Spinal Postop Surgery Instructions

SPINAL SURGERY

Whilst in Hospital

Day 0-Surgery

• Lie any position, as tolerated
• TEDs Stockings ± Pneumatic Calf Compressors
• IDC if not voided after 8 hours with +ve bladder scan
• Neuro Limb Obsevery 4 hours
• Diet as tolerated
• IV antibiotics Keflin 1g every 8 hours up to 24 hrs

Day 1-Post Surgery

• Check postop Hb on Day 1 postop
• PCA as per Anaesthetist, remove 24-48 hours
• If Epidural Analgesia is used, this may be removed in 24 to 48 hours
• If suction drain is used, this may be removed in 24 to 48 hours, as advised by your surgeon
• · Mobilise with assistance & Physio twice a day
• If implants have been used, you will have a CT or Xray performed
• DVT prophylaxis Heparin 5000 Units injectionstwice a day to start on the evening of Day 1
• Daily Dressing changes after Daily Shower

Day 2 Post Surgery till Discharge

• PCA as per Anaesthetist, remove 24-48 hours
• Remove IDC once mobile
• Slow release oral analgesia of choice every 12 hours (eg Tramadol/Palexia/Oxycontin)
• Self-mobilise as tolerated&with Physio twice a day
• Walk up & down steps and stairs for DISCHARGE milestone

Average Hospital Stay

If Rehabilitation is required, request for bed availability needs to be made as soon as possible. There is usually a waitlist for transfer to Rehab Hospital (Hill Pvt, Westmead Rehab, Minchinbury Pvt, Mount Wilga, Lady Davidson, Royal Ryde Rehab

Post Discharge SPINAL Instructions

In General

• Pain from the incision site can last for up to 4 weeks, simple analgesia is usually sufficient.
• In the larger complex surgeries where there is more muscle dissection, you will have a higher level of pain, requiring stronger analgesia. Please discuss any concerns or adverse reactions you may have to the medications.
• You should not wait till the pain is extreme before taking your analgesia.
• You will need to have your analgesia titrated to a level sufficient to allow you to perform post-surgery exercises at home, at the physiotherapist or at rehabilitation.
• In most cases, your wound will be closed with resorbable sutures, and will not require any stitch removal.
• At the ends of the incisions where the knots of the sutures are, you may encounter some irritation or even a small tail of suture material surfacing. Do not be alarmed. If there is any doubt, please contact the Practice for advice and perhaps email a photo of the wound.
• You may feel some hypersensitivity and numbness around incision. Do not be alarmed, this is common during the healing period.
• Daily hair washes, full showers and personal hygiene should be attended to. There is no issues with the wound or the dressing getting wet.
• Change the dressings daily for the first 7 days, and allow exposure to air thereafter.
• Wear loose clothing near the wound to minimize irritation of the skin.
• Maintain regular bowel motion with the use of laxatives to minimize analgesia related constipation.

Important

• If you have developed an increasing area of redness, swelling, or have developed a discharge from your wound, please contact the practice for advice and instructions. You may be required to attend our practice or your GP for additional treatment.
• If you have developed a new or worsening neurological condition, contact the practice IMMEDIATELY. You may need to have a SCAN prior to our assessment.

Specific to Your Surgery

Anterior Cervical Surgeries

• It is common and normal for you to have some degree of neck pain, shoulder pain, pain between the shoulder blades (interscapular) and headaches for 3 to 4 weeks following surgery.
• It is common and normal for you have some difficulty in swallowing (dysphagia) for the first 1 to 2 weeks.
• It is common and normal for you have some numbness above the horizontal incision.
• You do not have to change your diet. Swallowing smaller portions and having sips of water between swallows will ease most swallowing difficulties.
• You can sleep in any position you like. There is no restrictions: on your back, side or front, no pillow, 1 or 2 pillows.
• · You should be performing gentle twice daily range of movement exercise (forwards, backwards, sideways & rotation) without manipulation. Daily exercises with accelerate recovery of the muscles of your neck.
• Having physiotherapy is at your discretion, especially useful if you have a lot of muscle spasms.
• You can start driving after 10-14 days depending on your pain levels, or as advised by your surgeon.
• If you develop a delayed onset of huskiness of your voice, please contact the Practice for advice. You may need to be review in the Practice.

