Preparing for surgery

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.

Pre-operative labwork

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.

Medical clearance

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.

Pre-operative hospital interview

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.

Time off work and help at home

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. 

Checklist

As your surgery date is approaching, review this checklist to ensure all the steps are completed.

  • 2 weeks before surgery
    • Pre-operative interview with hospital scheduled and pre-operative labwork completed. The hospital will arrange for you to have a nasal swab to screen for MRSA/MSSA.
    • Pre-operative medical clearance completed/scheduled
  • 1 week before surgery
    • Stop taking aspirin and antiplatelet medications such as Plavix. Stop taking anti-inflammatories such as Advil, ibuprofen, Aleve, Motrin, Voltaren, etc. If aspirin or antiplatelet medication is prescribed by your doctor, check with them before stopping to make sure it is appropriate.
  • 2 days before surgery
    • Check with the hospital for arrival time on the day of surgery
  • Night before surgery
    • Do not eat or drink anything past midnight unless otherwise instructed by the anesthesiologist
    • Shower with a soap called Hibiclens the night before your surgery. The hospital will give you the soap.

What to expect during your hospital stay

Day of surgery

  1. Paperwork. Bring your MRI if you did not leave it at the office before surgery.
  2. Registration. Register at the hospital. They will tell you where to go.
  3. Pre-op holding. In pre-op holding you will be given a gown to change in to and given a bag for your personal belongings. You will meet your holding nurse who will review your chart and start your IV. You will be given pre operative medications. You will also meet with your surgical team including the anesthesiologist, nurse anesthetist, and surgical nurse. You will see Dr. Mazahery prior to your surgery. Your family member can stay with you until you are transferred to the operating room.
  4. Operating room. You will be taken to the operating room. Your family will be directed to the waiting room. Dr. Mazahery will meet them there when your surgery is complete.
  5. Recovery room. When your surgery is complete you will be transferred to the recovery room to be monitored. You are typically here for 1 to 2 hours. If you are having a same day surgery, you will then be transferred to secondary recovery, and your family will be notified when they can see you. If you are being admitted to the hospital, you will be transferred to your room and your family will see you at that time. 

Hospital post-operative day 1

If you are admitted to the hospital overnight you will be discharged home the day after surgery.

Pain management

We employ a multi-modal 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.

Physical therapy 

We strongly encourage early mobilization after surgery to help with your recovery. Your first session of physical therapy will start on post-operative day #1. The physical therapist will help you mobilize safely. You will be shown techniques to get in and out of bed and chairs, how to use a walker, and mobilize in the hallway and stairs.

Drain

You may have a drain in your incision post-operatively to help prevent fluid from collecting at the surgical site. This is not used in every surgery, and is typically removed on post-operative day #1 or #2.

Foley catheter 

You may have a foley catheter placed in your bladder during surgery to help prevent urinary retention. This is typically removed on post-operative day #1 or #2.

Hospital post-operative day 2

Physical therapy

You will have another session of physical therapy encouraging walking in the hallways and safety going up and down stairs.

Discharge planning 

We will arrange what devices you may need at home, such as a walker, and have them available for you to take with you.

Home medications 

You will be instructed what home medications to resume or discontinue. You will be given prescriptions for pain medication to take at home. 

Expected length of hospital stay

The amount of time you will be in the hospital depends on your individual surgery and post-operative recovery. Typical lengths of stay in the hospital are as follows:

  • Lumbar discectomy: same day discharge
  • Lumbar fusion: 2 nights in hospital (may be less for minimally invasive surgery)

Possible complications of spine 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.

Anesthesia

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.

Blood clots

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.

Lung problems

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. 

Dural tear

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.

Nerve injury/spinal cord injury

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

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.

Infection and delayed wound healing

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. 

Bleeding

You may require a blood transfusion during or after surgery from the expected blood loss from your procedure. There is up to a 25% chance of requiring a blood transfusion in reconstructive spine cases. 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. This risk increases to 1%-7% with an anterior lumbar approach (ALIF). The risk of epidural hematoma are rare at 0.1%. Multiple level lumbar surgery or bleeding disorders have higher risk for these complications.

Persistent pain

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. 

Postlaminectomy instability

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.

Implant/hardware failure

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.

Pseudoarthrosis

There is a risk that the bone graft and fusion does not fully heal. If the fusion does not fully heal and is causing pain or instability, there may be a need for additional surgery. There is a 20%-30% risk of pseudoarthrosis in one to two level instrumented fusions. This risk increases with the number of levels that are being fused.  Smoking greatly increases the risk of pseudoarthrosis.

Adjacent level degeneration

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 is a 25% chance of requiring additional surgery within 10 years to address adjacent level degeneration.

Statistics referenced from

Rao, Raj MD (2006) Complications in Orthopaedics- Spine Surgery Milwaukee, WI: American Academy of Orthopaedic Surgeons