Pre-Operative Education Guide for Spinal Surgery Patients

The Spine The spine stretches from the base of the skull to just above the buttocks. It is composed of 24 bones, called vertebrae, that are stacked on top of each other. In between the vertebrae are discs, which provide cushioning and protection. They are made of spongy material with a ring of stronger material. The bones of spine provide support for the body and protect the spinal cord. The spinal cord transmits information, such as pain and other sensations, between the brain and the body. The spinal cord is also gives us the ability to move our body. The spine is divided into five areas. The vertebrae that make up these areas are uniquely shaped to match their role in supporting the body. The cervical spine has 7 vertebrae The thoracic spine has 12 vertebrae The lumbar spine has 5 vertebrae The sacrum is the base of the spine, and consists of 5 bones fused together The coccyx is connected to the base of the sacrum Image from Fotolia.com

The Spine In a healthy spine, the discs in the spine lined up with vertebrae to provide cushioning. Due to aging and injury the discs may weaken, bulge or rupture. Spinal nerves run from the spinal cord to other parts of our body. They come out of the spinal cord in spaces between the vertebrae. Spinal nerves carry information between the spinal cord and the rest of our body. If a disc bulges or ruptures, the material from the disc may press on the spinal nerves, causing pain or decreased sensation to other parts of the body. Disc Vertebra Spinal Cord Vertebra Ruptured Disc Spinal Nerve Image from Fotolia.com

Spinal Nerves Spinal nerves provide sensation and the ability to move different parts of the body. This diagram shows how symptoms of pain, numbness or weakness in the arm or leg may be related to problems in the spine. Symptoms of Cervical 6 and 7 nerves Symptoms of Lumbar 5 and Sacral 1 nerves Image from Fotolia.com

Surgical Procedures If symptoms are due to a ruptured disc, the surgeon may be able to make a small incision and remove the disc material that is pressing on the spinal cord or spinal nerves. This is called a discectomy. Sometimes removal of a portion of the vertebrae is necessary to relieve symptoms. This is called a laminectomy. Sometimes the vertebrae are weakened because of injury and disease, and a spinal fusion procedure is recommended to take pressure off of spinal nerves and to improve the structure of the spine. The disc between the fused vertebrae is removed, and bone graft is placed between the vertebrae. Rods and screws are used to support the fused vertebrae, and additional bone graft may be used to help with healing. Image from Fotolia.com Image from University of Florida Neurosciences Department Spinal fusion stops movement in areas of the spine, reducing pain and increasing your ability to function. In addition, the height of the damaged disc is restored. Regular exercise and physical therapy will be important to your recovery.

Pain Pain is normal following surgery. Post-operative pain often feels different from the chronic pain you have been experiencing from your spine problems. Pain may be caused by the incision, swelling and muscle tension. Be sure to tell your doctor what pain medications and dosage you are taking before your surgery, so that we can be more effective in controlling your pain. Pain medications are given to reduce pain; unfortunately it is not possible to be pain-free after any type of surgery. You will be asked how bad your pain is using a scale from 0 to 10. A “0” means no pain, while a “10” means the worst possible pain. The diagram below shows a pain scale: Image from GeriatricPain.org It is important to keep pain controlled as well as possible. If you are in too much pain it will be difficult for you to walk and participate in physical therapy. Experts at the Cleveland Clinic have found that good pain control reduces the amount of time needed to recover from surgery and may reduce the risk of surgical complications.

Pain Fortunately there are many methods used to provide relief from pain, including: Repositioning and early ambulation Heat/ Cold packs Relaxation Medications Acetaminophen Narcotics or opioids (Percocet, Norco, Morphine, Dilaudid) Muscle relaxants (Flexeril, Valium) Medications for nerve pain (Lyrica, Neurontin) Narcotic pain medications can be very beneficial but may cause side effects such as constipation and nausea. Stool softeners are prescribed after surgery to help prevent constipation. Walking and drinking water will also help. Taking narcotic pain medications with food will help prevent nausea. Narcotic pain medication may cause itching, which may be relieved by Benadryl. Excessive sleepiness can be caused by narcotics, and decreasing the amount of medication may be helpful.