shower twice before surgery using the Hibiclens® soap. Use it the night
before and the morning of your surgery. You may get this soap during your
clinic visit, or you can buy it at your local drug store. First, shower with your
own soap. Rinse. Pour the Hibiclens® soap on a damp, clean washcloth or
new shower sponge. Wash (do not scrub) the surgical area for 2-3 minutes.
Rinse well. Do not use lotions, powder, or perfumes. Do not use Hibiclens®
on your face, hair, rectal area, or genitals.

10. Try your best to have a restful night before surgery. If you are coming from
out of town, you may want to stay in Madison. The Housing
Accommodations Coordinator (608) 263-0315 can provide you with a list of
nearby hotels at a discounted rate.

11. Do not wear make-up. Please remove nail polish from at least one finger.

12. The morning of surgery, brush your teeth and rinse, but do not swallow.

13. Please remove and leave all jewelry, body piercings, and rings at home. Do
not bring large sums of money and credit cards with you. Please bring money
for co-payment for any medicines you want filled at the hospital.

14. Bring along inhalers, CPAP, glucose meter, eye glasses, eye drops, hearing
aids, dentures, prostheses, and other special equipment that you will need. Be
sure these items are labeled and in a case. Please do not bring bottles of pills
with you the morning of surgery unless you have been told to do so. You will
be asked to leave your glasses, dentures, and hearing aids with your family
before you go to surgery.


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15. Please bring non-skid slippers or slip-on shoes and a few personal items. You
may want to bring loose fitting clothes or pajamas. You may want to bring a
book or something to do. TVs are in each room. Bring a calling card or your
cell phone if you wish to make long distance calls.

16. You may bring in your laptop. All of the rooms have wireless internet access.
Please leave your belongings in the trunk of your car the day you check in
(except CPAP and inhalers). Once your room is ready, your family can bring
your things to you. The hospital is not responsible for lost or stolen items.

Day of Surgery

The First Day Surgery (FDS) Unit is open 5:30 am to 6:00 pm. The Main Hospital
door is open at all times. Please check in at FDS at your scheduled time. Enter
using the Main Hospital Door the day of your surgery. See map on back of front
cover.

After you arrive, you will be taken to a room to prepare for surgery. Your family
member(s) will be given a pager and directed to a waiting room. A nurse will ask
you questions about your health and help you get ready. A member of the
anesthesia team will meet with you and answer questions. You will have an IV
(intravenous) placed in a vein of your hand or arm. An IV is used to give fluids
and medicine. You may be given medicine to help you relax. Before you leave for
the operating room (OR), we will page your family so you can meet with them
again.

A Note to Families

The amount of time your loved one spends in the operating room depends on the
type of surgery. You can wait in the Surgery Waiting Area (C5/2) on the second
floor. If you have family that will be calling, please have them call
(608) 263-8590. You may want to bring along a book or something to do since the
time may seem to pass slowly. There are coffee, tea, reading materials, computers,
and TVs in this waiting area from 7:30 am to 6:30 pm weekdays. If you wish to
leave the waiting area, please tell the volunteer at the desk. The nurses will keep
you informed during surgery. The surgeon will talk with you after surgery.

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Sometime during the day, take your parking pass to the main hospital information
desk to have it stamped and to get one pass to be used during your loved one’s
stay.

In the Operating Room (OR)

Once you are in the OR, your nurse will answer questions
and make sure you are comfortable.

The staff wears masks, gowns, and hats. They will help
you move onto a narrow, firm bed. The nurse will place a
safety belt, like a seat belt, across your legs. They will
place ECG (electrocardiogram) patches on your chest, a
blood pressure cuff on your arm, and a plastic clip on
your finger to check your heart rate and oxygen level.
The anesthesiologist will ask you to breathe oxygen
through a soft plastic mask and medicine will be given
through your IV.


In the Post Anesthesia Care Unit (PACU)

After your surgery, you will be taken to the PACU
where staff will watch you as you begin your
recovery. They will check your vital signs and pain
level. Family and friends are not allowed in the
PACU. Once you are stable, most often in 1-2 hours,
you will be transferred to the inpatient orthopedic unit.
Some patients may go to an Intensive Care Unit (ICU)
for special care. Family and friends are able to visit
you once you are settled in your room.







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Inpatient Unit

Your nurse will continue to check on you after you arrive on the orthopedic
inpatient unit (B6/4). This will include: a neurological assessment of strength and
sensation, dressing check, pain assessment, urine output, and bladder volume. To
check urine output and bladder volume, we will use a bladder scan machine. It
measures the amount of urine in your bladder.

The tubes, drains, and equipment you may see include:
 Face mask or tube under your nose to give you oxygen
 Plastic clip on your finger to check your heart rate and oxygen level
 Drain in your wound
 Catheter to drain urine from your bladder
 Intravenous or IV pump for fluids and medicine
 Leg wraps that inflate and deflate and elastic stockings to improve blood
flow in your legs

Eating after Surgery

Slowly moving from liquids to solids may prevent nausea. You may not be able to
eat right after surgery. At first, you may get only ice chips. As your body allows,
your diet will progress from clear liquids (juice and broth) to full liquids (milk or
ice cream) to normal foods.

Coughing and Deep Breathing

The nurse will ask you to breathe deeply, cough, and use a breathing tool called an
incentive spirometer. Deep breathing helps prevent pneumonia.

To cough and deep breathe:

1. Place a pillow over your chest to decrease the pain while coughing.
2. Breathe in deeply and slowly through your nose. Hold it for a few seconds.
3. Exhale slowly through the mouth.
4. Repeat twice more.
5. Breathe in again; hold it, and then cough.



