Top Ten Frequently Asked Questions about Spine Surgery
1. How much pain will I feel?
Every patient experiences pain individually. That’s why your spine team has a variety of resources, including a dedicated pain management team, to control your discomfort. We ask that you help us by providing a list of all medications you were taking before surgery, including pain medications (please let us know which ones have been more or less effective for you). Make sure your team is also aware of any allergies, adverse reactions to drugs, and whether you are taking any long-acting opiate drugs, such as methadone, morphine, or oxycontin. We also need to know if you are followed by a pain management physician on a regular basis. In addition, it is important that you tell us if you smoke, drink alcohol, or use recreational drugs, as these factors may influence your tolerance to pain medications (we are not judging you, so please be honest). Mount Sinai prides itself on our pain management; our goal is to minimize your pain so you are comfortable enough to start physical therapy, and work your way back to normal, everyday functioning.
2. Who will manage my pain after surgery?
Initially in the recovery room, the anesthesiologist and nursing staff will manage your discomfort. You will be asked to rate the pain on a scale of zero (“no pain”) to 10 (“the worst pain you could possibly feel”).You may be put on a Patient Controlled Analgesia (PCA) Pump, which allows you to push a button to receive an immediate dose of pain medication intravenously; we use different medications depending on how well you respond. Children may also use these pumps depending on their age and the severity of their surgical procedure. Many patients will have the pain team assigned to manage their ongoing care, while patients with less-complex pain management issues will be followed by the nurse practitioner, physician assistant, or resident physicians (who will refer you to the pain management team, if necessary).
3. How long will I be in the hospital?
Hospitalization for spine patients usually lasts one to five days depending on the type of procedure being done; many of our patients undergoing a microdiscectomy may even go home the same day as surgery. Ask your physician what the typical length of stay is for the procedure you are having so you can plan ahead. You will be given notice of discharge 24 to 48 hours in advance of the actual discharge time, whether you’re going home or to a rehabilitation facility. The date of discharge is determined by the spine team at daily multidisciplinary discharge planning rounds, in which the nurse manager, case manager, social worker, nurse, physical therapist, and nurse practitioner or physician assistant discuss your treatment. It is important to make a team member aware of any concerns you may have regarding discharge.
We encourage all patients undergoing spine surgery to enlist a friend, relative, or neighbor as a “Healthcare Partner” who can help with logistics such as transportation from the hospital and household needs like grocery shopping. After surgery, the majority of spine patients will be unable to lift anything weighing more than five pounds for approximately six weeks. There may also be restrictions on your ability to drive or return to work. All of these considerations should be discussed with your physician before surgery. Our first priority is ensuring your safe discharge.
4. When will I go back to living life normally?
Most spine surgery patients return for their first post-operative visit one to two weeks after the procedure so we can remove sutures or staples and possibly take X-Rays. At this appointment you and your physician may discuss a time frame for returning to normal routines, such as driving, work, exercise, and sexual activity. This timing will depend on the type of surgery you underwent, any other physical conditions you may have, and your level of physical activity prior to surgery. We often delay outpatient physical therapy several weeks to allow time for healing.
5. Will I have to wear a brace?
After surgery your physician will determine whether you need a brace based on a number of factors, such as the integrity of your bone and the type of procedure you had. Braces may be used simply for protective reasons, such as guarding against injury in the event of a fall.
6. Will I need rehabilitation?
Your need for rehabilitation will be determined by your physical therapist in conjunction with the spine team at interdisciplinary rounds. If the team members believe you may benefit from more intensive physical or occupational therapy, or that you might have difficulty caring for yourself safely at home, they will refer you to a rehabilitation facility. The Mount Sinai Hospital has one of the top 20 Rehabilitation Centers in the United States. Our Physical Medicine and Rehabilitation staff members also run a subacute (meaning treatment for less severe conditions) rehabilitation unit at the nearby Terence Cardinal Cooke Health Care Center. It’s important to familiarize yourself with your insurance coverage; many policies do not allow for an acute rehabilitation stay. If necessary our team will advocate on your behalf with your insurance case manager to place you in the appropriate rehabilitation environment. Please note that when the social worker applies for placement in an acute or subacute unit, they must apply to three facilities, not just your first choice. Also be aware that acceptance to a rehabilitation facility requires authorization from the insurance company after a physical therapy evaluation once you have undergone surgery; acceptance depends on authorization and bed availability.
7. What if I need special equipment?
A physical therapist will determine whether you’ll need special equipment to keep you safe and comfortable. The therapist will let the team know what equipment may be necessary, and place the order with a medical equipment provider. The equipment will either be delivered to Mount Sinai or to your home or rehabilitation facility on the day of your discharge.
8. Will I need a blood transfusion?
Many of our surgical procedures are done with minimally invasive techniques that reduce blood loss, which dramatically cuts down on the need for transfusions. Our operating room team also has ways of “salvaging” blood during the procedure, further cutting back on transfusions. For fusion surgeries and reconstructive surgeries, such as scoliosis repairs, blood transfusions may be necessary either in the operating room or during the first three days after the procedure. In the event you do need a transfusion, our blood bank will provide the necessary blood. If your physician has identified you as someone who may require a transfusion during your hospitalization, you or someone you know may donate blood in advance through the New York Blood Center. You cannot donate more than four weeks before surgery, and your physician must fill out a donor clearance form. There is also a fee for donation. Please contact the New York Blood Center for further information (800-933-2566; nybloodcenter.org).
9. Will my insurance cover my surgery and hospitalization?
Mount Sinai provides care for all patients. The clinic or physician’s office will preauthorize your surgery with your insurance provider before your procedure. To fully understand your plan, we recommend that you personally contact your insurance carrier to find out what they cover in terms of hospitalization, rehabilitation services, and equipment needed after surgery. Please note that most plans do not cover private rooms, private duty nursing, home attendants, or transportation home from the hospital.
When talking with your insurance carrier, make sure you know your diagnosis and the type of spine surgery you will have, and ask the following key questions:
- Is there a limit to the number of days I will be covered in the hospital?
- Does my diagnosis and procedure make me eligible for an acute rehabilitation stay (if yes, for how many days)? Will it cover transportation to the facility? What facilities are in my insurance network?
- Does my diagnosis and procedure make me eligible for a subacute rehabilitation stay (if yes, for how many days)? Will it cover transportation to the facility? What facilities are in my insurance network?
- What home care services, such as physical therapy, occupational therapy, or home health aides, are covered? (Note that home care is often limited, so please make personal arrangements for help at home.)
- What equipment, such as a wheelchair, walker, cane, elevated shower seat, commode, or dressing equipment, is covered? Is there a co-pay?
If you have Workmen’s compensation, contact your Workmen’s compensation case manager, and bring that person’s contact information and your case identification number with you.
10. What should I bring to the hospital?
Please bring a written list of all medications you currently take along with the pills in their labeled pharmacy vials; this ensures your medication will be available even if our pharmacy doesn’t have it in stock.
Do not bring valuables, jewelry, or other items that could easily be lost during your stay.