your guide to spine surgery · spine care ph: 212-746-2152 fax: 646-962-0640 ali baaj, md...
TRANSCRIPT
Center for Comprehensive Spine Care
YOUR GUIDE TO SPINE SURGERY
The Weill Cornell Medicine
Center for Comprehensive Spine Care
888-922-2257
WELCOME ………………………………………………………………………….……........................................3NEUROLOGICAL SURGERY......................…………….………………………………………………………... 4 AttendingSpineSurgeons……………………………………....................…………......4 AdvancedPracticeProviders...…………………….……………...............................5 SpineCenterCoordinator………………………..………………...............................5WHO’S WHO..…….........................……………….…………….….................................................... 6PREPARING FOR SURGERY ……………………………..………………..............................………….….... 7 TheMonthBeforeSurgery—YourChecklist……………………………………......………....…..7 PreoperativeEvaluationandPaperwork.…….….............................…………….7 Imaging…………………………………………….………...........................….………………7 Insurance.…………………………………………………………………….............……………… 7 Medications.……………………………………………………………………...................…….7 OverallHealth……………………………………………………………..............………………8 HomeSafetyEvaluation………………………………………..……….……........………….8 FamilyMember/CaregiveSupport…………………………...……………….............…9 PrivateRoom&PrivateDutyNursing.…………....………………………………..……..9 MyChart………………………………………………………………………............................9 TheDayBeforeSurgery………………………………………………………………..........….…………9 PreoperativePhoneCall……………………………………........………………….…………9 WhattoBringtotheHospital…………….…………………………….…..............…...10 TheDayofSurgery..……………………………………………..................................................10 Check-In.………………..………………………………………………..…....................…......10 InfectionPrevention……..………………………………..…………………..........………...10ANESTHESIOLOGY...………………..….……………..……………...…………..........................................11 AboutAnesthesia...................................................................................................11AFTER SURGERY.........…………………………………………………………………………..............……….….12 RecoveryRoom/PACU……………..…………………………………..….…………….……...12 TransfertoYourRoom….……………..............................................................12 WhattoExpectDuringYourHospitalStay………………….…………….…………….12 VisitingHours………………………………………………….………………..............……....12 DischargePlanning…………………………………………….………..……….......………….12 PostoperativeAppointment……………..……..………………………..............……….13 IncisionCare……………………………….……………………………….........…………......13 DeepBreathing……………………………………………….…………………................…14 PreventingBloodClots.……………………………………….……………………...………..14 PostoperativePainManagement……………………….……………….........………..15 Activity&Positions………………………………………….………..…………………....15-17 Driving.………………………………………………….......................................…………17COMMUNITY DIRECTORY...…………………………………….........................................................18 MedicalSupplyStores………………..…….….....................…………………………….…………18 Pharmacies…………………………………….….…...................................…………….………….18 HotelsandTemporaryHousing……………….……....................................………………19 Parking..……………………………………….……….........................……………………………………19 PlacestoEatatNYP…………………..……………………………......................…………………..19IMPORTANT CONTACT INFORMATION…………………………………………...........………………20-21MAPS…….……………………………………………………………………………………....................…………...22NOTES………………………………….…………………………...............................……………………..………23
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2 Your Guide to Spine Surgery
DearPatient,
OnbehalfofthephysiciansandstaffatWeillCornellMedicineCenterforComprehensiveSpineCare,thankyouforpartneringwithusandtrustinguswithyourcare.Millionsofpeoplesufferfromneckorbackpainatsomepointintheirlives.Sometimesthispaincanbeattributedtotrauma,aspinaltumor,oraninfection.Moreoften,thepainischronic,progres-sive,andunrelenting.Thispainoftenrespondstovarioustypesofintervention.
Theteamofphysicians,nurses,therapists,andstaffattheWeillCornellMedicineCenterforComprehensiveSpineCareprovidesstate-of-the-art,comprehensive,integratedcareforpatientswithbackpainandalltypesofspine-relatedconditionsandinjuries.Patientsreceiveacompletecontinuumofcare,fromdiagnosistotreatmentandrecovery.Whensurgeryispartoftheplan,thespinesurgeonsfromWeillCornellMedicine’sneurosurgeryfacultyofferworld-classsurgicalexpertiseinTLIFandotheradvanced,minimallyinvasiveprocedures.
TheCenterforComprehensiveSpineCarepridesitselfonathree-partplanforeachpatient:
Expert, Accurate Diagnosis. Toomanypeoplesufferfrombackorneckpainfromunknowncauses—orworse,duetoamisdiagnosis.Ourworld-classexpertswillpinpointtheexactcauseofyourpaintodeterminethemosteffectivetreatment.
Comprehensive Treatment. Ourteamapproachallowsustodrawonexpertisefromneurolo-gy,neurosurgery,rehabilitationmedicine,anesthesiology,andphysicaltherapy.Afterassess-ingyourcase,thespineteamwilltailoratreatmentplanthatmayincludephysicaltherapy,medication,interventionalpainmanagement,acupuncture,andmovementtherapies.Whensurgeryisrequired,weofferthemostadvancedminimallyinvasivetechniques,includinglateralaccesssurgerythatdramaticallyshortensyourrecoverytime.Weofferon-sitereha-bilitation,ledbyphysicaltherapistswhoseholisticspinerehabilitationincludestherapeuticexercise,manualtechniques,yoga,McKenzietechnique,andpooltherapy.
Patient/Provider Partnership. Patienteducationisoneofthehallmarksofourapproach.Weconsideryouourpartnerincollaborativelyplanningthemosteffectiveandcustomizedapproachtorestoringyoutohealth.
Theinformationinthisbookletisintendedtoprovideareferencetoguideyouthroughyoursurgicalexperience;itisbasedonwhatistypicallyexperienced.Itisimportantforyoutorememberthatyouareinchargeofyourrecovery.Thesooneryoubecomeactive,withintheactivityrestrictionsrecommendedbyyoursurgicalteam,thesooneryoumaystarttoreturntonormalactivity.Weknowthatchoosingaspinesurgeonisabigdecision;thankyouforchoosingourteam.Welookforwardtoworkingwithyoutoensurethebestexperienceandoutcome.
