Most spinal surgeries are performed in the neck and lower back.

Cervical spine (Neck) surgery

It is usually performed from the front. To do decompression of the nerve or spinal cord and insert a fused or movable disc spacer.

Lumbar spine (Lower back) surgery, there are two main types of surgery.

1. Surgery to do nerve decompression alone without spinal implant fixation
2. Surgery to do nerve decompression in combination with spinal implant fixation

Preparation before surgery

• Stop smoking: because it affects the degeneration of the intervertebral disc. It affects neck pain and back pain. It also affects spinal fusion in case of spinal fusion surgery.
• Weight control: especially for lower back surgery to reduce the force loading on the intervertebral discs and joints, both in the operated level or adjacent level. This will reduce the force loading on the spinal implant in the case of inserting spinal implant.
• Control blood sugar levels: In patient with diabetes and poor blood sugar control will increase the chance of infection of the surgical wound, especially in patients who need to have an implant fixation in the spine.
• Treat osteoporosis: the osteoporosis will be affected in cases when a spinal fixation is required. Either on the cervical spine or lumbar spine surgery by affecting the firmness of the spinal implant fixation.
• Discontinue drugs that affect blood clotting: such as aspirin, anticoagulant/blood thinner drugs or some supplements, such as cod liver oil. This is depending on the surgical procedure performed. Your doctor will recommend stopping the drug before surgery.
• Pre-operative medical evaluation: general physical examination, blood results and chest x-ray or an electrocardiogram (EKG). Consultation to see an internal medicine physician or cardiologist to assess the readiness of the body before surgery.

Postoperative care

1. Cervical spine (Neck) surgery

• Mostly surgery from the front. The patient will have an anterior surgical wound. Most of the time, the scar will be across the left side of the neck.
• After surgery, there will be a small tube to drain the blood in the neck area. And most of them can be removed 1-2 days after surgery.
• Urinary catheter inserted generally can be removed within 1 day after surgery.
• Your doctor may consider wearing a soft collar to limit neck activity in the early stages.
• Patient can sit up/walk as tolerate after surgery.
• 1-2 nights hospital stay after surgery.
• The surgical wound heals for 7-10 days.

2. Lumbar spine (lower back) surgery without spinal implant fixation

• Most are small incisions at back performed through a microscope or endoscope.
• May insert a small tube to drain the blood for 1-2 days in surgery through a microscope.
• Do not insert a blood drain catheter for endoscopic surgery.
• There may be a urinary catheter inserted. Generally can be removed within 1 day after surgery.
• Your doctor may consider back brace(LS support), especially for herniated disc surgery. Aim to limit back activity after the initial period to reduce the chances of recurrence.
• Patient can ambulate as tolerate after surgery.
• 1-2 nights hospital stay after surgery.
• The surgical wound heals for 7-10 days.

3. Lumbar spine (lower back) surgery with spinal implant fixation

• It may be a minimally invasive surgery or open conventional surgery. It depends on the disease and the suitability of each patient.
• There may be pain in the surgical wound, especially on the first day after surgery. Pain medication is given by a medical team.
• Insert a blood drain catheter for 1-2 days
• Insert a urinary catheter. It can generally be removed when the patient is moving well (Mostly within 1-2 days after surgery).
• Your doctor may consider back brace(LS support) to limit back activity in the early stages.
• Patient can sit up/walk as tolerate after surgery.
• 2-4 nights hospital stay after surgery
• Surgical wound heals for 10-14 days.

Summary

Preoperative and postoperative preparation is the things that patient should know and will be benefit for both patients and surgeons. This also reduce anxiety of the patient before surgery. The above recommendations are general recommendations for spinal surgery. However, each patient is specific. Including the appropriate procedures for each patient are different. The doctors in the surgical team will give advice on the patient's preparation before and after surgery.

By Dr. Pritsanai Pruttikul
Orthopedic Spine Surgeon