Home › Patient Info › Operations procedures › Spinal fusion back › ALIF Pathway

ALIF Pathway

Introduction

This is a guide to your upcoming operation. In it we explain what is likely to happen at each stage of the process. However your care will depend on your individual needs, so your progress may vary from this basic outline. Please become familiar with this guide and discuss any aspects you wish to with your surgeon or the nursing staff.

You will be admitted on the morning of surgery, unless this is impractical or you have some significant medical problems. You should expect to be in hospital for three days.

Before Surgery

You should stop taking anti-inflammatory drugs at least ten days prior to surgery as they can increase the risk of bleeding. These tablets include Voltaren, Nurofen, Brufen, Feldene, Naprosyn, Indocid, Celebrex & Mobic. If you are on low-dose aspirin (eg. prescribed to prevent stroke or heart attack) you need to discuss this with your surgeon as you will likely need to cease this medication. If you are currently taking Warfarin (Coumadin or Marevan), Iscover or Plavix tablets you should notify your surgeon as you will need to stop taking this medication under medical supervision. You should stop all vitamin and mineral supplements ten days prior to surgery.

You should keep the skin near the operation site clean. If you have a cut or pimple on the skin in the area, you should notify your surgeon prior to surgery.

Admission

You should not eat or drink 6 hours prior to surgery. This usually means from 2 am on the morning of your operation. (You may not be the first patient on the list, but the order may need to be changed unexpectedly)

You should bring with you:

• Personal effects (nightgown or pyjamas, slippers, dressing gown, toiletries)
• Any medication you are taking
• Medicare and private health fund membership cards
• Your medical consent and admission paperwork
• Your x-rays and scans will be taken to the theatre by our staff on the morning of surgery.

Prior to going to theatre, you will:

• Have a shower with an antiseptic soap (Betadine)
• Be dressed in a theatre gown and disposable underwear
• Have special stockings fitted (to help prevent blood clots)

If you wish, your surgeon will speak to a family member in person after the end of the day’s surgery list. Please notify the hospital nursing staff of the details.

The Procedure

You will be prepared for surgery by the nursing staff in hospital. You will be taken from the ward to the operating theatre on a trolley. The operation will take about two hours, but you may spend up to three hours in the theatre complex, by the time you wait in the preoperative area, have the surgery and wake up in the recovery area.

The Anaesthetic

The anaesthetist will give you a general anaesthetic. A small needle will be placed in the back of your hand or in your forearm. This will be connected to a drip. You will be asked to breathe on an oxygen mask and the drugs to make you fall asleep will be injected through the drip. You will be asleep and not be aware of anything further until the operation is completed. Antibiotics are given to you at this stage and a catheter will be inserted into your bladder.

The Surgery

The operation involves a 5 to 7 cm cut over your abdomen just under your belly button. The peritoneum and its contents (contents of the abdomen covered with its thin lining) are then moved aside so that we are looking at your spine and the structures that pass across it. The main structures are the arteries and veins to your legs and the ureters, which connect your kidneys to your bladder. These are carefully moved aside and the vertebrae and the disc in between are exposed. An x-ray machine is used to confirm that we are at the right disc. The disc is then removed completely. The correct cage is then chosen and it is packed with bone substitute and marrow.

This cage is then inserted into the space between the two vertebrae.

The bone inside the cage will join up with the vertebrae and a fusion will take place (there will be healing of the bone from one vertebra to the other through the cage). A plate is inserted in front of the two vertebrae. The incision is then closed with deep long-lasting dissolving stitches and more rapidly dissolving stitches are used to close the skin. These are just under the skin and do not have to be removed. A dressing is applied and you are transferred back to the trolley.

The Recovery

The anaesthetist will reverse the anaesthetic. You will wake up in the recovery room. The nurses there will check your observations and the movement in your feet. Once you are sufficiently awake, you will be transferred back to the ward. Once in the ward, your progress will follow the clinical pathway.

After Surgery

When you return to the ward, you will be resting in bed and free to move into a comfortable position. You will have a drip in your arm for fluids and for pain control, you will have a PCA. A PCA (patient-controlled analgesia) consists of another line attached to your drip and a pump that delivers a drug like Morphine, Pethidine or Fentanyl into the drip. You can control the amount of medication you receive by pressing a button. There is a safety lock-out mechanism built in to the pump so that you cannot give yourself too much painkiller.

