Yur Guide t Orthpaedic Spie Surgery
Departmet f Orthpaedics Mut Siai Medical Ceter Oe Gustave L. Levy Place, Bx 1188 New Yrk, NY 10029-6574 www.mutsiai.rg Develped i cllabrati with The Office fr Excellece i Patiet Care Chalk Drawig by J.J. Masquerier, 1792, Wellcme Library
Mut Siai Orthpaedic Spie Surgery Thak yu fr chsig The Mut Siai Medical Ceter Departmet f Orthpaedics fr yur Spie Surgery. Our team f dedicated prfessials will wrk with yu t make yur surgical prcedure ad pstperative stay as cmfrtable as pssible. Yu ad yur surge, i cllabrati with ther members f the healthcare team, will wrk tgether t achieve the best pssible utcme. Please read this bklet thrughly as it will becme yur guide t udergig a spial prcedure at Mut Siai. We have eclsed checklists t assist yu i preparig fr surgery, what t expect durig yur hspitalizati ad pst-perative recvery, as well as hw yu ca help yurself ce discharged hme. While each idividual respds differetly t surgical prcedures, this bklet has bee develped t make yu aware f the experieces typical fr patiets udergig spial surgery. It is imprtat fr yu t remember that yu are i charge f yur w recvery. The recvery phase begis immediately after surgery. The ser yu becme active pst-peratively, the ser yu may begi t retur t rmal activity. Please feel free t ask ay f yur team members hw we ca best help yu i meetig yur gals. Prited 8/11
Table f Ctets Preparati fr Surgery...................................................1 Befre Gig t the Hspital..................................................1 Pre-perative Exercise Prgram.................................................2 Hme Mdificatis........................................................3 Bld Dati............................................................4 Isurace Cverage.........................................................5 Isurace Cverage (ctiued)................................................6 Frieds ad Family..........................................................6 The Night befre Surgery.....................................................7 What t Brig t the Hspital.................................................7 Hspital Ifrmati......................................................8 Where t G..............................................................8 Mut Siai Ifrmati.....................................................8 Map....................................................................10 Wh s Wh?..............................................................11 Billig Ifrmati........................................................12 Yur Surgery.........................................................13 Pai Maagemet.........................................................15 i
Uderstadig yur Spie Surgery Micrdiscectmy/Decmpressi Lumbar Lamiectmy............................16 Lumbar Fusi (Aterir ad Psterir)........................................18 Cervical Discectmy ad Fusi (Aterir).......................................20 Cervical Lamiectmy ad Fusi (Psterir).....................................22 Sclisis Surgery...........................................................24 Imprtat Spie Precautis ad Activity Prgram................................26 Other Precautis:.........................................................28 Leavig the Hspital....................................................29 Discharge Ifrmati......................................................29 Time f Discharge.........................................................30 Pai Maagemet ad Wud Care...........................................31 Physical Therapy..........................................................32 Recvery Remider........................................................32 Ntes ad Questis........................................................33 ii
Preparati fr Surgery Befre Gig t the Hspital T make sure yu are healthy eugh t tlerate yur surgery well, yu will uderg a series f tests ahead f time. If yu are beig admitted as a emergecy, these tests will be de up arrival t the hspital. These will iclude a rthpaedic evaluati, a electrcardigram, x-rays, ad several bld tests. Yu may als be asked t date bld, fr use if yu eed a trasfusi. Other steps yu shuld take befre yur surgery iclude: Have yur teeth checked. T help avid ifecti, it is imprtat t cmplete ay detal wrk yu eed prir t surgery. Lse teeth ca als be at risk s please tify yur detist f yur upcmig surgery. Review all medicatis yu are takig with yur surge (be sure t iclude -prescripti drugs, such as ver-the-cuter remedies, as well as vitamis ad fd supplemets). If yu are takig herbal medicatis, it is als imprtat t meti these t yur surge as they may cause bleedig. It is imprtat fr yu t reprt a cmplete ad accurate histry f all medicatis (icludig medicati fr pai) s we ca prvide yu with the best level f care while yu are at Mut Siai. Please als discuss yur alchl csumpti ad use f ay recreatial drugs with yur surge. Yu may eed t stp sme medicatis such as bld thiers (icludig but t limited t aspiri, Cumadi, Plavix ) r ati-iflammatry agets (icludig but t limited t Advil, Mtri, Aleve, Ibuprfe, Celebrex, Tricsal, Cataflam, Vltare, Dlbid, Ldie, Nalf, Asaid, Idci, Idci SR, Oruvail, Tadl, Meclme, Pstel, Mbic, Relafe, Naprsy, Aaprx, Daypr, Feldee ). If yu are usure abut stppig ay f the medicatis yu are takig, be sure t ask yur surge. If yu are havig a spial fusi, yu may be asked t stp takig biphsphates (icludig but t limited t Fsamax r Actel ) Yu will be give prescriptis fr ay medicatis yu might eed specifically related t yur surgery befre discharge frm Mut Siai. Make sure yur surge kws abut yur past histry f medical cditis, surgeries, allergies ad drug allergies. Stp smkig smkig slws dw the healig prcess ad may iterfere with the develpmet f slid be fusi. If yu are verweight, lsig weight will help imprve yur mbility after surgery. 1