NeurologicalSurgery@TheWeillCornellMedicineCenterforComprehensiveSpineCare
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Your Guide to Spine Surgery 3
TheWeillCornellMedicineCenterforComprehensiveSpineCarehasanexpertlytrained,experiencedteamoffull-timespinesurgeonsonfaculty.Weperformmorethan1,500spinaloperationsperyear,mostofthem
usingminimallyinvasivetechniques,encompassingallpathologies,agegroups,andcomplexities.
•Weservelocal,regional,national,andinternationalpatients.•Wetakeaninterdisciplinaryapproachtocomprehensivespinecare.•Wefocusonminimallyinvasivesurgery,computernavigation,complexanddeformityspinalsurgery.•Comparedtonationalaverages,spinesurgeryatWeillCornellMedicineandNewYork-Presbyteriancomparesfavorablyintermsofthejudiciousandsparinguseofspinalfusionsurgery,lengthofstay,bloodloss,lengthofsurgery,earlycomplications,andpatientsatisfaction.•Weareattheforefrontofbasicscienceresearch,clinicalresearch,andresearchtrials;ourresearch,combinedwithoursurgicalexcellence,positionsusasaleaderinnationalandinternationalspinalsurgery.N
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Roger Härtl, MDDirectorofSpinalSurgeryDirectoroftheWeillCornell MedicineCenterforComprehensiveSpineCare ph:212-746-2152 fax:646-962-0640
Ali Baaj, MDCo-Director,SpinalDeformityandScoliosisProgramph:212-746-1164fax:646-962-0640
Michael Virk, MD, PhDph:646-962-3388fax:646-962-0640
About the Weill Cornell Medicine Center for Comprehensive Spine Care
Attending Spine Surgeons
Eric Elowitz, MDViceChairmanforQualityandPatientSafety,WeillCornellMedicineNeurosurgeryph:212-746-2870fax:646-962-0640
Kai-Ming Fu, MD, PhDCo-Director,SpinalDeformityandScoliosisProgramph:212-746-2260fax:646-962-0640
Athos Patsalides, MD ph:212-746-2821fax:212-746-8111
4 Your Guide to Spine Surgery
Edward Butler, MSN, ANP-BCNursePractitionerOutpatient
Rebecca Cramer, FNP-BCNursePractitionerOutpatient
Amanda Fazio, MSN, FNP-BCNursePractitionerOutpatient
Oscar Lleva, MSN, FNP-BCNursePractitionerOutpatient
Shilpa Nilavarath, MSN, AGNP-CNursePractitionerOutpatient
Sherlie Pierre, RNRegisteredNurseOutpatient
Suzan Wollard, PA-CChiefPhysicianAssistantInpatient
Beth Higgins, PA-CSeniorPhysicianAssistantInpatient
Allison Basham, MSHSPA, PA-CPhysicianAssistantInpatient
Chloe Holland, PA-CPhysicianAssistantInpatient
Rebecca Wilcox, MCMS, PA-CPhysicianAssistantInpatient
Advanced Practice ProvidersN
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Your Guide to Spine Surgery 5
DuringyourcareatNewYork-PresbyterianHospital/WeillCornellMedicalCenter,youwillmeetanumberofhealthcareprofessionalswhoworktogetherasyourhealthcareteam.Youandyourfamilyarealsoanimportantpartofthecareteam.Weencourageyoutospeakupandletyour
needsandconcernsbeknown.
Doctors. Theremaybemanydoctorsinvolvedinyourcare.Inadditiontoyourattendingdoctor,whoisoftenyourpersonaldoctororthedoctorwhoadmittedyou,youmaybeseenbyothermedicalorsurgicalspecialists,aswellasfellowsorresidents.Afellowisadoctorpursuingfurthertraininginhisorhersubspecialty.Aresidentisadoctorwhohascompletedmedicalschoolandisenrolledinaresidencytrainingprograminaparticularspecialty.Residentsarealsoreferredtoashousestaffandworkunderthecarefulsupervisionofattendingdoctors.
Nurses. Theremaybemanynursesinvolvedinyourcareaswell.Theyworkcloselywiththedoctorsandothermembersofthehealthcareteam.ThePatientCareDirectoristhenursewhoisresponsibleforthesupervisionofallnursingcareonaparticularunitorunits.Aregisterednurse(RN),whoisdesignat-edasyourprimarynurse,plansandcoordinatesyouroverallnursingcareandassignstasksasappropri-atetoothermembersofthenursingteam.
Nurse Practitioners (NPs). Nursepractitionersareadvancedpracticeregisterednurseswhohaveobtainedlicensureandcertificationthroughadditionaleducationandexperiencewhoprovidecarethroughcollaborationwithyourattendingandteam.Nursepractitionersmaydiagnose,treat,andpre-scribetestsormedicationsforapatient’sconditionwithintheirspecialtyareaofpractice.
Care Coordinators. CarecoordinatorsareRNswhoseethatyourdoctor’sordersarecarriedoutappro-priately.Thecarecoordinatormayaskyouquestionsaboutyourcareandmedicalinsurancesothatyoucanreceivetheappropriatebenefitscoveredunderyourpolicy.
Unit Clerks. Unitclerksgreetpatientsandvisitorsastheyarriveontheunit,answerphones,respondtocallbells,andscheduletests.Theyareavailabletoansweryourquestionsanddirectyouwithintheunit.Iftheunitclerkdoesnotknowtheanswer,heorsheisresponsibleforfindingtheappropriatepersonontheunitwhocanhelpyou.
Physician Assistants (PAs). Physicianassistantsarehealthprofessionalswhoaremembersofyourhealthcareteam.Underthesupervisionofyourattendingphysician,theycandeliverarangeofmedicalandsurgicalservices,conductphysicalexams,diagnoseandtreatillnesses,orderandinterprettests,counselonpreventivehealthcare,assistinsurgery,andprescribemedications.
Social Workers. Socialworkershelpyouandyourfamilymanageyourhospitalstayandplanforyourreturnhome.Thesocialworkercanaddresstheemotionalissuesthatcomewithbeinginahospital,providepatientandfamilycounseling,coordinatedischargeplanning,andofferinformationaboutsup-portgroups.
