Most patients who undergo spinal surgery have weeks or months to prepare for their procedure. It's important to learn as much as you can about your spine surgery. In this article, you will learn about the pre-operative steps to help you prepare for your procedure.

Importance of Preoperative Evaluation
Surgical procedures of any type carry varying amounts of risk. A surgical risk assessment combines this risk percentage with the patient’s physical and emotional health. During the preoperative evaluation, facts about the patient’s health (eg, pre-existing conditions such as diabetes) are investigated enabling medical staff to take pro-active steps to reduce surgical risk.

This evaluation includes an in-depth review of the patient’s medical history, findings from x-rays, CT scans, MRI studies, and/or other diagnostic tests. The patient’s general health is reviewed during a physical and neurological examination.

The preoperative evaluation identifies physical conditions (existing and unknown) that could cause surgical complications (eg, cardiac or breathing difficulties). In some cases, the patient may be referred to a medical specialist for consultation prior to surgery.

Pre-operative Goals
The pre-operative evaluation helps the medical staff provide the patient with the correct amount of:

• anesthesia
• pre-operative medical treatment
• monitoring during surgery
• post-operative pain management and care.

The pre-operative process also provides opportunities for the patient, primary care physician, treating specialists, surgeon, and anesthesiologist to communicate concerns before and after surgery.

Medical History and Examination
A detailed medical history gathers information about allergies (eg, to medication, food, allergens), side effects from medication, medication and/or dietary supplements taken daily, pre-existing medical conditions, family history, tobacco and alcohol use, bleeding history (eg, unusual bruising), and previous surgical experiences (eg, problems with anesthesia).

During the physical examination, the patient’s blood pressure, pulse, respiratory rate, body temperature, height and weight are recorded. The physician listens to the patient’s heart and breathing, notes any abnormalities of the head, eyes, ears, nose, and throat. The patient’s physical stamina (eg, walking, climbing stairs) and range of motion (eg, neck) are observed. During the neurological exam, the patient’s mental status, as well as sensory and motor function is considered.

Any condition affecting the cardiovascular, pulmonary, gastrointestinal, endocrine, and nervous systems can increase surgical risk. Understanding these problems and addressing them before and during surgery can make the spinal procedure safer.

Pre-operative Tests

Blood
A small blood sample can provide a wealth of information about the patient’s general health. A low red blood cell count (hemoglobin) may indicate the presence of anemia. Red blood cells are needed to carry oxygen throughout the body. White blood cells (WBC) are needed to fight infection. Platelets are the smallest cells in the blood and are essential to blood coagulation. A partial thromboplastin time (PTT) test reveals clot formation time. The level of glucose (sugar) in the blood (blood glucose level) is helpful in determining if the patient has diabetes or is hypoglycemic (low blood sugar).

Metabolic
Electrolytes are needed for metabolic function. For example, calcium is necessary for contraction of skeletal muscle as well as relaxation of cardiac muscle. Blood urea nitrogen (BUN) indicates metabolic function of the liver and kidney efficiency.

Urinary
A urinalysis detects urinary tract infection, kidney function, diabetes, and the body’s state of hydration/dehydration.

Pregnancy
Female patients of childbearing age may be given a pregnancy test.

Medications
Other tests may be used to measure the level of medication in the patient’s system. Some medications can affect anesthesia, such as anti-arrhythmics (drugs used to control cardiac rhythm).

Cardiovascular
Male patients over age 50 and female patients over age 60 may be given a preoperative electrocardiogram (EKG). Patients with a history of cardiovascular surgery, angina, diabetes, peripheral vascular disease, or smokers are usually EKG candidates, whatever their age. These same patients may also be given a chest x-ray.

Pulmonary
To assess pulmonary (lung) function, the patient may be asked to breath into a spirometer. This instrument measures the volume of air inhaled and exhaled. Arterial Blood Gases (ABG) measure the oxygen and carbon dioxide levels in the blood as well as oxygenation and movement of air in and out of the lungs (ventilation).

Other Pre-operative Considerations

Blood Loss
In any type of surgical procedure, loss of blood is a possibility. Your surgeon and/or anesthesiologist will discuss the advantages and disadvantages of donating your own blood (autologous donation) prior to surgery compared to taking someone else’s donated blood.

Stop Smoking (Tobacco Use)
Patients who smoke or use tobacco are advised to stop several weeks before spine surgery. Cigarettes and other tobacco products contain hundreds of toxins, which effect blood’s ability to carry oxygen. Smoking (tobacco use) increases the risk of surgical and anesthesia complications. Smokers suffer from more respiratory ailments than non-smokers; smokers require more supplemental oxygen during surgery and may need assistance breathing following surgery. Patients who smoke also stand a greater risk for failed fusion.

Consent Forms
Prior to your surgery, you will meet with your surgeon and anesthesiologist, either separately or together. During this consultation, you and your surgeon and/or anesthesiologist will review your medical records, the benefits of the proposed surgery, type of anesthesia, the surgical procedure(s), potential risks and complications, pain management, pre- and post-hospitalization, rehabilitation, and recovery.

The surgical and anesthesiology plan is put into writing in a document termed a Consent Form. By signing this document, the patient gives their permission to the surgeon and/or anesthesiologist to perform procedure(s). The surgical and anesthesiology Consent Forms may be separate documents.

Pre-operative Check List
If your spine surgery is pre-planned, you will be given many instructions (usually in writing) to follow before your procedure. Keep in mind the following list is not all-inclusive. Be sure to strictly follow the list provided by your spine specialist. 

1. Certain types of prescribed and over-the-counter medications thin the blood and retard blood coagulation. Anticoagulant drugs such as Coumadin and aspirin are examples. You may be instructed to stop taking these types of medications a week before your surgery.
    
2. Make arrangements for your transportation to and from the hospital or surgery center. You will not be allowed to drive yourself home.
    
3. Depending on the type of spine surgery, you may need assistance at home. Plan to have someone stay with you for at least the first day or two. If home assistance (eg, home health care aid) is required on an on-going basis, your physician can help make these arrangements.
    
4. Do meal planning and purchase groceries ahead of time. You may want to rearrange your kitchen, bedroom, and bathroom areas for convenience and safety.
    
5. Follow your physician’s instructions about eating and drinking the day before and day of surgery.
    
6. If you take medications on a daily basis (eg, blood pressure pills), check to see if you should take these medications the morning of surgery or not.
    
7. Do not hesitate to ask questions. 

Day of Surgery
If you will be traveling to the hospital or surgery center the day of surgery, plan to leave your home early. Feeling rushed will not help you to relax. Wear loose fitting clothing that is easy to take off and put back on. Shoes that you can slip off and on are suggested. If you will be staying at the hospital overnight, pack night clothes, slippers, and toiletries. Leave watches, earrings, and jewelry at home. Do take hearing aids, glasses, and dentures.

After hospital admission, you will be taken to the preoperative area. Medical staff will review your medical history and other reports. Your vital signs will be checked (and rechecked) and an intravenous line (IV) will be started. Different drugs, including some anesthetics, may be administered through the IV. Although you may not be awake, at the appropriate time, you will be wheeled into the operating room (OR). In the OR, the anesthesiologist will put you to sleep and monitor all vital signs during the entire surgical procedure.

Following surgery, you will wake up in the recovery area where medical staff will continue to monitor your pulse, respiration, blood pressure, and other signs. Post-operative pain will be managed. Once stable and awake, you will be moved into your hospital room. If your procedure allows you to go home the same day, medical staff will provide you with written instructions to follow. To learn more about what happens immediately after surgery, read SpineUniverse's artice on post-operative care.