Pre-perative Exercise Prgram Yur surge will advise a series f exercises t help stregthe yur muscles. It is very imprtat t d these exercises faithfully, startig as s as pssible, because they will help yu adapt mre quickly ad easily after surgery. We have icluded sme illustratis f exercises that yur dctr may recmmed. Please be sure t d ly the exercises yur dctr suggests. Glute Sets Squeeze yur buttcks tgether. D t hld breath. Hld cuts.* Repeat times.* Quad Sets Lie back, press kee it mat, tighteig muscle the frt f yur thigh. D t hld breath. Hld cuts.* Repeat times.* Akle Pumps Place a twel rll uder calf. Mve ft up. Keep kee straight. Hld cuts.* Mve ft dw ad hld. Repeat times.* * Yur surge r physical therapist will tell yu what t eter i these blaks (i.e. hw may cuts, hw may times). 2
Hme Mdificatis A umber f simple chages ca make yur hme safer ad mre practical fr yur retur frm the hspital. While yur physical r ccupatial therapists may have additial suggestis after yur surgery, the fllwig steps are geerally recmmeded fr everye. Mst f these items are readily available frm medical/surgical supply stres. It is advised t check with yur isurace cmpay t see if yu are cvered fr ay r all f the belw items. Thrughut yur hme Remve thrw rugs ad ther hazards; pay special atteti t the psiti f electrical crds. Place items yu use regularly (kitche utesils, tiletries, clthes, etc.) at arm level s yu d t have t reach up r bed dw. Fr elderly patiets r patiets with special eeds, yu may wat t csider rearragig furiture s yu ca maeuver easily with a cae, crutches, r walker. Bedrm Make sure yur bed is accessible ad f adequate height s yu d t have t bed t much gettig i ad ut. Raise the bed with bed risers if ecessary. Make sure lamps ca be tured ad ff easily, preferably frm bed. Check t see that yur remte ctrls ad battery-perated devices have ew batteries. If yu are havig eck surgery, yu may beefit frm a sleepig wedge. Livig Rm Have available a high, stable chair with a firm seat cushi ad armrests. Durig yur hspital stay, yur physical r ccupatial therapist may suggest sme f the fllwig items. Sme ca be shipped t yur hme if t prvided yur day f discharge. Bathrm Fr yur safety ad cmfrt, yu might csider: Bars/hadrails i the bath/shwer A raised tilet seat if yu have a lw tilet A shwer bech/chair fr bathig A had-held shwerhead 3
Bld Dati Sme patiets udergig spie surgery may als eed a bld trasfusi. If yu receive a trasfusi, the mst likely time is the first r secd day fllwig surgery, althugh it ca ccur at ay pit durig yur hspital stay. As part f yur preparati fr surgery, yu ad yur family may date bld prir t yur surgery t be used i the evet that a trasfusi is ecessary. Datis ca be made up t 5-10 days befre yur surgery; 10 days if yu are datig bld ut f state, ad 5 days if yur surgery takes place i the same state. This allws fr adequate shippig time. If yu chse t t make a dati, r are t eligible t d s (see guidelies belw) ad yu require a trasfusi, Mut Siai will prvide bld fr yu. There is a fee fr datis. Fr Ifrmati:! Please te that yur bld ca ly be used withi 4 weeks frm the date f yur dati. New Yrk Bld Ceter Phe: 1 (800) 439-6876 Fax: 1 (516) 334-4936 Yu must have a scheduled appitmet fr yur dati. Yur physicia must cmplete a Physicia Order Frm prir t dati. The checklist belw ca be used t determie if yu are eligible t date bld i preparati fr yur surgery at Mut Siai. Please ctact yur physicia r the New Yrk Bld Ceter at 800-439-6876 if yu have ay questis abut these guidelies. Guidelies fr Bld Dati Yu are at least 10 years ld. Patiets ver 70 may date with medical clearace frm their physicia. Yu weigh at least 110 lbs. Yu have bee ifecti/symptm free fr at least 3 days. Yu are t curretly takig atibitics. Yu have t had a adverse reacti t bld dati i the past. Yu d t have a histry f cardivascular disease. 4
Isurace Cverage Befre yu cme t the hspital, yu may wat t check with yur isurace cmpay t iquire abut yur cverage (bth hspital stay ad pst-discharge eeds, icludig rehabilitati, hme care, ad equipmet). If a rehabilitati ceter is beig csidered fr yu pst-discharge, please te, beig tld by yur isurace cmpay that yu have cverage r beefits des t always mea yu will receive authrizati fr admissi t a acute rehabilitati facility frm yur isurer. Admissi t a acute rehabilitati facility is based t ly yur isurace cverage but als cliical criteria ad bed availability. The Mut Siai staff will wrk with yur isurer t prvide yu with the mst apprpriate level f rehabilitati services up discharge. Specific Questis t Ask Yur Isurace Cmpay Make sure that yu specify yur diagsis ad the type f spie surgery yu will be havig. Is there a limit the umber f days I am cvered fr hspitalizati fr the surgery? Des my isurace pay fr a private rm r urse s aide? Please te, rutiely these are t cvered by isurers ad are paid fr ut-f-pcket. Des my diagsis ad prcedure meet medical criteria fr a acute rehabilitati facility? Acute rehabilitati facilities are veright prgrams, either at Mut Siai r ather istituti. Such prgrams prvide itesive therapy fr at least three hurs per day, Mday thrugh Saturday. The average legth f stay is 7 days. m m m