Dietitians.Registereddietitiansarealsoprofessionalmembersofthehealthcareteam.Theyplanforyourdietaryandnutritionalneedsduringyourhospitalstayaccordingtoyourdoctor’sorders.Ifyourequireaspecialdiet,yourdietitianprovidesyouwithinformationandteachesyouhowtofollowthedietbeforeyougohome.
Physical Therapists. Physicaltherapistsassessyourphysicalandfunctionalneedsandprovideyouwithexercisesandprogramstohelpyouregainstrength,restoreyourmobility,andimproveyourabilitytodohomeandworkactivitiesinpreparationfordischarge.
Occupational Therapists. Occupationaltherapistsprovidetherapydesignedtohelpimproveyourabilitytocarryoutactivitiesofdailyliving—suchasdressing,bathing,andgrooming—followingyourdischarge.
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6 Your Guide to Spine Surgery
The Month Before Surgery: Your Checklist
Preoperative Evaluation and Paperwork□Scheduleapreoperativeappointmentwithyourprimarycareprovider,cardiologist,and/orotherspecialistasdeterminedbyyoursurgicalteam.Theappointment,includingpre-testing,labs,andphysicalexam,mustbewithin30daysofsurgeryandmustbereceivednolaterthan5businessdayspriortosurgeryforreview.□Pleasecallthesurgeon’sofficetoprovidethedateoftheappointmentoncescheduled.
Toensurethatyouareinoptimalphysicalcondition,yourproviderwillcarryoutanyrequireddiagnostictests,historyandphysicalexam,andmayrefertootherspecialistsifrequired.□Preoperativeworkupmayincludelaboratorytests,history/physicalexamination,EKG□Youmayhaveotherevaluationsasneeded(forexample,cardiology,pulmonology,hematology)□Completea2pagePre-ProcedureScreeningToolandreturnittoyoursurgeon’soffice.□Disabilityand/orFMLAformscanbefaxedtoyoursurgeon’soffice(seepage20forfaxnumbers).Pleasenotesomeformscanonlybecompletedaftersurgery.
Imaging□ProvideacopyofyourMRI,CTscan,x-rayorotherimagingtoyoursurgeonatleastoneweekpriortosurgery.□Ifanynewimagingisneeded,pleasecontactthesurgeon’sofficetoarrange.
Insurance□Todiscussinsuranceauthorizationorfinancialresponsibilitypleasecontactthesurgicalcoordinatorassignedtoyoursurgeon.Usuallyinsuranceauthorizationisinitiatedabouttwoweekspriortothesurgicaldate.□Foranyhospitalrelatedbillingquestions:212-297-4545□Foranesthesiarelatedbillingquestions:212-746-3885
Medications□Somemedicationscanbeharmfulduringsurgerybecausetheyincreaseyourriskofbleeding. Discontinue 7 days prior to surgery:
• Anti-inflammatories(suchasibuprofen,Advil,Aleve,naproxen,meloxicam,diclofenac)• VitaminE• FIshOil• HerbalSupplements
□Ifyoutakearthritismedications,biologicagents,ormedicationforautoimmunediseases,pleasediscusswithyourrheumatologistandsurgeon’sofficetodetermineif/whenthesemedicationsmustbestopped.□Ifyoutakemedicationsthatcontainaspirinorbloodthinners(suchaswarfarin,Plavix,Eliquis,Xarelto),pleasediscusswithyoursurgicalteamandcardiologistbeforestoppingorstartingthesemedications.□Itisimportanttofollowyourcardiologist’srecommendationsexactly,asanyvariancecanputyouatincreasedriskfordangerouscomplications.□Pleasenotethatmostsurgeriescanbeperformedwhilecontinuing81mgaspirin.□Youmayconsiderstartingastoolsoftener2to3daysbeforesurgery.Oneover-the-counterexampleisColace,whichcanbetaken2to3timesperday.Ensuringadequatehydrationisanotherwaytohelpdecreaseyourriskforpostoperativeconstipation.□Pleasemake3copiesofyourupdatedmedicationlisttobringtothehospitalonthedayofsurgery.□Pleasecallthenursepractitionertodiscussanymedicalquestionsorconcerns.
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Your Guide to Spine Surgery 7
PREP
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Y Your Overall Health Is Important
Surgerycanbeacauseofstressbothphysicallyandmentally.Physicalandmentalwell-beingisimportantandmayrequirelifestylechangestoensureyouareatyourabsolutebestbefore,during,andaftersurgery!
Weight Control• Itisuptoyoutomaintainahealthyweightpriortosurgery.Beingoverweightcanincreaserisksof
complications(includinginfection,woundhealingproblems,readmission,anddelayedrecovery).• Weknowthatyouarelikelyexperiencingpain,whichcanmakeexercisedifficult,butspeakwith
yourhealthcareproviderstoidentifyanymodifiedexercisethatmightbepossibleforyou.• Ensuringabalanceddietwithportioncontroliscritical!Perhapsseeinganutritionistmightbehelp-
fulforyoutolearnthebestwaytoensureyouaretakinginthecorrectnutrients.
Mental Well-Being • Youroutlookandattitudeplayasignificantroleinyourex-
perience,recovery,andoutcome.Anxietiesandworriescanoftencreatebarrierstohealingandsuccessfuloutcomes.Considermeditationorguidedimagerytoencourageposi-tivethoughtsandhealthy,productivecoping.
• Youmayconsiderseeingamentalhealthproviderwhocanhelpyoufurtheridentifypersonalbarrierstomentalwell-be-ing,perfecttechniquestoovercomestressfulsituationsinahealthier,moreeffectiveway,anddevelophealthycopingmechanisms.Weworkcloselywithafewmentalhealthcareprovidersandwouldbehappytoprovideyouwithnamesfromwhichtochoose.
• Therearealsofreeapplicationsforyoursmartphonethatmightbehelpful,quick,andeasytouseformeditationorguidedimagery.Someoptions(forbothiPhoneandAndroid)includeHeadSpace,Calm,Omvana,TheMindfulnessApp,andStop,Breathe,andThink.
