Neurosurgery Roseburg

Craniotomy

What is it?
Craniotomy is an operation that involves removing a piece of bone from the skull (cranium) to provide access to the brain and its surrounding structures. The term craniotomy is derived from the Latin words cranium (head) and -otomy (act of cutting, incision).

The human skull, which is formed by the union of several cranial and facial bones, is anatomically divided into five regions: an upper region or vertex, a lower region or base, two side regions, and a frontal region, the face. The region of the skull through which the surgeon selects to perform a craniotomy is based on the type of condition requiring treatment. A skull base craniotomy is performed, for example, to treat Chiari (kee-ar-ee) malformations - congenital abnormalities of the base of the brain where the spinal column joins the skull. Named after Professor Hans Chiari - the German pathologist who in 1890 first described these abnormalities of the brain, these malformations usually cause a protrusion of the cerebellum through the bottom of the skull into the spinal canal, which results in poor circulation of cerebrospinal fluid from the brain to the spinal cord.

Why is it done?
Patients who suffer from the following cranial conditions are potential candidates for this operation:

• Tumors (e.g., brain, pituitary, optic nerve, acoustic neuroma)
• Cysts (e.g., arachnoid, colloid)
• Bleeding (hemorrhage)
• Blood clots (hematomas) from injuries (subdural hematomas or epidural hematomas)
• Weaknesses in blood vessels (cerebral aneurysms)
• Abnormal blood vessels (AVMs or arteriovenous malformations)
• Damage to the tissue covering the brain (dura)
• Cerebrospinal fluid (CSF) leaks
• Chiari malformations
• Premature fusion of the normally separate bones of the skull (craniosynostosis)
• Infection in the brain (brain abscesses)
• Skull trauma (e.g., fractures)

The Operation

An understanding of what a craniotomy involves will help you to approach your operation and recovery with confidence.

Incision
Part of the scalp is shaved and cleaned. An incision is then made through the scalp to the skull.

Exposure
A small hole, called a burr hole, is drilled through the skull to the brain. In some cases, several burr holes are drilled to allow your surgeon to lift and remove a piece of the bone. The bone between these holes is cut to create a flap in the skull through which the surgeon can access the brain and its surrounding structures. Next, the dura is cut to expose the brain.

Related Procedure
At this point in the operation, depending on the condition for which you are receiving treatment, several different procedures are performed. For example, your surgeon may remove tumors, clip aneurysms, drain cysts or shunt blood clots (a passage created between two natural bodies, such as blood vessels, shunts divert or permit flow from one body to the other).

Closure
The dura is then sutured closed, and the bone that was removed from the skull is put back in place and secured with metal plates and screws. The operation is completed when your surgeon closes and dresses the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection and blood loss, are some of the potential adverse risks of cranial surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

  Anterior Cervical Discectomy

What is it?
Pain in the neck and extremities, among other symptoms, may occur when an intervertebral disc herniates - when the annulus fibrosus (tough, outer ring) of the disc tears and the nucleus pulposus (soft jelly-like center) squeezes out and places pressure on neural structures, such as nerve roots or the spinal cord. Bony outgrowths, called bone spurs or osteophytes, which form when the joints of the spine calcify, may also cause these symptoms.

Anterior cervical discectomy is an operation that involves relieving the pressure placed on nerve roots and/or the spinal cord by a herniated disc or bone spurs - a condition referred to as neural compression.

Through a small incision made near the front of the neck (i.e., the anterior cervical spine), the surgeon removes disc material and/or a portion of the bone around the nerve roots and/or spinal cord to relieve these compressed neural structures and to give them additional space.

Discectomy involves removing all or part of an intervertebral disc. The term discectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal).

Why is it done?
Pressure placed on neural structures, such as nerve roots or the spinal cord, by a herniated disc or bone spur may irritate these neural structures and cause: pain in the neck and/or arms; and lack of coordination, numbness or weakness in the arms, forearms or fingers. Pressure placed on the spinal cord as it passes through the neck (cervical spine) can be serious since most the nerves for rest of the body (e.g., arms, chest, abdomen, legs) have to pass through the neck from the brain.

Patients who suffer from these symptoms are potential candidates for this operation.

The Operation

An understanding of what an anterior cervical discectomy involves will help you to approach your operation and recovery with confidence.

Incision
The operation is performed with you lying on your back. A small incision is made to one side of the front of your neck.

Exposure
After pulling aside the soft tissue - fat and muscle, your surgeon exposes the source of the neural compression.

