Post-operative instructions

What is the postoperative hospital stay?

The average hospitalization time after surgery on the skull or in cases of arthrodesis of the dorsal-lumbar spine is 3 6-days, while for anterior microdiscectomy or cervical arthrodesis the hospitalization time is reduced to 2 4-days. This timing is only indicative as it may vary in consideration of the patient's condition.

During the postoperative period, one or more instrumental control examinations will be carried out (CT, radiographs, magnetic resonance ...)


How is the discharge going?

On the day of discharge, the patient receives, for himself and his doctor, the letter filling in all the information on hospitalization: clinical history, type of surgery performed, results of instrumental and blood tests, therapy to be followed, dressings and removal of stitches.

The patient shows up at the admission office where he can too request the medical record and copies of the instrumental tests performed during hospitalization.


What therapies to follow after discharge?

The first therapies prescribed are those analgesics, which may be associated with anti-inflammatory drugs or corticoids, for a limited period. As appropriate, they can be added other drugs (antiepileptics, neuropathic pain relievers…).


How to manage the dressings and the scar?

Dressings are changed one or more times during hospitalization and the day before discharge. They will then be from redo every 4-5 days or whenever it gets wet or dirty, up to healing.

I stitches (in case the suture was not performed with an absorbable thread) must be removed, generally starting with 10 days after surgery, by the attending physician or neurosurgeon.


When to contact the neurosurgeon or attending physician?

- In case of general symptoms: fever, abnormal fatigue, loss of appetite, weight ...

- In case of local symptoms: red, swollen, particularly painful, foul-smelling scar, discharge from the scar (pus, clear liquid like water ...), dehiscence.

- In case of appearance of new pains intense

- In case of appearance of new neurological symptoms: severe headache, weakness or paralysis of a limb, difficulty speaking, acute cognitive decline ...




What should I do after the surgery?

Skull surgery is generally not very painful. The patient may feel tired after the surgery.

Generally the rest at home recommended is 4-6 weeks, or more if there are neurological disorders that require rehabilitation.

It is recommended to avoid driving the first few weeks, a fortiori in case of antiepileptic treatment.

After a skull surgery, you can, of course, live a normal life, after the recommended rest period.


When are histological results communicated?

If the surgery consisted in the excision of a tumor lesion, the results of its nature (histological, immunological, molecular ...) will be communicated to the patient on average within 15 days, even if they may take less time or more (sometimes up to a month in the case of national rereading or carrying out more specific exams).


When is the follow-up visit with the neurosurgeon scheduled?

The follow-up visit with the neurosurgeon is usually scheduled after a month or two. After discharge, it is important schedule the follow-up visit together with the surgeon.

Depending on the pathology being treated, it may be necessary to perform a CT scan or an MRI of the skull before this visit. This information will be specified by the neurosurgeon.

Subsequent visits depend on the pathology, but often the check-up is done at 3 months, 6 months, one year, and then possibly annually.




What should I do after the surgery?

Spine surgery (cervical, dorsal and lumbar) requires a period of rest of the back for decrease mechanical constraints and avoid pain. There microdiscectomy (excision of disc herniation) and anterior arthrodesis surgery (cervical arthrodesis and anterior lumbar arthrodesis), or posterior with a minimally invasive technique, generally generate less pain.

Arthrodesis surgeries with instrumentation of the spine may require a external support of type bust (lumbar band) o collar soft. This will be established with the neurosurgeon at the preoperative visit or after surgery.

The maintenance duration of the torso or collar is generally 4-6 weeks when used for muscle support. The neurosurgeon may authorize the removal of the support during the night or for washing.

On the other hand, when the situation requires rigid support (traumatology, instability, tumors, instruments or spinal column not solid enough…) it may be necessary for a longer period (3 months).

Soft collar C1, after cervical arthrodesis surgery
Lumbar band type bust with splints, after lumbar surgery

Is it normal to still have pain after surgery?

The first reason for performing spinal surgery is usually pain. This pain can affect the structure of the spine or the nerves, causing radiculopathy.

Often i acute mechanical pains due to a recent compression of a nerve (lumbosciatica, sciatica, cruralgia ...) decrease radically after surgery. THE chronic pains both the nerves and the spine (neck pain, back pain ...) may take longer to decrease.

Sometimes, especially if they are due to many factors, they don't completely resolve. The goal of the spine surgeon is to offer the patient a improvement of the quality of life.

In case of neuropathic pain preoperative (chronic inflammation of a nerve root leading to pains like tingling, burning sensation, hyposensitivity ...) in addition to the mechanical pain of nerve compression, the patient can continue to present it for some time.


What is allowed to do during postoperative rest and what is not recommended?

Both during the postoperative period and in a general way, it is very important to consider a good one back hygiene. It means adopting righteous posture to reduce mechanical constraints on the spine, discs, ligaments, joints, muscles and on the arthrodesis material.

The important is avoid carrying loads, avoid any flexion effort and keep your back straight. It is not recommended to drive during the first few weeks.

The best of re-education is done walking; helps the healing of tissues, regeneration and al bone reinforcement, To fusion in case of arthrodesis, al relaxation and muscle strengthening and allows reduce postoperative pain or chronic.

Generally, no physiotherapeutic back education is needed during postoperative rest. Instead it becomes necessary in case of neurological disorders (walking problems, weakness of a group of muscles or one or more limbs) and for the muscle and postural re-education of the back after 1 or 2 months after surgery.

Postures to adopt and postures to avoid
Self re-education by walking

When is the follow-up visit with the neurosurgeon scheduled?

The follow-up visit with the neurosurgeon is usually scheduled after a month or two. After discharge, it is important schedule the follow-up visit together with the surgeon.

Depending on the pathology treated, it may be necessary to carry out instrumental control examinations: X-rays or CT or MRI of the spine prior to this visit. This information will be specified by the neurosurgeon.

After a microdiscectomy surgery, only a follow-up visit is generally scheduled, without performing postoperative instrumental examinations.

The subsequent check-ups, after an arthrodesis surgery, are generally carried out at 3 months, 6 months and possibly a year, in order to check the reduction of symptoms and the correct vertebral fusion.


What is recommended to do after rest and surgical follow-up?

According to the age and condition of the patient, it is recommended to carry out one postural and muscular re-education of the back in order to strengthen the back, to avoid the reformation of the problem and avoid chronic pain.

In case of persistent back pain, one is recommended physiotherapy of massages and muscle relaxation.

It is recommended to practice exercise frequently and walk everyday.

Il strengthening of the lumbar abdominal muscle belt it allows to reduce the constraints on the vertebral, disc and ligamentous structure of the spine, limiting disc degeneration (discopathy), the formation of herniated discs or deformation of the back. You can practice it alone or with the help of a physiotherapist.

Recommended resume sports activities gradually, starting with isometric exercises without load of weights (walking, swimming, elliptical bikes ...)

Physiotherapy. Muscle relaxation, muscle strengthening, postural ...
Strengthening exercises for the lumbar abdominal belt, recommended 4-6 weeks after surgery

- exercises for the back and neck are essential to maintain the correct posture of the spine and are generally part of any treatment program of the pathologies they cause pain in the back and neck. These videos provide instructions information and suggestions on the correct techniques and exercises to perform for relieve pain back and neck and ensure a strong and healthy spine.