Stop SmokingTheuseofnicotinehasbeenlinkedwithanincreasedriskofcomplicationsfollowingsurgery.Resourcesforsmokingcessation:
• NewYorkStateSmoker’sQuitline:1-866-NY-QUITS(1-866-697-8487)andnysmokefree.com• NewJerseyQuitline:1-866-NJSTOPS(657-8677)andnjquitline.org• QuitNowConnecticut:1-800-QUITNOW(784-8669)andquitnow.net/Connecticut
Home Safety EvaluationSomeimportantquestionstoconsideroraddressbeforesurgery:
• Stairs:Arethererailings?Doyouhavestairstogetintooroutofyourhome?• Havingafamilymember/caregiverpresenttoassistyouifneededishighlyrecommended.• Preparethehome:Removethrowrugs,cords,orotherobstaclesfromthefloortoallowfor
easyandsafewalking.• Avoidstepstoolsandladdersafterdischarge.Placenecessaryitemsincabinetsordressers
atalevelthatyoucaneasilyreach(nottoohigh/nottoolow).• Groceryshopping/mealprep/planningforafterdischarge• AssistiveDevices:Ifthereareanyassistivedeviceneedsidentifiedaftersurgerywhileinthe
hospital,theinpatientteamwillhelpcoordinateobtainingthese.Usually,therearenotanydevicestopurchasebeforesurgery.
8 Your Guide to Spine Surgery
NEW!
TheIntegrativeHealthandWell-beingprogramatNewYork-Pres-
byterianoffersafreeone-hoursessiontohelppatientsprepareforsurgery.Themind-bodytechniqueshavebeenshowntoreduceanxi-etybeforesurgeryandreducetheamountofpainmedicationneededafterward.Ifyouwouldliketoregis-terfortheclass,visitwww.nyp.org/integrativehealthandclickon“BookaGroupClass,”thenchoose“ClassSchedule”fromthetopmenu.
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ERYFamily Member/Caregiver Support• Whoisyourmaincontactperson?
• Thesurgeonwillspeaktoadesignatedfamilymemberorfriendaftertheprocedureiscomplete.Ifthispersonneedstobecalled,pleaseprovidephonenumbertosurgeonpriortosurgery.
• DuetotheFederalHealthInsurancePortabilityandAccountabilityAct(HIPAA),hospitalstaffcannotgivehealthinformationtomultiplepeopleoverthephone.
• Escortupondischarge:Youwillneedanadulttoescortyouhomeafteryourprocedure.Withoutanadulttoaccompanyyou,yourdischargemaybedelayed.It’simportanttoensureyoumakeithomesafely!
• Itisimportanttohaveafamilymember,closefriend,orcaregivertoassistinpreparationforsurgeryandthroughoutrecovery.Thefollowingareareasthatthispersoncanbehelpful:
• Transportationtoandfromthehospital—itisbesttoplantransportationaheadoftime• Providingsupportandassistancearoundhomeduringthefirstweekafterdischarge
Private RoomForsurgeriesthatrequiresolelyaone-nightstay,mostpatientsspendthenightonaspecialunit,whichhasthebenefitofprivateroom.However,ifyouwouldliketoplacearequesttoensureaprivateroomisreservedinadvance,pleasecall212-746-4259todiscussoptionsandfinances.ThereisnoguaranteeofaprivateroomunlessyouspeakwithAdmittingpriortoyouradmissiondate.
Private Duty NursingIfyouwouldlikeaPrivateDutyNurseorCompanion,youcancall212-746-4091.Privatedutyservicesareprovidedbyanindependentcontractorwhowillexpectpaymentpriortotheserviceandarenotincludedinthehospitalcharges.
MyChart PleasesignupforWeillCornellConnect/MyChart,whichwillallowyouonlineaccesstosomeofyourmedicalrecordsandtosendsecuremessagestoyourhealthcareteam.Visit:mychart.med.cornell.edu/mychart
The Day Before SurgeryPreoperative Phone Call•AnORnursewillcallyouthebusinessdaybeforesurgerytoconfirmyourprocedureandarrivaltime.•Duringthiscall,youwillalsoberemindedofthefollowinginstructions:
• DONOTeatanysolidfood(includingcandyormints)aftermidnightonthedayofyoursurgery.
• YOUMAYdrinkupto8ouncesofclearliquidsonthedayofsurgery,upto2hoursbeforeyourhospitalarrivaltime.*
• OK:water,sportsdrinks,applejuice,blackcoffee/tea(nocreamormilk)• NO:milk,cream,alcohol,ordrinksyoucannotseethrough(forexample,orange
juice)*If you have any history of delayed gastric emptying, please do NOT eat or drink any-thing after midnight the night before surgery.
• Takeallofyourusualmedicationswithasipofwaterpriortocomingtothehospital,unlessinstructedotherwise.
If you do not receive a phone call by 4 pm, please call 212-746-5299 if you are scheduled for surgery in Greenberg 3 West or 212-746-5582 if you are scheduled for surgery in the Starr F10 ambulatory surgery center. Your Guide to Spine Surgery 9
10 Your Guide to Spine Surgery
What to Bring to the Hospital: Important Checklist
Bring: □Advancedirectives□Completelistofcurrentmedications□Listofallergies□EmergencyContactInformation,includingphonenumber□CPAPmachine,inhalers,eyedrops,allParkinson’smedications,andanybrand-namemedicationforwhichyouwouldnotwantagenericsubstitute.*□Wearloose-fitting,comfortableclothing□Achangeofclothestowearhome□Insurancecard/information□Eyeglass,denturesorhearingaids,anyassistivedevicesyouuse(forexample,awalkerorcane).Pleaseensureallarelabelled. *If you are bringing medications, please bring them in the original bottles with original labels so that the hospital pharmacy can approve them to be utilized during your hospitalization–do NOT bring medica-tions unlabeled or in a daily pill organizer.
