You’ve tried conservative treatments for your back pain, and they didn’t work. Your medical team is recommending surgery. What happens next?
Dr. Andrew Marky, neurosurgery physician lead and a spine surgeon at Novant Health Brain & Spine Surgery – Ballantyne in Charlotte, North Carolina, walks us – step by step – through the process.
First, a patient must be healthy enough for surgery. Smoking cigarettes or using other nicotine-based products, having a body mass index over 40 and having serious medical conditions such as diabetes and severe heart and lung conditions, may make patients ineligible for elective surgery, Marky said. Smoking has many adverse health effects, puts additional strain on the heart and makes healing more difficult.
But assuming you are a candidate for back surgery, the process begins with a conversation with your surgeon.
“We talk through the surgery itself – the details of it – so patients have a good understanding of what we’re doing,” Marky said. “Some patients don’t want to know any details; others want to know exactly what’s going to happen. We talk about the expected recovery time, which can vary from patient to patient. Once we have insurance approval, we schedule surgery.”
Surgery is generally scheduled for four to six weeks after that consultation. Something to remember: There was a time when many of us had older friends or family who had back surgery and were not happy with the results. Some patients even worry that they’ll end up in worse shape. But treatment techniques and understanding of the spine have both advanced significantly in recent years. Doctors are finding more surgical solutions than ever.
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About a week before surgery, the patient will visit the hospital for pre-op bloodwork, a meeting with the anesthesia team and a review of their health history. If patients have significant complicating health conditions (often called comorbidities) like heart or lung problems, they’ll be asked to see a medical specialist to get a clearance letter, Marky said.
At that visit, they’ll also get a packet of information with guidelines on what to do the night before surgery. Not eating after midnight is one of the most important tips.
The day of surgery, the patient is usually asked to be at the hospital about two hours before their operation. During that waiting period, the patient will meet with their surgeon and anesthesiologist and have the opportunity to ask any last-minute questions.
“We mark their surgical site during that meeting,” Marky said. “In the meantime, the nurses are getting them checked in, getting their IV started, getting their surgical gown.”
Once the room is ready, the patient will be brought back and placed under general anesthesia.
Family members can stay in the waiting room or receive post-surgery updates by phone.
“It can be a long process even if the surgery is short,” Marky said. “The time from when a family member says goodbye to the patient until the patient is awake in recovery can be three hours or more.”
Once patients are awake in the recovery room, family members are often permitted to visit.
Often, someone who has had back surgery is going to spend one or more nights in the hospital. Family members can stay with patients in the hospital again – a practice that was prohibited during the worst of COVID-19.
Later in the day or certainly by the next morning, someone from the physical therapy team will make sure the patient is able to get out of bed. “We want them up and out of bed the same day,” Marky said. “The nursing team will help them walk – usually up and down the hall.”
Doctors determine if it’s safe for the patient to go home. Patients must be able to get up and around, use the bathroom and be able to eat and drink before they’re discharged. Their pain should be under control, as well. Some patients – particularly seniors – may need to go to either a skilled nursing or an inpatient rehab facility after surgery. If that’s the case, the case manager for the hospital will work with the patient’s insurance company on placement. It may take several days before the right facility has been identified and approved. Those patients remain in the hospital a little longer.
Surgeons want to see their patients for a post-op visit usually about two weeks after discharge from the hospital. “In that intervening couple of weeks, a lot of times, we will have either home health care or physical therapy out to the house to check on the patient,” Marky said. Younger patients may not need that level of care; older patients often do.
“The majority of people are going to do some form of physical therapy after surgery,” Marky said. “We usually recommend waiting until after the first follow-up appointment so we can be sure the patient is healing as they should. We don't want to get too aggressive with activity before that point.”
The importance of physical therapy after many surgeries cannot be overstated. For the best outcomes, it’s imperative that patients follow doctors’ and physical therapists’ orders. Post-surgical PT helps ensure proper and speedier healing – and this part is entirely up to the patient.
Back surgery has come a long way
Back surgery is different than it used to be.
Many of us have heard stories about back surgeries performed in the 1970s, ’80s and early ’90s that were long, involved and sometimes traumatic. And the outcomes weren’t always ideal, either.
Today, minimally invasive procedures – often with robot-assisted navigation – predominate the spine surgery landscape, and recovery times have lessened considerably.
“This is not your father’s surgery,” said Dr. Chase Bennett, a spine surgeon at Novant Health Brain & Spine Surgery in Bermuda Run, North Carolina, in discussing the newer, less invasive techniques often used today. “When compared to the traditional approach, the incisions are smaller, and we don’t have to peel back all of that muscle to reach the spine. As a result, patients generally have less postoperative pain, a decreased risk of infection and a quicker overall recovery.”