Removal
Disc material - and, in some cases, a portion of the bone - around the nerve roots and/or spinal cord is then removed to relieve the compressed neural structures and to give them additional space.

Closure
The operation is completed when your surgeon closes and dresses the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. You will normally be up and walking in the hospital by the end of the first day after the surgery.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

Anterior Cervical Discectomy with Fusion

 

What is it?
Pain in the neck and extremities, among other symptoms, may occur when an intervertebral disc herniates - when the annulus fibrosus (tough, outer ring) of the disc tears and the nucleus pulposus (soft, jelly-like center) squeezes out and places pressure on neural structures, such as nerve roots or the spinal cord. Bony outgrowths, called bone spurs or osteophytes, which form when the joints of the spine calcify, may also cause these symptoms.

Anterior cervical discectomy with fusion is an operation that involves relieving the pressure placed on nerve roots and/or the spinal cord by a herniated disc or bone spurs - a condition referred to as nerve root compression.

Through a small incision made near the front of the neck (i.e., the anterior cervical spine), the surgeon:

• Removes the intervertebral disc to access the compressed neural structures
• Relieves the pressure by removing the source of the compression
• Places a bone graft between the adjacent vertebrae, and
• In some cases, implants a small metal plate to stabilize the spine while it heals.

Discectomy involves removing all or part of an intervertebral disc. The term discectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal). Spinal fusion involves placing bone graft between two or more opposing vertebrae to promote bone growth between the vertebral bodies.

Why is it done?
Pressure placed on neural structures, such as nerve roots or the spinal cord, by a herniated disc or bone spur may irritate these neural structures and cause: pain in the neck and/or arms; and lack of coordination, numbness or weakness in the arms, forearms or fingers. Pressure placed on the spinal cord as it passes through the neck (cervical spine) can be serious since most the nerves for rest of the body (e.g., arms, chest, abdomen, legs) have to pass through the neck from the brain.

Patients who suffer from these symptoms are potential candidates for this operation.

The Operation

An understanding of what an anterior cervical discectomy with fusion involves will help you to approach your operation and recovery with confidence.

Incision
The operation is performed with you lying on your back. A small incision is made to one side of the front of your neck.

Exposure
After pulling aside the soft tissue - fat and muscle, your surgeon exposes the disc between the vertebrae.

Removal
The intervertebral disc - and, in some cases, a portion of the bone around the nerve roots and/or spinal cord - is then removed to relieve the compressed neural structures and to give them additional space.

Material Placement
Through a separate incision, a small section of bone is obtained from your iliac crest (i.e., your hip) for use as a bone graft. The bone graft is placed in the disc space, where it helps the adjacent vertebrae to fuse.

Stabilization
A metal plate may be implanted on the front of the cervical spine to increase the stability of the spine immediately after the operation. Surgeons use these implants to decrease the amount of time that you have to wear a cervical collar after surgery and to increase your chances of developing a solid fusion.

Closure
The operation is completed when your surgeon closes and dresses the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. You will normally be up and walking in the hospital by the end of the first day after the surgery.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

Corpectomy

Cervical corpectomy is an operation to remove a portion of the vertebra and adjacent intervertebral discs for decompression of the cervical spinal cord and spinal nerves. A bone graft with or without a metal plate and screws is used to reconstruct the spine and provide stability.

Indication for operation
In some patients, the cervical spinal canal can be narrowed by bone spurs arising from the back of the vertebral body or the ligament behind the vertebral bodies. In this situation it may be necessary to remove one or more vertebral body and the discs above and below to adequately decompress the spinal cord and/or nerve roots because the area of compression cannot be addressed by an anterior cervical discectomy alone.

What happens afterward?
Most patients experience only mild discomfort at the operative site, which is generally well controlled with oral pain medicines. A mild sore throat is not uncommon and is usually short lived. Most patients are discharged from the hospital in 24-48 hours. Patients may notice immediate improvement in some or all of their symptoms, however, some symptoms may improve only gradually. A successful outcome will depend on your compliance with the health care provider's recommendations, and a realistic expectation for meeting the goals of surgery (which depend on one's condition preoperatively).

Since cigarette smoking dramatically impairs bone healing, smoking cessation will significantly improve the likelihood for a successful fusion.

The Operation

Incision
The patient is positioned on their back. If using the patient's own bone, an incision is made over the hip to harvest bone from the iliac crest. For the corpectomy, a small incision is made on either side of the neck. (A longer "up and down" incision may be required for multiple corpectomies).