Do NOT Bring:□Valuables□Medicationsfromhome(exceptinhalersoreyedropsifneeded)□Electricaldevices(suchashairdryersandheatingpads)
The Day of Surgery: Check-In Arriveat525E68thStreetandcheckinatGreenberg3West.Ifyouarescheduledforsurgeryintheambulatorysurgerycenter,pleasearriveat525E68thStreetandcheckinatStarr9.(Forinformationaboutparking,seepage19.)
•Familymembers/caregiversareallowedtostaywithyouduringthistime.
•Followingcheck-in,youwillbeginmeetingwithmembersofcareteam,includingyoursurgeon,anesthesiologist,andnurses.
For Your Safety
Verification:Priortosurgery,youwillfrequentlybeaskedyourname,dateofbirth,andwhatprocedureyouarehavingdone.
MedicationReconciliation:Pleasebepreparedtodiscussyourcurrentmedicationsincludingname,dosage,howoftenyoutakethem,andwhenthelastdosewastaken.
Infection Prevention
Youwillbegivenanantibioticbeforesurgery;thiswillbecontinuedforaslongasthesurgeonfeelsitisnecessary.Handwashingandproperhygieneisstronglyencouragedtodecreaseriskofinfectionaswellasavoidingpeoplewithacough,cold,fever,orotherillness.
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Your Guide to Spine Surgery 11
AN
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YAbout Anesthesia
TheDivisionofNeurosurgicalAnesthesiologyconsistsof10facultymembers.Weareanexperienced
teamthathasexcellentcollaborativerelationshipswiththeneurosurgeons,neuroradiologists,neurophysiologists,andnurseswithwhomweworkonadailybasis.
Weareexpertsinthecareofpatientssufferingfromavarietyofneurologicdisorders,includingspineproblems.Wecareforbothminorandmajorspinalsurgicalpatients.Whetherapatientneedsavertebroplasty,anexcisionofaherniateddisk,alaminectomy,amultilevelspinalfusion,orplacementofspinalcordstimulators,wetailorouranestheticnotonlytoensurepatientcomfortandsafetybutalsotofacilitatetheuseofthelatesttechnologyinthemonitoringofspinalcordfunction.Wealsohavebeenattheforefrontofdevelopingsedationandpainreliefprotocolsforpatientsundergoingspinesurgery.
TheDivisionworkscloselywiththedivisionofPainMedicine(vistthewebsiteatpainmedicine.weillcornell.org)andthePre-AnesthesiaEvaluationClinic(anesthesiology.weill.cornell.edu/for-patients/what-to-expect).
ThePainTeamconsistsofboard-certifiedphysiciansandfullytrainedstaff,andtheydelivercomprehensive,multidisciplinarycareforindividualswithacute,chronic,andcancer-relatedpain.
ThePre-AnesthesiaEvaluationClinicprovidesconsultationservicestopatientsscheduledforelectivesurgery.Locatedonthe9thflooroftheDavidH.KochCenterat1283YorkAvenue(at68thStreet),thisunitisstaffedfrom8amto5pm,MondaythroughFriday.Patientsareseenbyappointment.
Recovery Room/PACU AftersurgeryyouwillbecloselymonitoredinthePost-AnesthesiaCareUnit(PACU),alsocalledtheRecoveryRoomastheanesthesiawearsoffandyouwakeup.YouareexpectedtostayinthePACUunderthecareofyoursurgicalteam,speciallytrainednursesandstaffuntilyouarestableandaroomisavailableforyou.Or,ifyouarehavinganambulatoryprocedure,untilyouarestablefordischarge.
Transfer to Your RoomIfyouareadmittedtothehospital,assoonasabedbecomesavailableyouwillbetransferredtoyourroomandwillcontinueyourrecoveryprocessthereuntildischarge.
What to Expect During Your Hospital Stay
Duringyourhospitalstay,youwillbecaredforbytheneurosurgeryteamunderthedirectionofthesurgeon.Thisteamincludesnurses,nursepractitioners,physicianassistants,surgeryresi-dents,anesthesiologists;itmayalsoincludephysicaltherapists,occupationaltherapists,social
workers,carecoordinators,nutritionandcustodialstaff,andvolunteers.
Yourdailyschedulewhileinthehospitalmaybesimilartothis:•Earlymorning:yourmedicalteamwillawakenandexamineyoutomakesurethatyouarerecov-eringproperlyfromanesthesiaandsurgery.Thiswillbebrief.•Morning:yourmedicalteamwillspeaktoyouaboutyourdailygoalsandwillupdateyouontheplansfordischarge.Anymemberofyourteammaybeaskedtocomebacktospeakwithyouprivatelyuponyourrequestifyouhaveconcerns.•Latemorning:ifyouarebeingdischarged,instructionsandprescriptionswillbereviewedwithyou.Dischargeisgenerallyaround10am.•Earlyafternoon:yourmedicalteamwillre-examineyoutoensureyouaremakingprogress.
Wewillstrivetomeetallyourneeds,andwewelcomeyourinput.Pleaseletthemedicalteamknowifyouhavequestions.
Visiting HoursIngeneral,visitinghoursarefrom9amto9pm.However,visitinghourscanvaryaccordingtothelocation,condition,andneedsofthepatient.Pleaselookforsignsindicatingspecialvisitinghoursonaparticularunit,oraskthenursingstaffonthatunit.Ourstaffwillworkwithpatientsandfamilies,especiallythoseinaroomwithtwobeds,toallowpatientstimetorestandsleep.
Discharge PlanningDischargeplanningbeginsearlyinyourhospitalstay.Thereareafewdischargeoptionsthatarethemostcommon,includingbutnotlimitedtothefollowing:
•Home,withorwithouthomecareservices•Rehabilitation(AcuteorSubacute)
Ifhomecareservicesorinpatientrehabilitationisindicated,theinpatientrehabilitationteamwillevaluateyouaftersurgery.Basedontheirfindings,theywillprovidearecommendationincollabora-tionwithyoursurgeon’steamfortoensureasafedischarge.Thesocialworkeranddischargeplanningteamwillworktoprovideoptionswithintherecommendation.Theywillworktogetherwithyouandtheteamtocarryoutthedischargeplan;theymayassistinarrangingtransportation,rehabservices,assistivedevicesasmedicallyindicated.Ifpossible,theseservicesanddevicesmaybeprocessedthroughyourinsurance.
