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Preoperative Questions and Postoperative Instructions
Age Limit
There is no age limit for surgery. However, advanced age slightly increases the risk of complications related to general anesthesia and hospital stay. The main concern is not age itself but associated conditions such as coronary artery disease, hypertension, and diabetes.
Studies have shown that elderly patients (octogenarians, 80 years and older) can undergo even major spinal surgeries with proper preparation without experiencing significant problems.
Hospital Admission
You may eat normally until the evening before surgery, but after midnight, you should only drink water. You may also take a sleeping pill if needed.
Hospitalization
The patient is admitted to the hospital on the day of surgery. The preoperative evaluation is completed about a week earlier in a hospital visit that does not require hospitalization. This evaluation includes:
- Blood tests, including coagulation studies
- Chest X-ray
- Electrocardiogram (ECG) and cardiologist evaluation
- Anesthesiologist consultation
- Blood typing and crossmatching (if necessary)
Blood Donation
In most major surgeries, a blood recycling system (cell saver) is used, allowing about half of the lost blood to be collected, filtered, and returned to the patient. Medications that reduce blood loss are also used, and controlled low blood pressure and blood dilution help minimize bleeding. Nevertheless, a blood transfusion of 1-2 units may still be required.
Medications
Anti-inflammatory drugs (aspirin, Salospir, Voltaren, Mesulid) should be stopped one week before surgery. For pain relief, Depon and Lonarid can be used instead.
Medications for other conditions (such as hypertension or diabetes) are usually allowed with a small amount of water on the morning of surgery. However, dosage adjustments may be needed for diabetes medications. Patients should discuss their medications with Dr. Papadopoulos or the anesthesiologist.
Smoking
Smoking slows down tissue healing, weakens the immune system, and inhibits bone formation, which is critical for spinal fusion. Patients should quit smoking at least two months before surgery and six months after. Ideally, they should quit permanently.
Anesthesia
These surgeries are performed with specialized anesthesiologists trained in spinal surgery. This reduces complications and enables spinal cord monitoring during surgery.
Although smaller spinal procedures like discectomy can be performed under epidural anesthesia (Papadopoulos EC et al.; Spine J, 2006), general anesthesia is the safest and most comfortable option for the patient.
Surgery
Dr. Papadopoulos performs the entire surgery, assisted by other doctors. The duration varies:
- 1 to 3-4 hours for most spinal surgeries
- 6-10 hours for complex scoliosis corrections or spinal osteotomies
Intraoperative Spinal Cord Monitoring
A specialized technologist is present in the operating room, solely responsible for spinal cord and nerve monitoring. This neurosurveillance system minimizes the risk of paralysis and significantly reduces the chance of nerve injury.
Surgical Wound Closure
- Scoliosis surgeries: No external stitches; the incision is closed using plastic surgery techniques to prevent scarring. Self-absorbing sutures are used, covered with Sterile-Strips (small adhesive strips) that are removed after 15-20 days.
- Other surgeries: Traditional sutures are preferred to reduce the risk of wound dehiscence.
Postoperatively, the wound must remain dry and should not leak fluid. If fluid is present, the doctor must be notified.
Postoperative Complications
Complications are classified as early or late:
- The most common early complication is wound infection, which is treatable.
- Serious complications like paralysis are extremely rare.
- Preventive measures are taken to avoid complications affecting the respiratory, circulatory, and urinary systems:
- Respiratory complications: Patients receive breathing exercises and antibiotics.
- Blood clot prevention: Special devices are placed on the legs during surgery, and blood thinners may be given afterward.
- Late complications include adjacent level degeneration or fusion failure (<5% incidence, rarely symptomatic).
Visitor Policy
A family member may stay with the patient for as long as needed. However, excessive visits should be avoided to allow the patient to rest.
Walking
Patients typically start walking on the same day or the next day after surgery. Walking is the main form of postoperative physical therapy.
Pain Management
Painkillers are given as needed. The goal is for the patient to be comfortable without using anti-inflammatory drugs.
- Strong painkillers are usually needed for one week, but some discomfort may last up to one month, depending on individual pain tolerance.
Hospital Discharge
Patients are discharged when they can walk independently. This typically occurs between postoperative days 2 and 6, depending on wound pain and fatigue.
Fatigue results from the body’s stress hormone response (adrenaline, cortisol) and lasts for a few days.
Before discharge, the patient should be able to:
- Get out of bed independently
- Walk up and down a few stairs
Going Home
Most patients return home in a family vehicle. They may sit in the front passenger seat with a seatbelt. The trip should be as short as possible.
Diet
A high-protein diet (fish, chicken, meat, milk, eggs) is recommended to support healing.
Although appetite is often reduced postoperatively, calorie needs are higher, and proper nutrition is encouraged.
Toilet Use
Regular toilet use is allowed. In rare cases, a raised toilet seat may be needed.
Showering
- Showering is allowed immediately after surgery if the wound is protected with waterproof dressings.
- From day 7, getting the wound wet is not a concern, but scrubbing with soap should be avoided.
- After two weeks, Sterile-Strips may begin to peel off naturally.
Movement Restrictions
- Walking: No restrictions. Patients may walk as much as they like.
- Sitting: No restrictions, except for fatigue tolerance.
- Bending: Avoid bending and sleeping on the stomach.
- Stairs: Use only when necessary.
- Driving: Avoid until stitches are removed. Driving may cause pain, irritate the wound, and getting in and out of low cars is difficult.
Follow-Up Appointments
The wound is typically checked at 15 days and 6 weeks. Further follow-ups occur at regular intervals for up to one year.
Bracing (Back Support)
Most patients do not need a brace. When prescribed, it serves as a reminder not to bend, twist, or lift heavy objects during recovery.
Physical Therapy
Rarely required. Walking is considered sufficient physical therapy.
Return to Work or School
- Discectomy: Return to work in 1 week.
- Spinal fusion: Return to work in 1 month (or 3 months for manual labor).
Sexual Activity
Allowed without restrictions, except for excessive weight-bearing, bending, and twisting.
Sports
- Walking is permitted immediately.
- After stitches are removed: Patients can start regular walking exercises.
- For microdiscectomy: Running is allowed after 6 weeks, and contact sports (basketball) after 3 months.
- For spinal fusion: These timeframes double but must be confirmed by the surgeon.
When to Contact the Doctor
- If the wound leaks fluid, swells, or becomes red.
- If leg weakness develops.
- If fever exceeds 38°C (100.4°F).
- If sudden leg pain or swelling occurs, as it may indicate deep vein thrombosis (DVT).
Χειρουργός Σπονδυλικής Στήλης
- Ο Χειρουργός Σπονδυλικής Στήλης/ Σκολίωσης Δρ. Ηλίας Χαρ. Παπαδόπουλος γεννήθηκε και μεγάλωσε στην Αθήνα. Αποφοίτησε με Άριστα από την Ιατρική Σχολή Αθηνών το 1994 και στη συνέχεια ειδικεύτηκε στην ορθοπαιδική, στην Α’ Ορθοπαιδική Κλινική του Πανεπιστημίου Αθηνών.
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