Decompression
The cervical spine is widely exposed by separating the spaces between the normal tissues. The discs above and below the vertebrae involved are removed. The middle portion of the vertebrae is removed (some of which is saved for use in the fusion) using cutting instruments and drills to decompress the underlying spinal cord and nerve roots.

Reconstruction
A strut of bone is placed to span the bony defect and provide support to the front of the spine. The bone is incorporated (fused) into the remaining vertebrae over time. Bone from the bone bank (allograft) may be substituted for the patient's own bone. A metal plate and screws are often used to provide extra support and facilitate the fusion process.

Closure
Absorbable sutures and sometimes skin staples are used to close the incisions. A cervical collar may or may not be required for use after surgery. The doctor will follow the fusion with periodic x-ray exams after the operation.

Laminoplasty

What is it?
For patients with painfully restricted spinal canals in their necks, this procedure immediately relieves pressure by creating more space for the spinal cord and roots. The technique is often referred to as an "open door laminoplasty," because the back of the vertebrae is made to swing open like a door.

The Operation

Incision
An incision is made on the back of the neck.

A groove is cut down one side of the cervical vertebrae creating a hinge.

The other side of the vertebrae is cut all the way through.

The tips of the spinous processes are removed to create room for the bones to pull open like a door.

The back of each vertebrae is bent open like a door on its hinge, taking pressure off the spinal cord and nerve roots.

Small wedges made of bone are placed in the opened space of the door.

End of Operation
The door of the vertebrae swings shut, and the wedges stop it from closing all the way. The spinal cord and the nerve roots rest comfortably behind the door.

Recovery

As you prepare yourself mentally to undergo spinal surgery, you also need to prepare yourself for the recovery period that will follow your operation. While the surgery entails work on the part of the surgeon, after that, the brunt of the work is in your hands. To ensure a smooth and healthy recovery, it is important that, as a patient, you closely follow the set of instructions that your surgical team gives you.

Hospital Recovery

After the operation, you will be brought to the recovery room or intensive care unit (ICU) for observation. When you wake up from the anesthesia, you may be slightly disoriented, and not know where you are. The nurses and doctors around you will tell you where you are, and remind you that you have undergone surgery. As the effects of the anesthesia wear off, you will feel very tired, and, at this point, will be encouraged to rest.

Members of your surgical team may ask you to respond to some simple commands, such as "Wiggle your fingers and toes" and "Take deep breaths." When you awaken, you will be lying on your back, which may seem surprising, if you have had surgery through an incision in the back; however, lying on your back is not harmful to the surgical area.

Prior to the surgery, an intravenous (IV) tube will be inserted into your arm to provide your body with fluids during your hospital stay. The administration of these fluids will make you feel swollen for the first few days after the operation.

When you awake from the anesthesia, you may feel the urge to urinate. So, in addition to the IV, a catheter tube (also commonly called a Foley Catheter) will be placed into your bladder to drain urine from your system. The catheter serves two purposes: (1) it permits the doctors and nurses to monitor how much urine your body is producing, and (2) it eliminates the need for you to get up and go to the bathroom. Once you are able to get up and move around, the catheter will be removed, and you can then use the bathroom normally.

During your hospital stay, you will get additional instructions from your nurses and other members of your surgical teams regarding your diet and activity.

Proper nutrition is an important factor in your recovery. Your surgeon may restrict what you drink and eat, or place you on a special diet, depending on the surgical approach that was used during the operation. Calories and food intake are an important part of recovery. Some patients find that their physician orders are less restrictive than the diet they follow at home. After the surgery, you will continue to receive intravenous fluids until you are able to tolerate regular liquids, which typically involves gradually transitioning you from sips of clear fluids to full liquids (including JELL-O® gelatin). From there, you will be given small amounts of solid food until you are ready to return to a regular diet.

With respect to physical activity, in most cases, your surgeon will want for you to get out of bed on the first or second day after your surgery. Nurses and physical therapists will assist you with this activity until you feel comfortable enough to get up and move around on your own.

Home Recovery

Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home - a list of "dos and don'ts," which you will be asked to follow for the first 6 to 8 weeks of your home recovery. So, if you are unsure of any of these instructions, ask for clarification. Following these instructions is crucial to your recovery.

Nowadays, surgery involves one or more incisions depending on the surgical approach used to perform the operation. Therefore, when you are discharged home you may still have a surgical dressing on your incision(s). Either a nurse will visit your home to change the dressing or a caregiver, such as one of your family members, will be taught to do it for you. It is important that the dressing be changed daily and kept dry.