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12 Your Guide to Spine Surgery
Your Guide to Spine Surgery 13
AFTER YO
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Postoperative Appointment
Upondischargefromthehospital,pleasecallyoursurgeon’sofficetoscheduleyourfirstpostoperativevisit.Itisusuallyabout2to4weeksaftersurgerybutmayvarybasedonyourspecificcase.
Incision Care
IMPORTANT NOTE: If a plastic surgeon was involved in your surgery, all incision instructions will be provided by the plastic surgery service. In that case, please disregard the instructions below and contact your plastic surgeon.
The Basics
•DONOTapplybandages,lotions,orointmentstothesurgicalwound.•DONOTscratchorscrubthewound.•DOkeeptheincisioncleananddry. Showering After Surgery
• Youwillbeinstructedonwhichpostoperativedayyoucanremovethedressingandshowerwiththeincisionexposed.Itusuallyrangesfrom3to5daysaftersurgery.
• Atthattimeremovethedressing,letsoapandwaterrunovertheincisiondaily,andpatdrywithacleantowel.
• DONOTsubmergeinwater(pool,tub)untilyouareclearedtodosoatyourpostoperativeap-pointment.Usuallyitisrecommendedtoavoidsubmergingtheincisionareafor2to4weekspostoperativelyoruntilwellhealed.
• Iftherearedrains,incisionopening,orscabsthistimeframemaybeextended.
Sutures/Staples/Drains
• Iftherearestaplesorsuturesusedtocloseyourincision,theywillberemovedbythePAorNPatyourtwo-weekpostoperativeappointment.
• Ifexternalsuturesorstaplesarenotused,theskinisclosedwithinternalmeltingsutures,glue,andsteri-strips(smallwhitepaperstrips)areusedtoclosetheincision.Itisokaytogetthesteri-stripswetduringshoweringoncethedressingisremoved.
• Ifyouweredischargedwithdrainsinplace,pleasekeepadailylogofdrainageamounttobereviewedatyourfirstpostoperativevisitwiththeplasticsurgeon.
14 Your Guide to Spine Surgery
Deep Breathing
Yoursurgicalteamwillencouragedeepbreathingfollowingsurgery.Sometimesthisrequirestheuseofadevicecalledanincentivespirometer(examplepicturedatright).Ifyouareinstructedtousethisdevice,pleasefollowthedirectionsandfrequencyexactly.Thisisveryimportantinensuringyourlungsareinflatingproperlytopreventanyfluidcollectioninthelungspostoperatively.
Ifyoureceiveanincentivespirometerinthehospi-tal,pleasetakeithomeortorehabtouseforthefirsttwoweeksaftersurgery.
Preventing Blood Clots/Deep Vein Thrombosis
Deepveinthrombosis(DVT)isabloodclotinadeepveininyourleg.DVTcanhappenwhenyourbloodisflowingslowlybecauseofillness,surgery,orjustbeinginthehospital.DVTcancauselegswelling.DVTcanalsobreakoffandgothelung(pulmonaryembolismorPE).Bloodclotsthatgotothelungcanmakeithardtobreatheandareoneofthemostseriouscomplicationsaftersurgery.
Onewayyoucandecreaseyourriskforbloodclotsfollowingsurgeryisbychangingpositionatleastevery45to60minutes,avoidingprolongedsitting,andgettingupandwalkingearlyandregularly.
CompressionsystemsliketheoneshownatrightarealsousedtopreventDVT.Asequentialcompressiondevice(SCD)consistsofsoftsleevesthatwraparoundthelowerlegsandinflatewithairtomassagethelegs.Thisgentleoff-and-onsqueezinghelpsbloodflowsmoothlyanddecreasesriskforDVT.
SCDsareorderedbyyourdoctorandarepartofyourtreatmentaftersurgery.YournursewillhelpsetupyourSCDs.YoushouldwearyourSCDsanytimeyouareinbed.Takethemoffbeforemovingtoachair,orwhilewalkingorbathing.
If you feel pain or “pins and needles” in your legs, tell your nurse right away, as this could be a sign of DVT.
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Your Guide to Spine Surgery 15
Postoperative Pain Management
•Painmedicationswillbeprescribedtotakeasneeded.Weanthesemedicationastolerated.• Besuretofollowbowelregimenincludingstoolsoftenersandlaxativeswhiletakingthis
medication.Ensureadequateoralhydrationandfiberintakeastolerated.• Itmaytakeuptoaweekaftergeneralanesthesiatoresumenormalbowelmovements.• Ifyoudevelopanyabdominalpain,nausea,orvomitingcalltheofficeimmediately.
•Musclerelaxersmaybeprescribedformuscletensionandspasm.Pleasetakeasdirected andweanastolerated. •Tohelpeasediscomfort,youmayapplyaheatingpadoriceasneeded20minuteson, 20minutesoff.Avoidapplyingdirectlytoskin.Toavoidanyskindamageplaceatowel orclothbetweenyourskinandtheheatingpadorice.•Nervemedications:Ifyouweretakingmedicationslikegabapentin,Neurontin,orlyricaPRIOR tosurgery,pleasecontinueyourpreoperativedoseaftersurgery.Thesemedications areusuallycontinuedfor1to2monthsaftersurgeryandshouldbeweanedoffunder medicalsupervision.ThesemedicationsmustbetakenconsistentlyandareNOTtobetakenasneeded;donotstopmedicationsuddenlywithoutspeakingtoyourproviderfirst.•Ifyoualreadyhaveapainmanagementprovider,postoperativefollow-upwillbeimperativewith thatprovidersothattheymayprescribeyourpainmedicationsasappropriateforyou.•Occasionally,painmedicationsarerequiredforlongerthan6weekspostoperatively.Ifthatisthe case,youmaybereferredtoapainmanagementprovider.
