CHAPTER 9
Your Surgical Journey
From preparation through recovery—what to expect every step of the way
Understanding what to expect before, during, and after spine surgery reduces anxiety and helps you prepare for the best possible outcome. This chapter walks you through the entire surgical journey, from your decision to proceed through full recovery.
Before Surgery: Preparation Phase
Medical Optimization (4-6 Weeks Before)
Your surgical team will ensure you're in the best possible health for surgery:
- Medical clearance: Visit your primary care doctor for pre-operative evaluation
- Lab work: Blood tests to check for anemia, infection, or clotting issues
- Cardiac evaluation: EKG or stress test if you have heart disease risk factors
- Medication review: Adjust blood thinners, diabetes medications, and other drugs
- Smoking cessation: Must stop smoking at least 4 weeks before surgery
- Weight optimization: Lose weight if recommended by your surgeon
Home Preparation (1-2 Weeks Before)
- Arrange help: Line up family or friends to assist for first 1-2 weeks
- Prepare your home:
- Move frequently used items to waist height
- Remove tripping hazards (rugs, cords)
- Set up recovery area on main floor if possible
- Install grab bars in bathroom if needed
- Stock supplies: Medications, ice packs, comfortable clothing, healthy foods
- Arrange transportation: Someone must drive you home and to follow-up appointments
Final Week Before Surgery
- Pre-operative appointment: Meet with surgical team, review instructions
- Stop certain medications: Blood thinners, NSAIDs, supplements (as directed)
- Shower with special soap: Chlorhexidine wash night before and morning of surgery
- Nothing to eat or drink: After midnight before surgery (or as instructed)
- Arrange childcare/pet care: For day of surgery and recovery period
Day of Surgery: What to Expect
Arrival Time: You'll typically arrive 1-2 hours before your scheduled surgery time for check-in and preparation.
Pre-Operative Area
- Check-in and paperwork: Verify identity, consent forms, medical history
- Change into gown: Remove jewelry, contacts, dentures
- IV placement: Nurse starts intravenous line for fluids and medications
- Meet the team: Anesthesiologist, nurses, and Dr. Greenberg visit to answer questions
- Surgical site marking: Surgeon marks the correct level on your spine
- Pre-operative medications: Antibiotics and anti-nausea medications
In the Operating Room
- Transfer to OR table: Positioned carefully for your specific procedure
- Anesthesia: General anesthesia puts you completely asleep
- Monitoring: Continuous monitoring of heart rate, blood pressure, oxygen
- Neuromonitoring: Real-time nerve monitoring during surgery for safety
- Surgery duration: Varies by procedure (1-4 hours typically)
Recovery Room (PACU)
- Wake up gradually: Nurses monitor you as anesthesia wears off
- Pain management: Medications given to keep you comfortable
- Vital signs monitoring: Frequent checks of blood pressure, heart rate, oxygen
- Neurological checks: Nurses assess movement and sensation in arms/legs
- Family update: Dr. Greenberg speaks with your family after surgery
- Duration: 1-2 hours in recovery room before moving to hospital room or discharge
Hospital Stay and Early Recovery
Same-Day Discharge Procedures
Many minimally invasive procedures allow same-day discharge:
- Microdiscectomy
- Endoscopic discectomy
- Cervical foraminotomy
- SI joint fusion
Discharge criteria: Stable vital signs, adequate pain control, able to walk with assistance, able to urinate, no complications.
Overnight Stay Procedures
Some procedures require 1-2 night hospital stay:
- ACDF (cervical fusion)
- Cervical disc replacement
- Lumbar laminectomy
- MIS TLIF/PLIF (lumbar fusion)
What to Expect in the Hospital
- Pain management: Combination of oral and IV medications
- Early mobilization: Physical therapist helps you walk same day or next day
- Breathing exercises: Incentive spirometer to prevent pneumonia
- Wound care: Nurses check incision and change dressing
- Diet advancement: Start with clear liquids, advance as tolerated
- Bowel function: Stool softeners to prevent constipation from pain medications
Recovery Timeline
Week 1-2: Immediate Post-Op
- Activity: Short walks multiple times daily, no lifting over 5-10 lbs
- Pain: Gradually improving, transition from prescription to over-the-counter medications
- Wound care: Keep incision clean and dry, watch for signs of infection
- Follow-up: First post-op visit at 10-14 days for wound check
- Restrictions: No bending, lifting, or twisting (varies by procedure)
Week 3-6: Early Recovery
- Activity: Gradually increase walking distance and duration
- Return to work: Desk work possible for many procedures
- Physical therapy: May begin gentle exercises and stretching
- Driving: When off narcotics and can turn head/body comfortably
- Pain: Should be significantly improved from pre-surgery levels
Week 6-12: Progressive Recovery
- Activity: Gradually return to normal activities as tolerated
- Physical therapy: Progress to strengthening exercises
- Return to physical work: Depends on job demands and procedure type
- Imaging: X-rays at 6-12 weeks to assess healing (for fusion procedures)
- Restrictions lifted: Most restrictions removed by 12 weeks
Month 3-6: Continued Improvement
- Activity: Return to most activities including exercise and sports
- Strength: Continue building core and overall strength
- Fusion healing: Bone graft continues to mature (for fusion procedures)
- Maximum improvement: Most patients reach peak improvement by 6 months
Month 6-12: Full Recovery
- Fusion complete: Solid fusion achieved by 12 months (for fusion procedures)
- Full activity: Return to all activities without restrictions
- Maintenance: Continue core strengthening and healthy habits
- Long-term follow-up: Annual or as-needed visits with Dr. Greenberg
Physical Therapy and Rehabilitation
Why Physical Therapy Matters
Physical therapy is crucial for optimal recovery. It helps you regain strength, flexibility, and function while teaching you how to protect your spine long-term.
Phases of Rehabilitation
- Phase 1 (Weeks 1-6): Gentle range of motion, walking, basic activities of daily living
- Phase 2 (Weeks 6-12): Progressive strengthening, core stabilization, flexibility
- Phase 3 (Months 3-6): Advanced strengthening, return to sport/work activities, functional training
Home Exercise Program
Your physical therapist will teach you exercises to do at home. Consistency with your home program is just as important as attending therapy sessions.
When to Call Your Surgeon
⚠️ Contact Dr. Greenberg's office immediately if you experience:
- Signs of infection: Fever over 101°F, increasing redness/swelling/drainage from incision
- New neurological symptoms: New weakness, numbness, or loss of bowel/bladder control
- Severe pain: Pain that's getting worse instead of better, or not controlled by medications
- Wound problems: Incision opening, clear fluid leaking (possible CSF leak)
- Breathing problems: Shortness of breath, chest pain, calf pain/swelling (possible blood clot)
Key Takeaways
- Preparation is crucial: Optimize your health, stop smoking, and prepare your home before surgery.
- Early mobilization helps: Walking soon after surgery reduces complications and speeds recovery.
- Recovery is gradual: Most improvement occurs in the first 3-6 months, with continued gains up to 12 months.
- Physical therapy is essential: Commit to your rehabilitation program for the best long-term outcomes.
- Know warning signs: Contact your surgeon immediately if you experience fever, new weakness, or severe pain.
Medical Disclaimer: This chapter provides educational information only and is not intended as personal medical advice. Every patient's condition is unique. Consult with Dr. Greenberg or another qualified spine specialist for an accurate diagnosis and personalized treatment plan.