Having spine surgery can be a stressful and emotional time for anyone, but the staff at Hospital for Special Surgery is invested in using a team approach to provide you with the best possible experience.
When scheduling your procedure with your surgeon, make sure you obtain an estimate of how long you will be in the hospital. Depending on the type of spine surgery, you may be admitted for a number of days. Make sure to plan accordingly, considering work schedules, holidays, and upcoming family plans.
The day before your scheduled procedure, a nurse from HSS will call you with additional instructions and reminders. You will be told when and where to come the next morning, and you will be reminded not to eat or drink anything after midnight. This does not apply to the medications that you have been instructed to take the morning of surgery with a small sip of water.
On the morning of your surgery, you will arrive several hours before your procedure is scheduled to begin.
Your anesthesiologist will be a Board-Certified or Board Eligible physician who is highly specialized in caring for patients having spine surgery. Having previously reviewed your chart, laboratory results, and other studies, your anesthesiologist will already know much about you. However, he or she will have a detailed conversation with you to clarify any issues and address any concerns you, or your anesthesiologist, may have.
Your anesthesiologist will also explain the type of anesthesia you will receive, including any special monitoring or necessary care, and discuss post-operative recovery and pain management. Earlier consultation with our Anesthesia Department can easily be arranged by your surgeon or at your request.
Essentially all patients undergoing spine surgery at Hospital for Special Surgery will receive general anesthesia, which involves being put to sleep with medications that are given to you through your intravenous line. However, the types of medications your anesthesiologist administers during your surgical anesthesia will be specifically suited for spine surgery and compatible with intra-operative neurological spinal cord monitoring.
Often, the choice of medication given during general anesthesia may impact your recovery and pain management after the surgery. Some of the considerations your anesthesiologist will take into account include the length of surgery, other health conditions, any pain medications you may have been previously taking, and any side effects you have had from previous general anesthetics.
Typically, the breathing tube is removed at the end of surgery; however, following longer or more involved spine surgery, your anesthesiologist and surgeon may decide to leave the breathing tube in place for several hours after the surgery. During this time, your body has time to recover from the anesthesia as well as the surgery and other physiologic changes that may have occurred. If this is the case, you will be closely monitored in the recovery room and kept comfortable by appropriate sedation. With some of the more involved spine surgeries your surgeon and anesthesiologist may perform a “wake up test.” This is usually accomplished by having you follow a simple command, such as “wiggling your toes,” or “moving your feet” as the anesthesia is wearing off. It is not difficult or uncomfortable, but it is something you may notice.
There will be some level of pain following all orthopedic surgeries. The Anesthesia Department works closely with patients and uses a multidisciplinary approach to aggressively manage post operative pain. This includes a variety of different pain medications, physical therapy, and possibly epidural or spinal medications.
With the exception of some of the less extensive spine surgeries, your orthopedic spine surgeon will request the consult of our Department’s Acute Pain Service (APS). The APS is a specialized team consisting of an anesthesiologist, a nurse trained in pain management, and a pharmacist. A combination of different pain treatments are incorporated, depending on the type of discomfort you experience as well as the side effects to which you may be sensitive.
The APS provides most patients with a “patient controlled analgesia” device (PCA). This is an electronic device that is programmed by the APS and allows you to immediately and safely administer pain medicine as you feel necessary. The APS Team will visit you every day.
Our Department also has a Pain Medicine Service, comprised of anesthesiologists specifically trained in the care of patients on long term or complex pain therapies. Our dedicated pain service teams remain in the hospital and are available to you 24 hours a day.
We know your experience with us will be beneficial and will ultimately result in a better quality of life for you and your loved ones. If you have any questions regarding your perioperative anesthetic care, please contact the Anesthesia Department at 212.606.1206.
Reviewed and updated by Yi Lin, MD