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Anterior Posterior Spinal Fusion
WHAT YOU NEED TO KNOW:
Spinal fusion is surgery to repair vertebrae in your spine. During surgery, 2 or more vertebrae are joined together using bone grafts or implants, screws, and rods. Spinal fusion is used to treat fractured vertebrae or painful spinal conditions that cannot be controlled with medicine or other treatments. It may be used to correct a deformity, such as scoliosis. It also may be done if you have a disc (cushion between the vertebrae) that has been damaged.
WHILE YOU ARE HERE:
Before Your Surgery:
- Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
- Blood tests: You may need blood taken to give healthcare providers information about how your body is working. The blood may be taken from your hand, arm, or IV.
- Blood transfusion: You may need a blood transfusion for certain medical conditions. You may also need a transfusion if you lose a large amount of blood during surgery. You may ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
- Call button: You may use the call button when you need your healthcare provider. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
- Gown: A hospital gown is needed so that healthcare providers can easily check and treat you. Providers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
- Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
- An IV is a small tube placed in your vein that is used to give you medicine or liquids.
- A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine.
- Vital signs: Healthcare providers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. Vital signs give information about your current health.
- Chest x-ray: This is a picture of your lungs and heart. Healthcare providers use it to see how your lungs and heart are doing. Healthcare providers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
- Special tubes: Some tubes may be put into an artery or vein before, during, or after surgery. These will help healthcare providers watch how you are doing during or after surgery.
- Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
- Pulmonary artery catheter: This is a balloon-tipped catheter (thin tube) inserted through a vein in your neck or groin. The pulmonary artery (PA) catheter goes into the right side of your heart and continues to your pulmonary artery. The balloon is inflated to wedge the catheter in place. The PA catheter has a device in it that measures the pressure in your heart and lungs. The catheter is attached to a monitor that shows the pressure measurements. The measurements can also show healthcare providers how your heart responds to certain heart medicines.
- General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
During Your Surgery:
- You may be given medicine to make you drowsy. You will be taken to the operating room. General anesthesia will be given to keep you asleep and free from pain during the surgery. A central IV catheter may be put into a large vein under your collarbone or in your neck. Sticky pads will be taped to your skin to watch your nerve activity. Your healthcare provider will clean your skin with soap and water. Sheets are put over you to keep the surgery area clean.
- Incisions will be made in the front, back, or both sides of your body. These incisions will give healthcare providers access to your spine. One incision may be down the middle of your back. Another incision may go from your front around to your back. Cervical spine fusion is usually operated on from the front. Thoracic and lumbar fusion surgeries are usually operated on from the back. A laparoscope may be put in a small incision near your belly button. The scope is a long metal tube with a light and mirror on the end.
- One or more pieces of bone will be taken from another area of your body to use as grafts. Bone grafts or artificial bone will be placed between the vertebrae. Metal plates, screws, and cages may also be placed. These hold vertebrae together while the bone grafts heal, or they help to straighten the spine. X-rays may be taken during surgery. This tells your doctor if the metal pieces are in the right place. The incisions will be closed with sutures. Bandages will be put over the incisions.
After Your Surgery:
You are taken to a recovery room until you wake up, then you are taken to your room. You may need to stay in the hospital for several days. Do not get out of bed until your healthcare provider says it is okay. Bandages are used to cover your stitches or staples. These bandages keep the surgery areas clean and dry to help prevent infection. A healthcare provider may remove the dressings soon after surgery to check the incisions.
- Activity guidelines: You must move carefully after surgery. Healthcare providers will teach you how to log roll in bed. This means that you must move your entire body as a unit and not twist your spine.
- After surgery, keep the bed flat or with the head of the bed up no more than 5 to 10 degrees. While lying in bed, turn from side to side often. When turning, keep a pillow between your legs and move your whole body at the same time. Do not sit except when using the toilet. You may be asked to walk as soon as the afternoon or evening after surgery.
- Your healthcare provider will tell you when it is okay to get out of bed. Call your healthcare provider before getting up for the first time. To get out of bed, log roll onto one side near the edge of the bed. Push up to a straight position with your arms. Keep your back straight as you swing your legs over the edge of the bed. Do not twist your body when getting up. If you feel weak or dizzy, sit or lie down right away. Then call your healthcare provider.
- Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell healthcare providers how well your lungs are working.
- Prevent constipation: High-fiber foods, extra liquids, and regular exercise can help you prevent constipation. Examples of high-fiber foods are fruit and bran. Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work. You may also be told to take over-the-counter fiber and stool softener medicines. Take these items as directed.
- Brace: A physical therapist may fit you for a brace. This brace may give you support and help you feel more comfortable, or it may limit your movement. You must wear the brace while walking or sitting in a chair. Ask your healthcare provider if you may go to the bathroom without the brace. You may need to wear the brace for 3 months.
- Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs or heart. Removing fluid lets your lungs fill up with air when you breathe, and helps your heart beat normally. The chest tube is attached to a container to collect the blood or fluid. Call a healthcare provider right away if the tube comes apart from the container. Let the provider know if the tubing gets bent, twisted, or the tape comes loose. You may need more than one chest tube.
- Take deep breaths and cough 10 times each hour. This will decrease your risk for a lung infection. Take a deep breath and hold it for as long as you can. Let the air out and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough. Repeat these steps 10 times every hour.
- You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.
- Drinking liquids: Men 19 years old and older should drink about three Liters of liquid each day (about 13 eight-ounce cups). Women 19 years old and older should drink about two Liters of liquid each day (about 9 eight-ounce cups). Follow your healthcare provider's advice if you must change the amount of liquid you drink. For most people, healthy liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty.
- Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
- A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out.
- Ice: Ice helps decrease swelling, pain, and redness. Ice is best started after surgery and used for the next 24 to 48 hours. Healthcare providers put crushed ice in a plastic bag and cover it with a towel. Place this on your incisions for 15 to 20 minutes every hour as long as you need it. Do not sleep on the ice pack because you may get frostbite.
- Intake and output may be measured. Healthcare providers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask healthcare providers if they need to measure or collect your urine.
- Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
- Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
- Pain Medicine: Healthcare providers may give you medicine to decrease your pain. Tell healthcare providers if the pain does not go away or comes back. A special pump may be used that allows you to push a button and give yourself the medicine through your IV. This is called patient-controlled analgesia. It is set up so that you cannot accidentally give yourself too much medicine.
- Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
- Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if healthcare providers need to keep your stomach empty.
- You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your healthcare provider before you take off the mask or oxygen tubing.
- You may need to wear pressure stockings. The stockings are tight and put pressure on your legs. This improves blood flow and helps prevent clots.
- You may need to wear inflatable boots after surgery. The boots have an air pump that tightens and loosens different areas of the boots. This device improves blood flow and helps prevent clots.
- Physical therapy: A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain.
- You may bleed more than usual or get an infection. Nerves in the area where the disc is removed could be injured. You may need to have more surgery. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
- You could have numbness or pain along the nerve path that limits movement. You could be incontinent. This means you could have problems controlling your bowel or bladder. You could be impotent. This means a man may not be able to have an erection. The dura (tough tissue covering the spinal cord) could be torn. This may cause fluid to leak out of the spinal cord. You may have to lie flat for a few days or may need surgery to sew up the hole in the dura. Without surgery, your back problems may get worse.
CARE AGREEMENT:You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment.
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