If any signs of infection are observed while changing the dressing, call your doctor. These signs include:

• Fever - a body temperature greater than 101°F (38°C)
• Drainage from the incision(s)
• Opening of the incision(s), and
• Redness or warmth around the incision(s).

In addition, call your doctor if you experience chills, nausea/vomiting, or suffer any type of trauma (e.g., a fall, automobile accident).

During this recovery period, you will also be instructed to keep your incision(s) clean, making sure only to use soap and water to cleanse the area. In general, you should not shower until your doctor has permitted you to do so.

In addition to caring for your incision(s), you will also be encouraged to:

• Drink plenty of fluids
• Maintain a healthy diet (high in protein)
• Walk or do deep-breathing exercises, and
• Gradually increase your physical activity.

Activities to avoid include any heavy lifting, climbing (including stairs), bending, or twisting. You should also avoid the use of skin lotion in the area of the incision(s); you need to keep this area dry until it has had the opportunity to heal well.

Follow up with your doctor on a regular basis during this post-operative period, and make sure to call your doctor if you have any concerns or questions.

JELL-O® gelatin is a registered trademark of Kraft Foods, Inc.

Lumbar Laminectomy

What is it?
Lumbar laminectomy is an operation that involves approaching the spine through an incision in the lower back to remove a portion of the bone over and/or around the nerve roots to provide them additional space.

Why is it done?
Patients who have pain caused by pinched nerves are potential candidates for this procedure.

The Operation

The operation is performed with you lying on your stomach.

Incision
Your surgeon makes an incision in your lower back to access your spine. To have a clear view of your spine, the surgeon then retracts the muscles and ligaments.

Bone/Disc Removal
Your surgeon removes a portion of the lamina, the bony rim around the spinal canal, if it is contributing to pressure on the dural sac or nerve roots. This part of the procedure is called a laminectomy. The term laminectomy is derived from the Latin words lamina (thin plate, sheet, or layer), and -ectomy (removal).

An opening is then cut in the ligamentum flavum - a ligament that connects vertebrae to the sacrum. A portion of the bone over the nerve root and/or disc material around the nerve root is removed to give your nerve root additional space.

Closure
The operation is completed when your surgeon closes and dresses the incision. Your surgeon may choose to place a drain into the wound after the surgery to protect the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. By the end of your first day after surgery, you will normally be up and walking in the hospital.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

Lumbar Microdiscectomy

What is it?

Pain in the lower back (lumbar spine) and legs, among other symptoms, may occur when an intervertebral disc herniates - when the annulus fibrosus (tough, outer ring) of the disc tears and the nucleus pulposus (soft, jelly-like center) squeezes out, and places pressure on, or "pinches," an adjacent nerve root.

Lumbar microdiscectomy is an operation that involves using a surgical microscope and microsurgical techniques to access and treat the lumbar spine. By providing magnification and illumination, the microscope allows for a limited dissection. Only that portion of the herniated disc, which is pinching one or more nerve roots, is removed. The term discectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal).

Why is it done?
Pressure placed on one or more nerve roots by a herniated disc may irritate these neural structures and cause:

• Debilitating leg pain
• Weakness and/or numbness in the legs and/or feet, and
• Bowel/bladder incontinence.

Patients who suffer from these symptoms as a result of a pinched nerve are potential candidates for this operation.

The Operation
An understanding of what a lumbar microdiscectomy involves will help you to approach your operation and recovery with confidence.

Incision
The operation is performed with you lying on your stomach. Because the operation is viewed through a microscope, this approach only requires a small incision. Your surgeon makes an incision in your lower back. Through this incision, microsurgical instruments are then inserted.

Removal
Once your pinched nerve is located, the extent of the pressure on the nerve can be determined. Using microsurgical techniques, your surgeon removes the herniated portion of the disc as well as any disc fragments that have broken off from the disc. The amount of effort required to complete the microdiscectomy depends, in part, on the size of the disc herniation, the number of fragments present, and the difficulty presented in finding and removing these fragments.

Closure
The operation is completed when your surgeon closes and dresses the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. You will normally be up and walking in the hospital on the same day after your surgery. Lumbar microdiscectomy is usually performed on an outpatient basis, with no overnight stay in the hospital.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

Microscopic Discectomy

What is it?
The procedure using the METRx™ System is an operation on the lumbar spine performed using microscope and microsurgical techniques.

The METRx™ System procedure requires only a very small incision and will remove only the portion of the ruptured disc, which is "pinching" one or more spinal nerve roots.