Activity
•Walkfrequentlyandasmuchastolerated.Thisisaveryimportantaspectofrecovery!• Startwalkingthesamedayordayfollowingsurgery.• Thegoalistoworktowardsonehourperday.Startwithshortfrequentwalksandplanfor
frequentrest.• Startwithshortfrequentwalksandgraduallyincreasethedurationandfrequencyofyour
walksastolerated.•Restrictionsareeffectiveimmediatelyaftersurgeryforatleastsixweeks:
• Avoidbendingortwistingatthewaist/neck.• Avoidliftingmorethantenpounds.• Avoidsittingforlongerthan60minutesconsecutively.Standevery30to60minutesforat
leastashortwalk.• Listentoyourbodyandrespectyourlimits,whichmaychangedaytoday.
•Ifabraceorcollarisrecommended,wearasinstructedbyyourhealthcareteam.Ifyouhave concernsaboutthefitofyourcollarorbrace,pleasecallSteveHallat212-737-1645.•Pleasespeakwithyoursurgicalteamregardingphysicaltherapy.
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Sleeping Positions Youmaysleepinanypositionthatiscomfortableforyou.Herearesomesuggestionsthatyoumayfindhelpful(butremembertheyaremerelysuggestions!)
On Your BackPlaceapillowunderyourheadandanotherpillowunderyourknees.
On Your SidePlaceapillowunderyourheadandanotherpillowbetweenyourknees.
16 Your Guide to Spine Surgery
•Walkeveryday;shortfrequentwalksworkingtowardgoalof1hourtotalperday,indoorsoroutdoorsifsafeforyou
•WalkingontreadmillOK
•Maystartphysicaltherapyforextremitystrengtheningifrecommended
•NOliftingmorethan10pounds
•NOrepetitivetwisting,turning,bendingatthewaist/neck
•Mayresumelow-intensityexerciseonelliptical,stationaryrecumbentbicycle,orswimmingifyouweredoingthispriortosurgery.Startslow,increaseinmoderationastolerated
•Maystart/continuephysicaltherapyforextremitystrengtheningifindicated
•NOliftingmorethan10pounds
•NOrepetitivetwisting,turning,bendingatthewaist/neck
•Continuetowalkeveryday
•Maystartunrestrictedphysicaltherapywithafocusoncoreandextremitystrengthening
•OKtostartresumingnormalactivity—startslowandincreaseinmoderationastolerated
•Continuetowalkeveryday
•Normalactivityastolerated
•Maycontinuephysicaltherapyasneeded
•Focusoncorestrength-ening
•Continuetowalkevery-day
*Restrictions may vary by patient or surgery performed. Review with your medical provider.
*
Proper Sitting Position•Ensurefeetaresupportedonthefloor.•Thespineshouldbesupported—apillowmaybehelpful.•Changepositionsfrequentlythroughouttheday.
Moving In and Out of Bed: “Log Rolling” Technique
1.Bendyourknees. 2.Rolltooneside. 3.Useyourarmstopushyourselfup.
Carrying Objects•Holditemsclosetoyourbody.•Bendwithyourhipsandkneesinsteadofyourback.
Remember:Avoidliftingmorethan10poundsforatleastthefirstsixweeks!
Driving•Youmayrideasapassengerwhenyoufeelready.Startwithshortdistancesandseehowyoufeel.•Ifalongertripisnecessary,planforfrequent(every30to60minutes)breakstostopandwalkaround.Thiswillhelppreventmusclefatigueorsorenessandalsohelppreventbloodclots.•Drivingisgenerallypermittedabout4to6weeksaftersurgeryandonceyouarenolongertakinganypainmedications.
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Your Guide to Spine Surgery 17
CO
MM
UN
ITY
DIR
ECTO
RYMANHATTAN
HealthSourcePharmacyandSurgicalSupplies13022ndAvenue,NewYork,NY10065Phone:212-794-8700
FalkSurgicalSupplies11671stAvenue,NewYork,NY10065Phone:212-744-8080
NuCarePharmacy&Surgical17891stAvenue,NewYork,NY10128Phone:212-426-9300AND2509thAvenue,NewYork,NY10001Phone:212-462-2525
ChelseaMobility&MedicalEquipment 3278thAvenue,NewYork,NY10001Phone:212-255-5522
QUEENS
BrandMedicalSuppliesInc 6637MyrtleAvenue,Glendale,NY11385Phone:718-381-4700
JonesSurgicalCo.,LLC 101-21MetropolitanAvenue,ForestHills,NY11375Phone:718-261-9500
J&KSurgical&MedicalSuppliesCorporation 15823HoraceHardingExpy,Flushing,NY11365Phone:718-358-6897
BROOKLYN
MedicalSupply123 798McDonaldAvenue,Brooklyn,NY11218Phone:718-431-0521
H&JMedicalSupply 236065thStreet,Brooklyn,NY11204Phone:718-236-0707
BRONX
A&GMedicalSupply 1040MorrisParkAvenue,Bronx,NY10461Phone:718-823-4700
MedstopPharmacy&SurgicalSupplies 1330JeromeAvenue,Bronx,NY10452Phone:718-552-2278
TriumphMedicalSupplyLLC 1506CastleHillAvenue,Bronx,NY10462Phone:347-810-6787
Medical Supply Stores
WalgreensPharmacy525East68thStreet(inNYP)SuiteF01-170212-249-6451
CVS11723rdAvenue212-988-8319
Pharmacies
Goldberger’sPharmacy12001stAvenue212-734-6998
DuaneReadePharmacy1327YorkAvenue212-737-6240
TowerChemistsPharmacy12921stAvenue212-628-1900
18 Your Guide to Spine Surgery
CO
MM
UN
ITY D
IRECTO
RYAffiniaGardensHotel215East64thStreetPh:212-355-1230Fax:212-758-7858
TheBenjamin125East50thStreetPh:212-715-2500Ph:212-320-8002Fax:212-715-2525
TheBentley500East62ndStreetPh:212-644-6000Fax:212-207-4800
ComfortInnCentralParkWest31West71stStreetPh:212-721-4770
ComfortInnMidtown129West46thStreetPh:212-221-2600
