As you prepare for surgery it is common to have many questions. This packet 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.
Most commonly, after a discectomy you will be discharged home after your surgery.
If you have a laminectomy, you may be discharged home after surgery, or stay overnight at the hospital and go home the next morning.
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. The dura can tear during surgery causing spinal fluid leakage. This occurs in 0.3%-13% of primary surgeries and up to 17% of revision surgeries. Symptoms include headache that is worse with sitting up and relieved when laying down, sensitivity to light, and clear fluid leaking from the incision. A dural tear can be repaired during surgery. You may be required to lay flat after surgery to assist with the repair. 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. 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.
Sexual dysfunction can be a result of nerve or spinal cord injury. This risk is higher with lumbar surgery requiring an anterior approach (ALIF) and occurs in up to 10% of cases. Men are at increased risk compared to women.
Recurrent disc herniation has been reported in 5%-11% of patients after discectomy. Risk factors include traumatic event, young age, male sex, and a history of smoking.
Symptoms of recurrent disc herniation include increased back pain and a recurrence of your pre-operative leg symptoms.
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.
It is very rare to require a blood transfusion after a discectomy or laminectomy. Multiple level lumbar surgery or bleeding disorders have higher risk for bleeding and requiring blood products. Spine surgery also carries the risk of unexpected bleeding. Care is taken to avoid nearby blood vessels, but the risk of injury varies depending on the type of surgery you are having. The risk of vascular injury is 1 and 5 per 10,000 operations with a lumbar discectomy. The risk of epidural hematoma are rare at 0.1%.
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.
During a decompression procedure it may be noted that there is instability of your spinal column that will require surgical fusion for stabilization. This may occur immediately during surgery, or months to years after your surgical procedure.
Statistics referenced from
Rao, Raj MD (2006) Complications in Orthopaedics- Spine Surgery Milwaukee, WI: American Academy of Orthopaedic Surgeon