As you prepare for surgery it is common to have many questions. This page is provided to help answer some of the most commonly asked questions, and to help you prepare for a smooth and successful operative experience. Please feel free to contact Dr. Mazahery and his staff for any additional questions you may have.
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There are important steps to follow prior to your surgery to ensure you are prepared for your surgical procedure. Below is a list of things which need to be completed before your surgery date.
You will be given a prescription for labwork to be completed within 1 month prior to your surgery date. We recommend that you complete your pre operative labwork at the hospital as certain labs can only be performed at the hospital.
Please ensure the results of this labwork are faxed to Dr. Mazahery's office at 703-810-5420.
You may need medical clearance from your primary care physician within 1 month prior to your surgery date. Please ensure your medical clearance is faxed to Dr. Mazahery's office at 703- 810-5420.
You will need an appointment at the pre-operative department at the hospital to review your medical history in preparation for anesthesia. This pre-operative interview should be completed before your appointment for medical clearance with your primary care physician. This will ensure your labs are completed and available for your primary care physician to review. Call the hospital to schedule this appointment. Call Reston Hospital at 703-689-9005 option #1 or Fairfax Hospital at 703-970-6565.
If you are having your surgery as an outpatient procedure at Surgical Specialty Center of Mid Atlantic, you will not need to do a pre-operative interview at the hospital. The surgery center will contact you for your pre-operative interview.
During this time it is also important to consider the amount of time you will need off work after your procedure and discuss this with your employer. It is also important to plan ahead for what help you may need at home after surgery and discuss this with family and friends. Arranging this prior to surgery will help you be able to focus on your recovery post-operatively.
As your surgery date is approaching, review this checklist to ensure all the steps are completed.
If you are admitted to the hospital overnight you will be discharged home the day after surgery.
We employ a multimodal pain management approach. We give you medications in the pre operative holding area prior to your surgery to help reduce post operative pain. You will also be given pain medications during surgery. You will be given oral narcotic medications post operatively as needed. We also utilize anti-inflammatories as needed for breakthrough pain.
You will have a drain in your incision post-operatively to help prevent fluid from collecting at the surgical site. Your dressing will be changed, and the drain removed the morning after your surgery.
You will be evaluated the morning after surgery. You will be given a prescription for pain medications to take at home. After your dressing is changed and you are tolerating oral pain medications, you will be discharged home. Most patients are discharged by early afternoon the day after surgery.
As with any surgery, you need to consider the risks and benefits of the procedure before proceeding with surgery. Complications vary depending on the extent of your surgery, and your overall health prior to surgery. Below is a list of the possible complications to consider prior to surgery.
You will require general anesthesia for your procedure. General anesthesia is typically safe for healthy individuals. Underlying medical conditions can increase your risks with general anesthesia. These risks include, but are not limited to, heart and lung issues, harm to your vocal cords or teeth, mental confusion, stroke, and death. You can discuss these risks further with the anesthesiologist prior to your surgery.
There is a risk of developing deep venous thrombosis (DVT), or blood clots, during or after surgery. These blood clots typically develop in the legs or lungs (pulmonary embolism). Blood thinners are typically not used after spine surgery due to the risk of post-operative bleeding. It is important to minimize the risk of blood clots by early mobilization after surgery, as well as placing sequential compressive devices on your legs while immobile. Symptoms of a blood clot include pain, redness, warmth, and swelling, commonly around the calf. Also monitor for increased shortness of breath or fever.
It is important to keep you lungs expanded after surgery. General anesthesia and immobility can decrease your lung function, which can predispose you to developing lung infections. Early mobilization and use of a breathing device called an incentive spirometer will help decrease this risk.
The thecal sac (the area that encloses the nerves and spinal fluid) is covered by a thin tissue called the dura. Although rare in cervical spine surgery, the dura can tear during surgery causing spinal fluid leakage. Symptoms include headache, sensitivity to light, and clear fluid leaking from the incision. A dural tear can be repaired during surgery. Occasionally, additional surgery is needed to reinforce the repair of the dura.
Although rare, there is a risk of nerve and spinal cord injury when operating around these structures. Nerve injury can result in weakness, pain, numbness, and tingling of the muscles controlled by the nerves affected. In rare cases you can develop a C5 nerve palsy after surgery which causes weakness of your arm and shoulder. This most commonly resolves with time, but can take up to months to fully resolve. Spinal cord injury can result in paralysis, but this is extremely rare and if there is a pre-operative concern your doctor will discuss this with you.
Although very rare, there is a risk of injury to the vessels within the surgical field including the vertebral and carotid arteries. Injury to the vessels can cause increased risk of stroke.
It is very common to experience hoarseness and difficulty with swallowing after an anterior cervical surgery. The degree of hoarseness and swallowing difficulty is variable. Most commonly hoarseness improves in 1-2 weeks post operatively. Rarely you can experience persistent hoarseness lasting months. Swallowing difficulty also typically resolves in 1-2 weeks post operatively. Longer recovery is usually associated with more extensive surgery.
As with any surgery, there is a risk of developing post-operative infection. Symptoms of infection at the surgical site include increased pain, redness, swelling, drainage, wound dehiscence, fever, and chills. Antibiotics as well as additional surgery may be needed to treat an infection. You may also have delayed wound healing due to seroma formation. A seroma is not an infection, but can cause increased drainage and delayed wound healing. Wound complications are increased if patients have risk factors such as obesity, diabetes, and vascular compromise. Wound healing issues are more common in posterior cervical surgeries.
It is very rare to require a blood transfusion after a cervical surgery. You can develop bleeding at the operative site called a hematoma. If a hematoma causes compression on the nerves, spinal cord, or causes difficulty with breathing, then additional surgery to evacuate the hematoma may be necessary.
Surgery is not a guarantee of resolution of your symptoms, and in rare cases pain can worsen after surgery. You can also have residual nerve pain after surgery due to inflammation, which may take time to resolve. It is important to discuss expected surgical outcomes prior to surgery.
There is a risk that when you fuse one segment of your spine, the segments above and below the fused area will see more stress. This increased stress may cause the areas surrounding the fusion site to breakdown. Studies have shown that there up to a 25% chance of requiring additional surgery within 10 years to address adjacent level degeneration.
There is a risk that the bone graft and fusion does not fully heal. This is called pseudoarthrosis. If the fusion does not fully heal and is causing pain or instability, there may be a need for additional surgery. Although there is a risk of pseudoarthrosis with any fusion, the risk increases with more extensive surgeries requiring multiple levels of fusion. Smoking, smokeless tobacco, and nicotine patches greatly increases the risk of pseudoarthrosis.
Screws, rods, cages, and plates may be implanted during a fusion operation. There is a risk that these implants may loosen, shift, break, or cause nerve irritation or damage and need to be removed or replaced.