m If yes, is there a limit the umber f days I am cvered fr? Which facilities are i my etwrk (cvered uder my pla)? Is trasprtati t the facility cvered? If yes, uder what circumstaces? Please te: Applicatis must be made t 3 acute rehabilitati facilities we cat ly apply t yur first chice. Des my diagsis ad prcedure meet medical criteria fr a sub-acute rehabilitati prgram? Sub-acute rehabilitati prgrams are veright shrt-term prgrams cducted i a ursig hme. O average, such prgrams prvide 1-2 hurs f therapy, Mday thrugh Friday. The legth f stay is apprximately 14-21 days, which varies yur prir level f idepedece ad prgress with yur rehabilitati prgram. m m m m If yes, is there a limit the umber f days I am cvered fr? Which facilities are i my etwrk? Is trasprtati t the facility cvered? If yes, uder what circumstaces? Please te applicatis must be made t 3 sub-acute rehabilitati facilities we cat ly apply t yur first chice. 5
Isurace Cverage (ctiued) Des my diagsis ad level f care required qualify me fr hme care? Hme care ivlves therapy ad services prvided t yu at yur hme. If yes, what kid f services? m m m m A urse? Physical therapy? Occupatial therapy? Assistace at hme, such as a hme health aide/attedat? If yes, d I have a c-pay fr ay f the services? Please te: Hme care is fte limited r t cvered at all by isurers, especially if yu have private isurace. Therefre, please make alterate care plas fr whe yu get hme. What types f equipmet are cvered? m m m m A walker, wheelchair, crutches, cae? Elevated tilet seat/cmmde? Shwer bech/chair? Dressig equipmet? Wrkma s Cmpesati Isurace If yu have Wrkma s Cmpesati Isurace, please make sure that yu ctact yur Wrkma s Cmpesati Case Maager. Make sure t brig yur case umber ad yur case maager s phe umber with yu t Mut Siai. If yu have additial isurace cverage, please brig that ifrmati with yu as well. Frieds ad Family Wh is yur primary ctact pers? Be sure t brig that pers s phe umber with yu t the hspital. The surge will speak t yur frieds ad family after yur prcedure is cmplete. If yu wuld like the surge t call smee istead, please tell the surge ahead f time ad prvide the phe umber. Hspital staff are t allwed t give ut ifrmati t multiple peple ver the telephe because f the privacy stipulatis f the Federal Health Isurace Prtability ad Accutability Act (HIPAA). If yur family has specific questis abut the prcedure, it is a gd idea t write them dw ad brig them t a appitmet prir t yur spie surgery. Pla ahead fr yur trasprtati hme (family, car service, ambulette). Please te that mst isurace des t cver the cst f gettig hme. Arrage fr a fried r family member t be available t assist yu after yu retur hme. Depedig yur isurace, yu may t be cvered t receive ay extra help. If yu are iterested, a list f private services ca be prvided. 6
The Night befre Surgery Take medicatis as istructed by yur surge ad medical dctr. D NOT eat r drik aythig after midight the ight befre yur surgery. What t Brig t the Hspital Yu ca make yur hspital stay that much easier by fllwig this checklist as yu pack: Isurace card/ifrmati List f medicatis, icludig dsage ad hw fte yu take them Prescripti Medicatis (Talk t yur surge abut the medicatis yu are takig ad discuss which es yu will brig t the hspital the day f surgery t be relabeled ad dispesed by staff.) List f allergies Cmpleted Health Care Prxy frm Emergecy ctact umber Names ad umbers f ay rehabilitati facilities yu may have made arragemets with Lse-fittig clthes, such as sweatpats ad t-shirts Rbe Rubber-sled, -slip shes (e.g., seakers, r slippers with a back) Tiletry items (tthbrush, tthpaste, cmb/brush) Ay assistive devices yu use (e.g., walker, cae). Please label all devices. Detures r hearig aids (with wrkig batteries) Eyeglasses (t ctact leses) Phe umbers f all physicias, family, ad frieds whm yu might eed t ctact A small amut f cash fr ewspapers, etc. It might be helpful t have a credit umber available (althugh yu d t eed t brig the actual card). Huse keys What NOT t Brig Valuables (such as large amuts f cash, checkbk, jewelry, expesive belgigs) Electrical devices (such as hairdryers ad heatig pads) 7
Hspital Ifrmati Where t G O the day f surgery, g t the 2 d flr f the Guggeheim Pavili at Mut Siai, usig either the 1190 Fifth Aveue r 1468 Madis Aveue etrace. After registerig, yu will g t a hldig rm, where yu will meet with yur aesthesilgist ad yur surge, befre beig take t the peratig rm. Mut Siai Ifrmati Telephe ad TV Services A persal telephe ad TV are available fr $13 ttal ($7 fr TV ad $6 fr phe) per day. The charge fr these services may be applied t yur hme telephe bill ad paid after yu leave the hspital. A staff member durig the admissi prcess will help yu make arragemets fr these services. Please uderstad that t esure a quiet, restful atmsphere; patiet phes cat receive calls after 9:00 pm, althugh yu will be able t make utgig calls after that time. If family members/frieds wish t call after hurs t check i, please ask them t call the urses stati at 212-241-7923. Family Waitig Rms This waitig rm is available fr family ad frieds f patiets udergig surgery. There will be staff preset t serve as liaiss betwee surges, medical staff ad families. It is lcated i the Guggeheim Pavili, 2 West. The rm is available Mday Friday 5:30 am - 8:00 pm. Visitig Hurs Visitig hurs are betwee 11:00 am ad 9:00 pm. We ask that yu ad yur family/frieds respect these hurs very clsely. (Early mrig hurs are typically devted t cliical care eeds, while after 9:00 pm, patiets are ecuraged t get the sleep they eed t speed their recvery.) Ay visits utside f regular visitig hurs will require the permissi f the ursig staff, the e excepti beig a patiet s trasfer frm the recvery rm t the Orthpaedics uit after 9:00 pm. 8