DoubletreeMetropolitanHotel569LexingtonAvenuePh:212-752-7000Fax:212-758-6311
DrakeHotel440ParkAvenuePh:212-420-0900Fax:212-371-4190
FitzpatrickHotel687LexingtonAvenuePh:212-355-0100Fax:212-308-5166
FranklinHotel164East87thStreetPh:212-369-100Fax:212-369-8000
TheGracieInn502East81stStreetPh:212-528-1700Fax:212-628-6420
HabitatHotel130East57thStPh:212-753-8841
HelmsleyGuestFacilityNewYork-Presbyterian1320YorkAvenuePh:212-472-8400Fax:212-535-8524
NewYorkMarriottEastSide525LexingtonAvenuePh:212-755-4000Fax:212-751-3440
Hotels & Temporary Housing
Parking
TheGreenbergPavilionGarage525East68thStreet212-746-2015
HelmsleyMedicalTowerGarage507East70thStreet212-746-1974
LaurenceG.PaysonHouseGarage426East71stStreet212-746-1977
ThePhippsHouseGarage1285YorkAvenue212-746-1979
TheGardenCafé212-746-6368MondaythroughFriday,6amto8pmSaturdayandSunday,7amto8pm“B”Levelofthemainhospitalbuilding
Places to Eat at NYP
AuBonPainMainLobby:24hoursaday/7daysaweekStarrPavilionLobby:M-F,7amto3pmPerelmanHeartCenterAtrium,4thFloorGreenberg: M-F,7amto7pm
Your Guide to Spine Surgery 19
IMPO
RTA
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CO
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CT
INFO
RMAT
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Dr.RogerHӓrtlOffice:212-746-2152Fax:212-746-8387
NursePractitioner:RebeccaCramerSurgicalCoordinator:AlbaBriceño
Office:646-962-9755Fax:646-962-0640
Dr.Kai-MingFuOffice:212-746-2260Fax:212-746-8387
NursePractitioner:AmandaFazioSurgicalCoordinator:JenenaWiltshire
Office:646-962-9754Fax:646-962-0640
Dr.AliBaajOffice:212-746-1164Fax:212-746-8387NursePractitioners:
AmandaFazio/EdwardButlerSurgicalCoordinator:AlbaBriceño
Office:646-962-9755Fax:646-962-0118
Dr.EricElowitzOffice:212-746-2870Fax:212-746-8387
NursePractitioner:EdwardButlerSurgicalCoordinator:JenenaWiltshire
Office:646-962-9754Fax:646-962-0640
Dr.MichaelVirkOffice:646-962-3388Fax:646-962-0117
NursePractitioner:ShilpaNilavarathSurgicalCoordinator:JenenaWiltshire
Office:646-962-3783Fax:646-962-0640
Dr.AthosPatalisadesOffice:212-746-2821Fax:212-746-8111
NursePractitioner:OscarLlevaSurgicalCoordinator:SharonRamos
Office:212-746-5183Fax:212-746-8111
Neurosurgery Team
Weill Cornell Medicine Center for Comprehensive Spine Care888-922-2257
20 Your Guide to Spine Surgery
Anesthesiaquestions:212-746-3885
GiftShop:212-746-4230MondaythroughFriday7:30amto9pm
SaturdayandSunday9amto9pm
Hospitalbillingquestions:212-297-4545
InformationDesk:212-746-4690MondaythroughFriday7:30amto8pm
Saturday,Sunday&Holidays,8amto8pm
InternationalServices:212-746-4455
MedicalRecords:212-746-0530
PatientServicesAdministration:212-746-4293
PastoralCare:212-746-6971
PrivateRoom–Admitting:212-746-4250
PrivateDutyNursing:212-746-4091
24-hourEmergencyOn-CallChaplain212-746-5100,pager#17205
PetTherapy:212-746-4690
IMPO
RTAN
T CO
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FORM
ATION
Hospital Numbers
Nursing Station Phone Numbers
Greenberg2North 212-746-0335Greenberg2South 212-746-0334Greenberg2West 212-746-0317Greenberg2SW: 212-746-0344 NeuroscienceIntensiveCareUnit(ICU)
Greenberg4Central 212-746-0322Greenberg4North 212-746-0320Greenberg4South 212-746-0323Greenberg4West 212-746-0399Greenberg5Central 212-746-0313Greenberg5North 212-746-0314Greenberg5West 212-746-0312Greenberg5South: 212-746-0311 IntensiveCareUnit(ICU)
Greenberg6Central 212-746-0310Greenberg6North 212-746-0309Greenberg6South: 212-746-0308 PediatricIntensiveCareUnit(PICU) Greenberg6West: 212-746-0318 NeonatalIntensiveCareUnit(NICU)
Payson2 212-746-5342Greenberg7Central 212-746-0303Greenberg7North 212-746-0301Greenberg7South 212-746-0306Greenberg7West 212-746-0315Greenberg8Central 212-746-0325Greenberg8North 212-746-0326Greenberg8South 212-746-0327Greenberg8West 212-746-0328Greenberg10Central 212-746-0329Greenberg10North 212-746-3625Greenberg10South 212-746-0330Greenberg10West 212-746-0573Greenberg11North 212-746-0331Greenberg11South 212-746-0332Greenberg14North 212-746-9814Greenberg14South 212-746-9815Baker15 212-746-7884Baker17 212-746-1411Greenberg2North: 212-746-5333 Dialysis
M-2: 212-746-9877 InterventionalNeuroradiology
Your Guide to Spine Surgery 21
MA
PS
Center for Comprehensive Spine Care
22 Your Guide to Spine Surgery
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Your Guide to Spine Surgery 23Rev03-2019
Center for Comprehensive Spine Care240 East 59th Street, 2nd FloorNew York, NY 10022888-922-2257comprehensivespine.weillcornell.org
525 East 68th Street (at York Avenue)New York, NY 10065212-746-5454www.nyp.org
Copyright2019WeillCornellMedicine
Dr.RogerHӓrtl212-746-2152
Dr.EricElowitz212-746-2870
Dr.AliBaaj212-746-1164
Dr.Kai-MingFu212-746-2260
Dr.MichaelVirk646-962-3388 Dr.AthosPatalisades212-746-2821
Our Neurosurgeons