Posterior Cervical Surgeries

• This surgery is extremely pain. You will have a significant amount of neck pain, shoulder pain, pain between the shoulder blades (interscapular) and headaches for 4 to 8 weeks following surgery.
• You can sleep in any position you like. There is no restrictions: on your back, side or front, no pillow, 1 or 2 pillows.
• You should be performing gentle twice daily range of movement exercise (forwards, backwards, sideways & rotation) without manipulation. Daily exercises with accelerate recovery of the muscles of your neck.
• Having physiotherapy is at your discretion, especially useful if you have a lot of muscle spasms.
• Avoid extreme forward and upward reaching exercises of your arms as this will stretch the wound and potentially compromise the sutures.
• You can start driving after 14-28 days depending on your pain levels, or as advised by your surgeon.

Lateral Thoraco-Lumbar Surgeries

• This surgery can be painful to your abdominal wall muscles for up to 4 weeks following surgery.
• It is common and normal for you have some band of numbness along the abdominal wall.
• It is common and normal for you have some hip joint pain and slight weaknesson flexion and extension for 3-4 weeks.
• You can sleep in any position you like. There is no restrictions: on your back, side or front, no pillow, 1 or 2 pillows.
• You should be performing gentle twice daily range of movement exercise (forwards, backwards, sideways & rotation) without manipulation. Daily exercises with accelerate recovery of the muscles of your neck.
• Having physiotherapy is at your discretion, especially useful if you have a lot of muscle spasms.
• Avoid extreme range of movement back exercises. You are not expected to try bending to touch your toes.
• You can lie in one position, sitin one position, stand and walk for a long as you feel comfortable. Short frequent periods are better tolerated
• Hydrotherapy (optional) can be started after 2-3 weeks, depending on your wound healing.
• · You can start driving after 14-28 days depending on your pain levels, or as advised by your surgeon.

Anterior Lumbar Surgeries

• This surgery can be painful to your abdominal wall muscles for up to 4 weeks following surgery.
• You can sleep in any position you like. There is no restrictions: on your back, side or front, no pillow, 1 or 2 pillows.
• You should be performing gentle twice daily range of movement exercise (forwards, backwards, sideways & rotation) without manipulation. Daily exercises with accelerate recovery of the muscles of your neck.
• Having physiotherapy is at your discretion, especially useful if you have a lot of muscle spasms.
• Avoid extreme range of movement back exercises. You are not expected to try bending to touch your toes.
• You can lie in one position, sitin one position, stand and walk for a long as you feel comfortable. Short frequent periods are better tolerated
• Hydrotherapy (optional) can be started after 2-3 weeks, depending on your wound healing.
• You can start driving after 14-28 days depending on your pain levels, or as advised by your surgeon.

Posterior Lumbar Surgeries

• This surgery can be extremely pain. You will have a significant amount of muscular back pain and buttock pain for 4 to 8 weeks following surgery.
• You can sleep in any position you like. There is no restrictions: on your back, side or front, no pillow, 1 or 2 pillows.
• You should be performing gentle twice daily range of movement exercise (forwards, backwards, sideways & rotation) without manipulation. Daily exercises with accelerate recovery of the muscles of your neck.
• Having physiotherapy is at your discretion, especially useful if you have a lot of muscle spasms.
• Avoid extreme range of movement back exercises. You are not expected to try bending to touch your toes.
• You can lie in one position, sitin one position, stand and walk for a long as you feel comfortable. Short frequent periods are better tolerated
• Hydrotherapy (optional) can be started after 2-3 weeks, depending on your wound healing.
• You can start driving after 28 days depending on your pain levels, or as advised by your surgeon.

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