Guest Ldgig Families ad guests f patiets receivig care at Mut Siai may chse t stay at lcal htels i the area that ffer discuts t ur patiets. Mut Siai has a exclusive agreemet with the Curtyard by Marritt, lcated at 92d Street ad First Aveue which ffers a variety f rms at substatial discuts. Reservatis ca be made by dialig 212-241-5431. The Htel Wales, lcated at 92d Street ad Madis Aveue, als ffers discuts ad ca be reached at 1-866-WALES-HOTEL. Meals Mut Siai makes every effrt t prvide utritius meals t ur patiets. T speed yur recvery, yur surge may specify what yu ca eat pst-peratively. If yu bserve Jewish Dietary Laws, there are ksher meals available t yu. Als, there are ther dietary meals available up request (e.g. Vegetaria, diabetic). Parkig The Mut Siai parkig facility, lcated 99th Street betwee Madis ad Park Aveues, is atteded frm 5:00 a.m. t 12:30 a.m. daily. At all ther hurs, please ctact the Security Desk i the mai lbby f the hspital fr assistace with parkig. Fr questis abut parkig, call 212-241-5125. 9
Map Cetral Park F I F T H A V E N U E W Fifth Ave. Etrace 1190 Fifth Ave. 1212 Fifth Ave. 5 The Kravis Childre s Hspital Warre Alpert Pavili (P) 1184 Fifth Ave. The Kravis Wme s Ceter Kligestei Pavili (KP) 1176 Fifth Ave. N EAST 101ST STREET Madis Ave. Etrace 1468 Madis Ave. M A D I S O N A V E N U E EAST 99TH STREET EAST 98TH STREET 6 S 7 3 East 101 St. West Elevatrs 33 E 10 Guggeheim Pavili (GP) Ceter fr Advaced Medicie (CAM) 5-17 E 102 St. EAST 102ND STREET 8 1 Aeberg Buildig Berg Faculty Practice Assciates 5 East 98th St. 11 Ceter fr Sciece ad Medicie (CSM) Uder Cstructi 1 4 9 2 East Elevatrs Kligestei Cliical Ceter (KCC) 1450 Madis Ave. Atra 19 East 98 St. Emergecy Walk-I Etrace Icah Medical Istitute 1425 Madis Ave. Parkig 1428 Mad. Ave. Martha Stewart Ceter fr Livig 1440 Madis Ave. 6 rev. 2.22.10 The Mut Siai Medical Ceter Grud Level Security/Ifrmati Lst? Call 212-241-6068 r 46068 frm a hspital phe. 5 Hatch Iterdemiatial Chapel Fr Peck Jewish Chapel, take stairs t 2d flr Admissis Pre-testig; Surgical ad Prcedural Registrati; Family Waitig Area 1 6 Martha Stewart Ceter fr Livig Mut Siai Heart 7 Patiet Service Ceter 8 Rehabilitati Services ad Cliics Rutteberg Treatmet Ceter 10 Ster Auditrium 11 Take Aeberg stairs t 2d flr. Take Guggeheim stairs r elevatr t 2d flr. ATM 2 Bus M1, 2, 3, 4, 106 Cafeteria Cffee Stad Elevatr Escalatr Rest Rm Stairs Subway at 96th St. ad Lexigt Ave. Telephe Wheelchair Access 9 Gift Shp lcated the 7th flr f the Guggeheim Pavili at the atrium 3 Gldwurm Auditrium 3 Hatch Auditrium 4 Take Guggeheim stairs t 2d flr. 6 10
Wh s Wh? While at Mut Siai, yu will be take care f by excellet physicias ad utstadig registered prfessial urses, as well as a etire healthcare team. This team may iclude physicias assistats, scial wrkers, pharmacists, physical ad ccupatial therapists, utritiists, ad assciate staff. Each staff member will prvide yu with differet aspects f yur care ad i rder t help yu uderstad their rles i yur recvery, we have listed a brief descripti f their rles. Cliical Nurse Maager (CNM): crdiates all Registered Nurses (RNs) ad Patiet Care Assciates (PCAs) the uit. The CNM versees all care delivered the uit. She is available fr ay questis r ccers yu may have. She als esures that yu receive excellet care durig yur stay. Nurse Practitier (NP): is a advaced practice urse specially traied t versee the patiet pla f care i cllabrati with the spie surge. The NP will fllw yu frm the pst aesthesia care uit util discharge. The NP has the ability t rder tests, X-rays, medicatis ad acts as the physicia liais fr patiets ad families i regards t patiet educati, ccers, ad prblems. Physicias Assistat (PA): is a healthcare prfessial licesed t practice medicie with the attedig physicias. The PA will cduct physical exams, diagse ad treat illess ad assist i surgery. The PA will als rder ad iterpret tests, prescribe medicati ad prvide a brad rage f diagstic ad therapeutic services. Registered Nurse (RN): will crdiate yur care durig yur stay icludig admiisterig yur medicati, mitrig yur pai ad respse t medicati ad ther treatmets, as well as mitr yur vital sigs. The RN will als mitr the status f yur surgical site, cmmuicate issues ad ccers t yur surge ad carry ut yur surge s rders fr yur care. Patiet Care Assciate (PCA): helps the RN give yu physical care such as bathig ad takig vital sigs. They will check yur pai level frequetly, as they help yu t regai yur idepedece. They reprt t yur RN. Mut Siai ffers a variety f additial services t cvered by yur isurace that are available t yu a fee-fr-service basis: Fr Private Duty Nurse: Access Nursig Service (212) 241-7383 Fr Private Rm r Private Uit (GP 11West): Ntify the Admittig Crdiatr admissi t the hspital Physical Therapist (PT): will wrk with yu t get yu back yur feet ad mvig agai by icreasig yur stregth, balace ad verall fuctial mbility. Occupatial Therapist (OT): will help yu t perfrm yur self-care ad imprve yur idepedece i cmpletig everyday essetial tasks. Scial Wrker: will arrage fr yur eeds up discharge, smetimes icludig rehabilitati, hme care, trasprtati, ad equipmet. The scial wrker is als available fr supprtive cuselig, if eeded. 11