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To use the incentive spirometer:

1. Exhale and place your lips tightly around the
mouthpiece.
2. Take a deep breath. Slowly raise the Flow Rate
Guide between the arrows.
3. Hold it. Continue to inhale, keeping the guide as
high as you can for as long as you can, or as directed
by your nurse or respiratory therapist.
4. Remove the mouthpiece and breathe out as usual.
5. Slowly, repeat 10 times each hour while you are awake.

Blood Clot Prevention

To improve blood flow and decrease the risk of getting a blood clot, you may need
to wear elastic stockings (TEDS) until you are walking and back to your normal
activities. You should remove them 2 times each day for one hour at a time. You
should always sleep with them on.

Pain Management

Many people worry about how much pain they will have after surgery. Although it
varies with each patient, you should expect some degree of pain after surgery. We
will work with you to make sure you have the best pain control possible. There are
a few options your doctor may choose for pain control. Your doctor will discuss
pain control options with you before surgery.

Your doctor may order pain pills or intravenous (IV) pain medicine. Your nurse
can deliver the IV pain medicine with a syringe or by a Patient Controlled
Analgesia (PCA) pump. The PCA pump allows the patient to deliver a set amount
of IV pain medicine at preset time intervals.

No matter what your doctor orders right after surgery, the goal is to use pain pills
as soon as you can. They give you longer lasting relief and better pain control than
many other ways.

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Some patients find pain relief from methods other than medicine. These include:
 Ice therapy
 Deep breathing exercises
 Distraction
 Repositioning

Your nurse may use a combination of these techniques. To help you, we offer 3
special TV channels.
 The C.A.R.E. channel (number 10 on your TV) which provides a continuous
relaxation environment.
 The Healing Images channel (number 15 on your TV) which includes
breathing, meditation, and imagery exercises.
 The Chuckle Channel (number 11 on your TV) which offers light-hearted
distraction with comedy.

You are a vital part of your pain management plan. You will need to talk with the
nursing staff about setting realistic goals. They will work closely with you to find
what works best for you.

A good pain management plan will allow you to improve your activity level. Good
pain control should also allow you to rest comfortably without feeling too sleepy.
Each person responds in their own way to pain medicine. It often takes a while to
find what works best for you.

For best results:

1. Talk with your doctor and nurses about the choices you have.

2. When possible, take (or ask for) pain medicine before activity or when pain
first begins. Pain pills take 20 - 30 minutes to work.

3. You will be asked to rate your pain using this scale.

0-10 Number Pain Scale
___________________________________________________
0 1 2 3 4 5 6 7 8 9 10
No Mild Moderate Severe Worst
Pain Pain
Possible

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4. Tell us about pain that will not go away. Do not worry about being a “bother.”
Pain can sometimes be a sign of problems.

5. Let us know if you feel any side effects from the pain medicine. This includes
feeling very sleepy, dizzy, or lightheaded.

Constipation

Surgery, pain medicine, decreased activity level, and a change in your diet all play
a role in getting constipated. After surgery, it is common to have a problem with
your bowels. Medicines may be ordered to help prevent or treat constipation.

Activity

You should expect to be walking the first day of surgery. Depending on your
surgery, your doctor may decide if you need to follow spine precautions.

These precautions include:
 Logroll
 Do not bend forward at the waist
 Do not twist
 Do not lift more than 10 pounds (about one gallon of milk)

Logrolling is a way of rolling from side to side in bed while keeping your spine
straight. If you need to lift or pick up an object from the floor, squat with your
knees while keeping your spine straight.

To prevent falls, use caution when getting up too quickly after eating, lying down,
resting, or using the toilet.

Walking Program

Most spine surgeries have a specific walking program to go with it, which you will
discuss with your doctor. Remember to begin your walking program once home.
It is important that you walk on a regular basis and gradually increase the distance
you walk. No impact aerobics. Walking is the form of aerobic exercise until your
doctor tells you otherwise.


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Leaving the Hospital

Once your doctor decides you are ready to go home, there are many things that
need to be done before you leave. These tasks may take several hours. Your
nurse will teach you about your diet, incision care, bathing, driving, activity level,
and your follow-up clinic visit.

The unit pharmacist will review your medicines with you. If you plan to have your
prescriptions filled at the UWHC pharmacy before you leave the hospital, please
bring money for your co-payment. If you are unclear about how to pay for your
medicines, a member of the case management team will help you.

The recovery time after surgery varies from person to person. Surgery can cause
you to feel weak and tired. In most cases, common sense will tell you when you
are doing too much. On the other hand, too little activity can delay the return of
your strength.

Once you are home, the Spine Clinic staff will work with you to balance pain
medicine, pain management, and activity. The goal is to work towards tapering you
off of pain medicine by 4-6 weeks depending on the type of surgery you had.








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Phone Numbers

Admissions. ................................................................................... (608) 263-8770
To get admit paper work started, speak with a financial counselor or
confirm insurance

First Day Surgery Unit . ................................................................ (608) 265-8857
Fax ................................................................................................ (608) 265-8858

Hospital Paging Operator .............................................................. (608) 262-0486

Housing Accommodations ........................................................... (608) 263-0315

Spine Clinic .................................................................................. (608) 265-3207
After hours or weekends .............................................................. (608) 262-0486
Spine Clinic Fax ........................................................................... (608) 263-4995
Toll-Free ........................................................................................ 1(800) 323-8942

Outpatient Pharmacy (E5/236) .................................................... (608) 263-1280

Patient Information (for room number). ....................................... (608) 263-8590

Patient Relations .......................................................................... (608) 263-8009

Registration ................................................................................... (608) 261-1600

Spiritual Care Services. ................................................................. (608) 263-8574

Surgical Waiting Area ................................................................... (608) 263-8590







Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©10/2014. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7027.