Why is it done?
Lumbar microdiscectomy using the METRx™ System is usually recommended only when specific conditions are met. In general, surgery is recommended when a ruptured disc is pinching a spinal nerve root(s) and you have:

Impaired bowel and/or bladder function

The Operation

Incision
In the operating room, the METRx™ System begins with a small incision in your lower back. Through this opening, your surgeon will insert the endoscope and surgical instruments. Because the work is viewed through an endoscope, this approach requires a relatively small incision.

Reaching the "Pinched" Nerve
Guided by diagnostic studies, your surgeon may remove a small portion of bony material from the back of your vertebra. Once this material is removed, the surgeon can locate the exact area where the nerve root is being pinched.

Identifying the Cause of the Pressure
Once the "pinched" nerve is located, the extent of the pressure on the nerve can be determined. Using endoscopic microsurgical procedures, your surgeon will remove the ruptured portion of the disc and any disc fragments which have broken off from the main disc.

Closing the Incision

The operation is completed when the endoscope is removed and the incision is closed with suture materials and a bandage.

Spinal Fusion

What is it?
A spinal fusion is simply the uniting of two bony segments, whether a fracture or a vertebral joint. The reason for instrumentation with rods and screws is to act as and 'internal cast' to stabilize the vertebra until the fusion, or bony re-growth, can occur.

Why is it done?
Historically spinal fusions have been used to correct degenerative spondylolisthesis. However, there are many indications for a spinal fusion and it is not the only procedure preformed to treat those various conditions. You should talk to your doctor about what procedure is best for you.

The Operation

The Incision
The patient is positioned on the operating table in a prone position. The incision is made over the anatomic position of the spinous process.

Bone is Removed
When indicated, soft tissue and bony decompression are performed to relieve neurological compression.

Screw Placement
For a degenerative spondylolisthesis case, a blunt probe is inserted through the pedicle and into the vertebral body.

Once the pedicle canals are prepared and the screw length determined, the TSRH-3D® screws are sequentially inserted.

Bone Graft

The facet joint capsules are removed and cancellous bone graft is placed into each facet joint. The transverse processes, sacral alae, and the lateral walls of the facet joints are decorticated with high-speed burs and curettes.

Corticocancellous bone graft taken from the iliac crest, along with any fragments of bone taken during decompression are firmly pressed into the bone fusion bed.

Compression
Once the construct has been assembled, segmental distraction and compression may be carved out.

It is important that you discuss the potential risks, complications, and benefits of TSRH-3D® Pedicle Screws with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

It is important that you discuss the potential risks, complications, and benefits of TSRH-3D® Pedicle Screws with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

Interbody Fusion

What is it?
An Interbody Fusion is the uniting of two bony segments, whether a fracture or a vertebral joint. In time, normally within 4 months, the bone grafts will unite with the vertebrae above and below to form one piece of bone.

Why is it done?
The reasons for the operation are to:

• Remove the degenerative disc
• Separate the two vertebral bodies, as they were before the disc degenerated
• Keep them in that position by interposing several pegs of bone (bone graft)

The Operation

Incision
There are a number of techniques for an interbody fusion of the lumbar spine.

Lamina are Removed
First the suregon removes the lamina or the portion of the vertebra that covers the spinal cord. Removing the lamina relives some of the pressure on the spine.

Bone is Removed
Then any bone that may be pinching the nerve roots is removed.

Bone Grafts
Bone grafts are added.

Rods and Screws
Rods are secured to the spine with screws in order to hold the discs in place while the bone graft fuses.

Closing the Incision
The incision is closed. The bone graft will fuse over time.

Interbody Fusion with Cages

What is it?
An Interbody Fusion using cages is designed to be a less invasive method to obtain spinal fusion. The procedure can be performed through an anterior or posterior approach.

Why is it done?
The reasons for the operation are to:

• Remove the degenerative disc
• Separate the two vertebral bodies, as they were before the disc degenerated
• Keep them in that position

The Operation

Incision
The disc space is approached through an incision. The muscles are not cut because they run vertically and can be moved to the side. The disc is removed by excising the front portion and removing the disc material back to the spinal canal. This removes the inflammatory proteins within the disc.

Spacers
Temporary spacers are impacted into the empty disc space disctracting and realigning the vertebral bodies into the proper position. This maneuver opens the collapsed foramen (nerve canal) and lifts pressure from the pinched nerve roots.