Billig Ifrmati Yu will receive several bills after yur hspital stay. The hspital bill will cver yur time i the peratig rm ad yur ipatiet stay. If yu have ay questis abut this bill, please call 212-731-3100. Fr questis abut yur surge s bill, ctact yur surge s ffice. Fr questis abut a bill frm a physicia ther tha yur surge, please call 212-987-3100 12
Yur Surgery Yur surge will discuss i detail with yu hw lg yur surgery rutiely takes. Mst fte, patiets receive geeral aesthesia. Yur surge ad aesthesilgist will discuss with yu the type f aesthesia that is best fr yu. Durig surgery, the surge will als decide whether t isert a catheter t cllect urie. Recvery Rm After surgery, yu will be clsely mitred i the recvery rm (als called the Pst-Aesthesia Care Uit, r PACU) as yur aesthesia wears ff. Uder certai circumstaces, yu might be placed i the Itesive Care Uit r ather pst surgery uit after surgery. Specially traied urses, physicias, ad ther medical staff will care fr yu, ad begi admiisterig pai medicati right away. Yu may fid the rm isy ad bright, with a lt f equipmet: this is a sig that yu are i gd hads. Extra blakets are available if yu feel cld. Yu are expected t stay i the recvery rm util yur cditi is stabilized ad a bed is available fr yu the Orthpaedic flr. Yur family ad frieds are ecuraged t remai i the waitig area, where they will be give updates yur prgress ad be tified whe yu are ready t be take t yur rm. Please te: If yu are a patiet uder 21 years f age yu may r may t be fllwed after surgery the pediatric flr. This is t allw fr a pediatricia t participate i yur care. 13
Trasfer t Yur Rm Oce yu have recvered frm the aesthesia, yu will be trasprted t the Orth - paedics flr, 8 Ceter, i the Guggeheim Pavili, where a team f rthpaedic ad rehabilitati specialists will take ver yur care fr the remaider f yur hspital stay. Legth f stay will vary depedig yur prcedure, which will be discussed with yu by yur surge. O arrivig i yur rm, yu will be give a ft pump a teless slipper that getly squeezes yur ft t help the circulati as well as a special device, called a icetive spirmeter, that will help yu breathe deeply t clear yur lugs. Yu may wake up with drais ad pssibly a catheter which are usually remved pstperatively whe yur mbility imprves. Please te, if yu have had cervical spie surgery yu may wake up with a surgical cllar yur eck. Mitrig Yur Prgress We will take yur temperature ad bld pressure, ad als check yur surgical site, every 4 hurs arud the clck. Oce a day, we will als take a bld sample. Fr the first 24 hurs, yur muth will be very dry, ad yur thrat may als hurt. Ice chips are available t ease these sesatis. Sme patiets may experiece a slwig f the digestive prcess as a result f sme medicatis r the surgical prcedure. Please let yur healthcare team kw if yu experiece ay abdmial pai r ausea; treatmet is available. 14
Pai Maagemet Althugh discmfrt is a rmal result f surgery, yur healthcare team is there t keep yur pai t a miimum. Yur surge will prescribe yur persal Pai Maagemet prgram, which will ivlve either itraveus medicati r the use f a pump yu activate yurself (als kw as Patiet-Ctrlled Aalgesia, r PCA pump). Yur urse will istruct yu the use f the PCA pump. Please remember that if yu are usig a PCA pump, it is imprtat that yu push the butt whe yu have pai. If yu are i pai, yu ca als request additial pai medicati. We ca als adequately ctrl yur pst-perative pai with ral medicati ce yu ca tlerate fd ad drik. Yu ca als help us help yu. The mre accurately yu ca describe yur symptms, the better we will be able t alleviate them ad help yu mve frward with yur recvery. Yur health team will use a pai scale f 0-10 fr yu t gauge yur pai; 0 beig pai ad 10 beig ubearable. Sice pai levels ted t g up ad dw durig the early recvery stages, tell yur urse r dctr if the pai gets wrse. Try t pipit the kid f pai yu are experiecig: Is it cstat? Itermittet? Sharp? Dull? Achig? Burig? Des it feel like muscle spasms? Sice pai als varies i itesity, we will ask yu t rate yur pai wheever we check yu. Please als let us kw if yu experiece side effects frm the pai medicati, such as ausea, itchig, dizziess, r cstipati. We ca help yu with thse symptms as well. Yu ca expect pai t decrease ad yur stamia t icrease as yur stay ges. By the time yu leave the ipatiet flr, yu shuld eed ly ral pai medicati. If Yu Need Help... If yu ecuter difficulties f ay kid that the immediate staff yur uit is uable t reslve, please feel free t ctact the Patiet Service Ceter, by dialig extesi 66, r 88990. The umber t dial frm utside Mut Siai is 212-659-8990. 15
Uderstadig yur Spie Surgery Micrdiscectmy/Decmpressi Lumbar Lamiectmy 16
Exercise is very imprtat t help yur recvery frm spie surgery. Yu are gig t eed t lear t mve differetly, ad stregthe yur back ad yur legs. A physical therapist will wrk with yu after surgery t help yu start mvig agai. A few exercises that yu ca start with are the same exercises frm the Pre- Operative exercise prgram page 2. Glut Sets Quad Sets Akle Pumps I rder t let yur spie heal, yu will wat t decrease the strai yu put yur spie. This strai fte cmes frm liftig bjects, twistig ad bedig yur spie. Gd bdy mechaics are essetial t prtectig yur spie. Oe f the first aspects f bdy mechaics is lg rllig. This is extremely imprtat: Yur physical therapist will wrk lg rllig with yu. This way f mvig will fte feel awkward at first, but ce yu make it a habit, it will be secd ature. Please review the pictures page 26. Whe yu are gettig it ad ut f yur bed, yu wat t picture yur spie as a lg, it des t bed. Yur hips, kees ad arms ca mve, but yur spie stays as e uit. Yur surge may prescribe a brace fr yu. He r she will let yu kw whe yu will eed t wear it. Yur physical therapist ad/r ccupatial therapist will review with yu the prper use f this brace. Yu may eed t use this brace whe yu are ut f bed ad with exercise. Other Precautis: Carry bjects with bth hads ad keep the bjects clse t yu. Preted that yu have VERY shrt arms. Push r pull bjects istead f liftig them. Whe pushig bjects, especially drs, keep yur arms very clse t yu ad let yur legs d the pushig. Whe reachig tward the grud r pickig smethig up, bed with yur hips ad kees istead f yur back. Yur surge will likely recmmed limitig the amut f time yu sped sittig at e time. I geeral, d t sit fr mre tha 20-30 miutes at e time ad make sure yu chage psitis fte. 17
