Upcoming spine surgery? Here’s how to prepare for optimal results

Facing spine surgery can feel overwhelming, but understanding how to properly prepare can make the process smoother and set you up for a better recovery.

With over 1 million people in the U.S. undergoing spine surgery each year, Buqing Liang, MD, a spine surgeon specialist at Loma Linda University Health, says there are different types of procedures based on the area of the spine being treated.

• Cervical spine surgery: Focuses on the neck area and is often done to treat issues like herniated discs, spinal stenosis, or instability that cause neck pain, arm numbness, or weakness.

• Thoracic spine surgery: Targets the mid-back region and may be needed for problems like spinal tumors, fractures, or severe curvature like scoliosis.

• Lumbar spine surgery: Addresses the lower back, where problems like herniated discs, degenerative disc disease, or nerve compression can lead to back or leg pain.

"Approaches to spine surgeries also vary," Liang says. "Surgeons can operate from the front, back, or side of the body and use different techniques based on a patient's specific needs."

Despite these differences, preparation steps are fairly consistent across types.

Six areas to address before undergoing spine surgery

If your surgery is elective, meaning you have time to meet with doctors and make a surgical plan, your medical team will evaluate six crucial areas: overall medical condition, blood thinners, diabetes management, smoking, drug abuse, and bone quality.

Overall medical condition

"When a patient comes to our clinic, we first evaluate them and determine if surgery is the right recommendation," Liang says.

First, the patient's general medical condition is assessed to make sure they can safely tolerate the surgery. This is usually cleared by their primary care physician or by the pre-surgical anesthesia team. They ensure the patient is fit for anesthesia and the duration of the procedure.

Additionally, the pre-surgical assessment looks for heart health, lung function, kidney function, blood pressure, and other vital systems, including blood tests to check for anemia, infection, and how well a patient's blood clots.

Blood thinners

If a patient is on blood thinners, they must discuss stopping them before surgery. The surgical team will coordinate with the prescribing doctor to determine if, when, and how long a patient can safely pause them - typically stopping about seven days before surgery and restarting about two weeks after.

Diabetes management

In addition to smoking, if a patient has diabetes, it's critical to control blood sugar before proceeding with surgery. This involves monitoring glucose levels because it lowers the risk of infection and wound complications after surgery, and checking hemoglobin A1C.

Smoking

Another important factor to consider is whether the patient smokes. Smoking can impair healing because it can restrict blood flow and oxygen to healing tissues, which increases the risk of complications.

"For many spine surgeries, especially fusion cases where we are placing screws, rods, and other hardware to encourage bone growth, the patient must stop smoking," Liang explains. "We generally require patients to quit smoking for at least three months before surgery."

Of course, the longer a patient has stopped, the better it is for their recovery. For patients who struggle to quit, Liang says that help is available to guide patients through the process.

Drug abuse

Like smoking, drug abuse, including alcohol, cannabis, opioids, stimulants, and hallucinogens, delays wound healing and increases the risks of infection. It can also interfere with anesthesia, leading to complications and a prolonged hospital stay. Patients are encouraged to stop drinking and using illicit drugs before the elective spine surgery.

Bone quality

Bone quality is crucial for spine surgery, especially for procedures like spinal fusion or deformity correction. Poor bone health can lead to complications such as implant failure, poor healing, and fractures. Bone density screening helps assess risk factors and optimizes treatments.

Taking calcium, vitamin D, doing weight-bearing exercises, avoiding smoking and alcohol, and taking certain medications all strengthen bones. If a patient has poor bone quality, Liang suggests receiving treatment from an endocrinologist before surgery.

Emergency surgery preparation

When surgery is urgent, often due to trauma from a motor vehicle collision, rapid degeneration of the spine, growth of a spinal tumor, or a severe infection, there may not be time for ideal prep. In these cases, Liang says that the medical team will quickly optimize a patient's condition by:

• Reversing blood thinners, if possible

• Starting antibiotics for infections

• Bringing in specialists such as a cardiologist, pulmonologist, nephrologist, and hematologist for optimal results

"It doesn't matter if a patient is coming from the clinic, trauma, or the emergency department. At Loma Linda University Health, we have the resources to support them every step of the way," Liang says. "In the operating room, we have the most advanced technology, including intraoperative neuromonitoring neural monitoring to track neurological function during surgery and intraoperative neuronavigation for more accurate placement of screws and surgical precision."

As the regional leader in neurosurgery, the experienced neurosurgeons from Loma Linda Medical Center are committed to performing the safest and most effective spine surgeries. For more information, call 877-558-0800 or visit our website here.