Reamer and Thread Tap
A hole in the vertebral body is created using a reamer and a thread tap. A threaded titanium cage is packed with bone graft and then screwed tightly into the hole. The threaded cage replaces the distraction plug and maintains the proper position of the vertebral bodies.

Temporary Plug Removed
The other temporary plug is removed and the hole is made ready for the second implant. The other implant packed with bone is inserted.

Incision Closure
The incision is closed and the bone graft will grow through and around the implants, forming a bone bridge that connects the vertebral bodies above and below.

Recovery

As you prepare yourself mentally to undergo spinal surgery, you also need to prepare yourself for the recovery period that will follow your operation. While the surgery entails work on the part of the surgeon, after that, the brunt of the work is in your hands. To ensure a smooth and healthy recovery, it is important that, as a patient, you closely follow the set of instructions that your surgical team gives you.

Hospital Recovery

After the operation, you will be brought to the recovery room or intensive care unit (ICU) for observation. When you wake up from the anesthesia, you may be slightly disoriented, and not know where you are. The nurses and doctors around you will tell you where you are, and remind you that you have undergone surgery. As the effects of the anesthesia wear off, you will feel very tired, and, at this point, will be encouraged to rest.

Members of your surgical team may ask you to respond to some simple commands, such as "Wiggle your fingers and toes" and "Take deep breaths." When you awaken, you will be lying on your back, which may seem surprising, if you have had surgery through an incision in the back; however, lying on your back is not harmful to the surgical area.

Prior to the surgery, an intravenous (IV) tube will be inserted into your arm to provide your body with fluids during your hospital stay. The administration of these fluids will make you feel swollen for the first few days after the operation.

When you awake from the anesthesia, you may feel the urge to urinate. So, in addition to the IV, a catheter tube (also commonly called a Foley Catheter) will be placed into your bladder to drain urine from your system. The catheter serves two purposes: (1) it permits the doctors and nurses to monitor how much urine your body is producing, and (2) it eliminates the need for you to get up and go to the bathroom. Once you are able to get up and move around, the catheter will be removed, and you can then use the bathroom normally.

During your hospital stay, you will get additional instructions from your nurses and other members of your surgical teams regarding your diet and activity.

Proper nutrition is an important factor in your recovery. Your surgeon may restrict what you drink and eat, or place you on a special diet, depending on the surgical approach that was used during the operation. Calories and food intake are an important part of recovery. Some patients find that their physician orders are less restrictive than the diet they follow at home. After the surgery, you will continue to receive intravenous fluids until you are able to tolerate regular liquids, which typically involves gradually transitioning you from sips of clear fluids to full liquids (including JELL-O® gelatin). From there, you will be given small amounts of solid food until you are ready to return to a regular diet.

With respect to physical activity, in most cases, your surgeon will want for you to get out of bed on the first or second day after your surgery. Nurses and physical therapists will assist you with this activity until you feel comfortable enough to get up and move around on your own.

Home Recovery

Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home - a list of "dos and don'ts," which you will be asked to follow for the first 6 to 8 weeks of your home recovery. So, if you are unsure of any of these instructions, ask for clarification. Following these instructions is crucial to your recovery.

Nowadays, surgery involves one or more incisions depending on the surgical approach used to perform the operation. Therefore, when you are discharged home you may still have a surgical dressing on your incision(s). Either a nurse will visit your home to change the dressing or a caregiver, such as one of your family members, will be taught to do it for you. It is important that the dressing be changed daily and kept dry.

If any signs of infection are observed while changing the dressing, call your doctor. These signs include:

• Fever - a body temperature greater than 101°F (38°C)
• Drainage from the incision(s)
• Opening of the incision(s), and
• Redness or warmth around the incision(s).

In addition, call your doctor if you experience chills, nausea/vomiting, or suffer any type of trauma (e.g., a fall, automobile accident).

During this recovery period, you will also be instructed to keep your incision(s) clean, making sure only to use soap and water to cleanse the area. In general, you should not shower until your doctor has permitted you to do so.

In addition to caring for your incision(s), you will also be encouraged to:

• Drink plenty of fluids
• Maintain a healthy diet (high in protein)
• Walk or do deep-breathing exercises, and
• Gradually increase your physical activity.

Activities to avoid include any heavy lifting, climbing (including stairs), bending, or twisting. You should also avoid the use of skin lotion in the area of the incision(s); you need to keep this area dry until it has had the opportunity to heal well.

Follow up with your doctor on a regular basis during this post-operative period, and make sure to call your doctor if you have any concerns or questions.

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