Uderstadig yur Spie Surgery Lumbar Fusi (Aterir ad Psterir) Exercise is very imprtat t help yur recvery frm spie surgery. Yu are gig t eed t lear t mve differetly, ad stregthe yur back ad yur legs. A physical therapist will wrk with yu after surgery t help yu start mvig agai. A few exercises that yu ca start with are the same exercises frm the Pre- Operative exercise prgram page 2. Glut Sets Quad Sets Akle Pumps 18
I rder t let yur spie heal, yu will wat t decrease the strai yu put yur spie. This strai fte cmes frm liftig bjects, twistig ad bedig yur spie. Gd bdy mechaics are essetial t prtectig yur spie. Oe f the first aspects f bdy mechaics is lg rllig. This is extremely imprtat: Yur physical therapist will wrk lg rllig with yu. This way f mvig will fte feel awkward at first, but ce yu make it a habit, it will be secd ature. Please review the pictures page 26. Whe yu are gettig it ad ut f yur bed, yu wat t picture yur spie as a lg, it des t bed. Yur hips, kees ad arms ca mve, but yur spie stays as e uit. Yur surge may prescribe a brace fr yu. He r she will let yu kw whe yu will eed t wear it. Yur physical therapist ad/r ccupatial therapist will review with yu the prper use f this brace. Yu may eed t use this brace whe yu are ut f bed ad with exercise. Other Precautis: Carry bjects with bth hads ad keep the bjects clse t yu. Preted that yu have VERY shrt arms. Push r pull bjects istead f liftig them. Whe pushig bjects, especially drs, keep yur arms very clse t yu ad let yur legs d the pushig. Whe reachig tward the grud r pickig smethig up, bed with yur hips ad kees istead f yur back. Yur surge will likely recmmed limitig the amut f time yu sped sittig at e time. I geeral, d t sit fr mre tha 20-30 miutes at e time ad make sure yu chage psitis fte. Other Remiders: Stp smkig ad use f ictie prir t yur surgery ad durig yur recvery If yu were takig biphsphates such as Fsamax, Actel r ati-iflammatry agets prir t surgery, check with yur surge befre re-startig these medicatis. 19
Uderstadig yur Spie Surgery Cervical Discectmy ad Fusi (Aterir) Exercise is very imprtat t help yur recvery frm spie surgery. Yu are gig t eed t lear t mve differetly, ad stregthe yur back ad yur legs. A physical therapist will wrk with yu after surgery t help yu start mvig agai. A few exercises that yu ca start with are the same exercises frm the Pre- Operative exercise prgram page 2. Glut Sets Quad Sets Akle Pumps 20
I rder t let yur spie heal, yu will wat t decrease the strai yu put yur spie. This strai fte cmes frm liftig bjects, twistig ad bedig yur spie. Gd bdy mechaics are essetial t prtectig yur spie. Oe f the first aspects f bdy mechaics is lg rllig. This is extremely imprtat: Yur physical therapist will wrk lg rllig with yu. This way f mvig will fte feel awkward at first, but ce yu make it a habit, it will be secd ature. Please review the pictures page 26. Whe yu are gettig it ad ut f yur bed, yu wat t picture yur spie as a lg, it des t bed. Yur hips, kees ad arms ca mve, but yur spie stays as e uit. Yur surge may prescribe a brace fr yu. He r she will let yu kw whe yu will eed t wear it. Yur physical therapist ad/r ccupatial therapist will review with yu the prper use f this brace. Yu may eed t use this brace whe yu are ut f bed ad with exercise. Other precautis: Carry bjects with bth hads ad keep the bjects clse t yu. Preted that yu have VERY shrt arms. Push r pull bjects istead f liftig them. Whe pushig bjects, especially drs, keep yur arms very clse t yu ad let yur legs d the pushig. Whe reachig tward the grud r pickig smethig up, bed with yur hips ad kees istead f yur back. Avid repetitive verhead activities. D t mve yur head rapidly. It is suggested t have sme type f supprt i bed (i.e. sleepig wedge, r pillw, t keep yur head up.) Other Remiders: D t drive if yu have bee istructed t wear a cervical cllar. Stp smkig ad use f ictie prir t yur surgery ad durig yur recvery. If yu were takig biphsphates such as Fsamax, Actel r ati-iflammatry agets prir t surgery, check with yur surge befre re-startig these medicatis. 21
Uderstadig yur Spie Surgery Cervical Lamiectmy ad Fusi (Psterir) Exercise is very imprtat t help yur recvery frm spie surgery. Yu are gig t eed t lear t mve differetly, ad stregthe yur back ad yur legs. A physical therapist will wrk with yu after surgery t help yu start mvig agai. A few exercises that yu ca start with are the same exercises frm the Pre- Operative exercise prgram page 2. Glut Sets Quad Sets Akle Pumps 22
I rder t let yur spie heal, yu will wat t decrease the strai yu put yur spie. This strai fte cmes frm liftig bjects, twistig ad bedig yur spie. Gd bdy mechaics are essetial t prtectig yur spie. Oe f the first aspects f bdy mechaics is lg rllig. This is extremely imprtat: Yur physical therapist will wrk lg rllig with yu. This way f mvig will fte feel awkward at first, but ce yu make it a habit, it will be secd ature. Please review the pictures page 26. Whe yu are gettig it ad ut f yur bed, yu wat t picture yur spie as a lg, it des t bed. Yur hips, kees ad arms ca mve, but yur spie stays as e uit. Yur surge may prescribe a brace fr yu. He r she will let yu kw whe yu will eed t wear it. Yur physical therapist ad/r ccupatial therapist will review with yu the prper use f this brace. Yu may eed t use this brace whe yu are ut f bed ad with exercise. Other Precautis: Carry bjects with bth hads ad keep the bjects clse t yu. Preted that yu have VERY shrt arms. Push r pull bjects istead f liftig them. Whe pushig bjects, especially drs, keep yur arms very clse t yu ad let yur legs d the pushig. Whe reachig tward the grud r pickig smethig up, bed with yur hips ad kees istead f yur back. Avid repetitive verhead activities. D t mve yur head rapidly. It is suggested t have sme type f supprt i bed (i.e. sleepig wedge r pillw t keep yur head up.) Other Remiders: D t drive if yu have bee istructed t wear a cervical cllar. 23
Uderstadig yur Spie Surgery Sclisis Surgery Exercise is very imprtat t help yur recvery frm spie surgery. Yu are gig t eed t lear t mve differetly ad stregthe yur back ad yur legs. A physical therapist will wrk with yu after surgery t help yu start mvig agai. A few exercises that yu ca start with are the same exercises frm the Pre- Operative exercise prgram page 2. Glut Sets Quad Sets Akle Pumps 24
I rder t let yur spie heal, yu will wat t decrease the strai yu put yur spie. This strai fte cmes frm liftig bjects, twistig ad bedig yur spie. Gd bdy mechaics are essetial t prtectig yur spie. Oe f the first aspects f bdy mechaics is lg rllig. This is extremely imprtat: Yur physical therapist will wrk lg rllig with yu. This way f mvig will fte feel awkward at first, but ce yu make it a habit, it will be secd ature. Please review the pictures page 26. Whe yu are gettig it ad ut f yur bed, yu wat t picture yur spie as a lg, it des t bed. Yur hips, kees ad arms ca mve, but yur spie stays as e uit. Yur surge may prescribe a brace fr yu. He r she will let yu kw whe yu will eed t wear it. Yur physical therapist ad/r ccupatial therapist will review with yu the prper use f this brace. Yu may eed t use this brace whe yu are ut f bed ad with exercise. Other precautis: Carry bjects with bth hads ad keep the bjects clse t yu. Preted that yu have VERY shrt arms. Push r pull bjects istead f liftig them. Whe pushig bjects, especially drs, keep yur arms very clse t yu ad let yur legs d the pushig. Whe reachig tward the grud r pickig smethig up, bed with yur hips ad kees istead f yur back. Yur surge will likely recmmed limitig the amut f time yu sped sittig at e time. I geeral, d t sit fr mre tha 20-30 miutes at e time ad make sure yu chage psitis fte. Other Remiders: Stp smkig ad use f ictie prir t yur surgery ad durig yur recvery. If yu were takig biphsphates such as Fsamax, Actel r ati-iflammatry agets prir t surgery, check with yur surge befre re-startig these medicatis. 25
Imprtat Spie Precautis ad Activity Prgram Oe f the first aspects f bdy mechaics is lg rllig. This is extremely imprtat: Yur physical therapist will wrk lg rllig with yu. This way f mvig will fte feel awkward at first, but ce yu make it a habit, it will be secd ature. Whe yu are gettig it ad ut f yur bed, yu wat t picture yur spie as a lg, it des t bed. Yur hips, kees ad arms ca mve, but yur spie stays as e uit. 1 4 i i 2 5 i i 3 6 Next clum 26
Avid liftig, twistig ad bedig that places strai yur spie DON T X 1. Twist at the waist 2. Sit up X X 3. Bed at the waist 4. Twist yur trs t reach items X If yu have ay questis, ask yur therapist r surge. 27
Other Precautis: 4 Carry bjects with bth hads ad keep the bjects clse t yu. Preted that yu have VERY shrt arms. 4 Push r pull bjects istead f liftig them. Whe pushig bjects, especially drs, keep yur arms very clse t yu ad let yur legs d the pushig. 4 Whe reachig tward the grud r pickig smethig up, bed with yur hips ad kees istead f yur back. 28
Leavig the Hspital Discharge Ifrmati Oce yur surge says yu are medically ready fr discharge, there are several ptis available. Yu ad yur healthcare team yur dctrs, urses, physical ad ccupatial therapists, ad scial wrker will make the decisi tgether with yur isurace prvider. Apprval ad authrizati frm yur isurace carrier may als affect the discharge decisi. Discharge Opti Descripti Apprpriate If Hme withut physical therapy Hme with utpatiet physical therapy Iitially yu will be discharged withut a immediate pla fr PT but yu will fllw-up with yur surge t pla fr utpatiet physical therapy. N hme care yu will g t a utpatiet physical therapy prgram. Equipmet eeds t be arraged prir t discharge. Yu ca fucti idepedetly (i.e., get i ad ut f bed ad bathe withut assistace, use a walker r cae by yurself); Yu have supprt at hme; ad Yu ca get t ad frm yur ut-patiet physical therapy. Yu ca fucti idepedetly (i.e., get i ad ut f bed ad bathe withut assistace, use a walker r cae by yurself); Yu have supprt at hme; ad Yu ca get t ad frm yur physical therapy. Hme with hme care Acute Rehabilitati (Trasfer t ipatiet rehabilita ti, either at Mut Siai r ather istituti) Sub-Acute Rehabilitati (Trasfer t a ursighme-based rehabilitati prgram) Hme visits by a physical therapist r ccupatial therapist. May r may t prvide yu with a urse r a aide* Equipmet eeds t be arraged prir t discharge. Yu will be expected t actively participate i Itesive therapy, at least 3 hurs per day Mday thrugh Friday**. Average legth f stay :7 days. 1-2 hurs f therapy per day, Mday thrugh Friday**. Average legth f stay:14-21 days, depedig patiet. Yu are fuctiig well i the hspital; Yu ca maage with limited assistace; ad Yu have the apprpriate supprt at hme. Yur recvery idicates that yu eed a itesive therapy prgram; Yur isurace apprves; Yu meet medical criteria ad there is bed availability. Yur recvery idicates that it wuld be helpful t have mre time befre yu retur hme; Yur isurace apprves, ad there is bed availability. * If yu feel yu eed a hme aide, but yur isurace des t cver the service, a list f agecies ca be prvided. ** Sme facilities may ffer limited therapy weekeds. 29
Time f Discharge Yu will be discharged as early i the day as pssible. Yur urse will give yu a apprximate time f discharge ad discuss arragemets with yur family member r fried if yu are gig hme. May isurace cmpaies d t cver the cst f trasprtati hme frm the hspital. We will assist yu if yu eed trasprtati arragemets made. Please keep i mid that trasprtati services may require paymet at time f service. If yu are gig hme, review discharge istructis with yur healthcare team ad make sure arragemets have bee made fr all the equipmet yu eed. If yu are beig discharged t a ipatiet rehabilitati settig, arrage t brig lse-fittig clthes ad seakers, ad tify frieds ad family f yur ew lcati. Geeral Discharge Istructis If yu are gig hme, please make a fllw-up appitmet with yur surge. Fllw-up with yur physicia abut resumig ay medicatis that may have bee stpped durig hspitalizati. It is t ucmm t experiece pai flares r episdes f umbess r recurrig erve type pai. I mst cases, these feeligs will reslve ver time.! % Call yur surge if: Yu tice sigificat redess, swellig ad draiage at the surgical site. (Miimal draiage is expected, but if yu see a icrease r chage, please call yur surge.) Yur temperature exceeds 101 degrees. Yu have ew calf pai r calf swellig. Yu d t have a bwel mvemet fr 5-7 days; please remember t take stl sfteers. T help avid cstipati, be sure t drik plety f fluids ad eat plety f fruits ad vegetables. If yu ctiue havig a prblem, it is imprtat fr yu t call yur surge. Call 911 if yu develp chest pai r shrtess f breath. 30
Pai Maagemet ad Wud Care Yu will be discharged with a prescripti fr pai medicati ad fr ay ther medicatis yur surge determies yu eed. Take pai medicati ly as prescribed ad avid alchl. Ntify yur dctr if yur pai medicati is t wrkig r yu are experiecig upleasat side effects, such as cstipati. If yu feel yur pai is gig, yur surge ca refer yu t a pai maagemet service. If yu have had chric pai i the past ad have see a chric pai maagemet prvider, please fllw up with them after yur surgery. If yu eed refills fr pai medicati, call yur surge durig weekday ffice hurs. Please try t aticipate ay pai medicati eeds befre the weeked r eveigs. Fr patiets with spial fusis, yu ca t take ati-iflammatry medicatis fr six mths after surgery. Wud Care Keep the wud area clea ad dry. Befre yu leave the hspital, yur urse will explai hw, ad hw fte, t chage dressigs. Yu will be able t shwer 5 days after surgery uless tld therwise. D t put aythig the wud besides sap ad water, uless therwise istructed. Staples r sutures will be remved frm yur wud i apprximately 2 weeks, depedig yur surgery. Depedig yur discharge pla, the staples will be remved at a rehabilitati facility, at hme by a visitig urse (which will be arraged prir t yur discharge frm the hspital), r durig a fllw-up appitmet with yur surge. 31
Physical Therapy Remember, rage f mti ad stregtheig exercises are essetial t gettig the mst ut f yur surgery. Surgery is just e step i yur recvery, yur physicia ad rehabilitati team will prescribe a prgram that will fit yu best. Make sure yu are a active participat i yur rehabilitati prgram i rder t beefit the mst frm yur surgery. Resumig Yur Nrmal Activities While i the hspital, yu will be taught the prper way t get thrugh the activities f daily livig. The pace f retur t activities is idividual t each patiet. Check with yur dctr as t whe yu ca safely resume: takig baths drivig (the average time is apprximately 6 weeks after surgery) wrk sexual activities sprts (while yu are ecuraged t remai physically active, bth fr yur geeral health ad fr maitaiig gd be quality, yu shuld discuss specific activities with yur dctr) Recvery Remider Be sure t fllw yur surge s recmmedatis regardig if ad whe t wear yur brace r cllar. Climb stairs carefully Up with the gd leg, dw with the bad leg, if apprpriate. Avid liftig, twistig ad bedig that places strai yur spie. Ctiue yur exercise prgram regularly, as prescribed by yur therapist t help keep yur bdy strg. Speak with yur rehabilitati team abut apprpriate sleepig psitis fllwig surgery. Speak with yur rehabilitati team abut hw t bathe (i.e. if the dressig ca get wet). Speak with yur surge abut whe drivig is apprpriate. Speak with yur surge abut whe sexual activity is safe. The amut f time yu sit i e psiti may be limited after surgery. Speak t yur surge ad rehabilitati team fr mre details. Thak yu fr chsig Mut Siai fr yur spie surgery. If yu r yur family have ay questis, please be sure t call yur surge. While i the hspital, please call the uit at 212-241-7923 ad ask fr the Cliical Nurse Maager. 32
Ntes ad Questis 33