You will have a bulky dressing over the wound on your abdomen. You will have a catheter in your bladder so that you will not need to worry about getting up to pass urine. You will have sequential compression devices on your legs, which gently squeeze your calves to decrease the chance of clots in the legs. Your tummy often does not work normally after surgery and you will be restricted to drinking clear fluids only.

The Day After Surgery

You will have a wash in bed / shower with the help of the nursing staff. Prior to your wash, the drip and PCA may be removed from your arm. You will then have tablets for pain relief. If necessary, you can have an injection.

You diet will be restricted to fluids until your tummy returns to normal. Then you will gradually be able to progress to eating a normal diet.

You will be seen by the physiotherapist on this day. The sequential compression devices will be removed. The physiotherapist will stand you up and take you for a short walk with the aid of a rollator (walking frame with wheels). The physiotherapist will also give you instructions about your activities during the recovery period, including an exercise programme.

Once the pain drugs have worn off and you are able to get out of bed safely by yourself, the catheter in your bladder will be removed. This will usually be before lunchtime. The nursing staff will observe that you are able to pass your urine normally afterwards. You need to tell them if you have not passed urine within six hours after the catheter is removed.

The Second Day After Surgery

You will be able to have a shower with minimal assistance / independently. The outer wound dressing will be removed leaving a small waterproof dressing that you can shower in. This inner dressing may need to be changed today if it is not sticking properly. Your stockings will be taken off for your shower and then reapplied.

The physiotherapist will visit, take you for a walk and make sure you can cope with stairs. You will likely be well enough to be discharged on this day.

The Day of Discharge

Once you are walking safely and are able to look after yourself, and only need tablets for pain, you will be able to go home. You may travel home in a car, but you should stop for a break if the trip is longer than half an hour or so. Your seat should be in an upright position. If you live more than one hour (100 km) from Brisbane, it may be better that you stay in Brisbane for a few days after surgery. Alternatively, you may travel by plane at this time.

Your wound will be reviewed and the dressing will be changed prior to your hospital discharge.

When You Get Home

You can expect some pain in the abdominal wound and sometimes in the low back and this may last a number of weeks. You should take your painkillers on a regular basis for the first two weeks and then gradually decrease and cease these. If you become constipated, you may need to increase your fluid or fresh fruit intake or obtain appropriate medication from the chemist.

You should make an appointment with your GP to take the dressing off about 10 days from surgery. If it falls off before this and the wound is clean, you should not worry. There are no stitches to remove as they are dissolving and under the skin. As the body dissolves the stitches, there is sometimes a mild reaction around the wound, seen as some redness and inflammation. You should wear your stockings for at least two weeks or until normal activities are resumed.

You should follow the guidelines given to you by your physiotherapist with regard to physical activity and your exercise programme. Generally, you should increase your activity level slowly with an aim to be back to most activities at six weeks. Sitting will usually be more uncomfortable than other activities and you will need to gradually build up your sitting, standing and walking tolerance.

You should endeavour to complete your exercise programme twice a day and to take progressively longer walks building up to 30 minute sessions twice daily. Once your wound has healed, you may do pool work as advised by your physiotherapist.

You should avoid sudden twisting and bending movements of your spine and should not stretch past the point of pain. Reach for objects on the floor by bending your knees. Minimise work done with arms over your head. You should not lift, pull or push anything heavy (i.e. nothing over 5 kg) until you have attended your post-operative visit with your surgeon.

You should not sit in low chairs. You should continue to sleep on your back or on your side with a pillow between your knees for the first month. If a fairly passive role is taken, you may resume sexual activity 4 weeks after your operation.

You should be safe to drive at three weeks. You may return to work at five to six weeks if you have a sedentary job such as administrative or clerical work, or eight weeks if your job is more physical.

We will contact you in the week after your surgery when you get home to check how you are and remind you of your post-operative appointment with Dr Licina. This will usually be eight weeks after surgery and an x-ray will also be done on this day. The cost of this post-op visit (not the x-ray) is included in the surgical fee. Any subsequent visit pertaining to this surgery will be charged at the rebate rate.

You should see your local doctor or contact your surgeon if:

• You develop severe and constant leg or back pain
• You have bleeding or discharge from your wound
• You are unwell and have a fever
• You develop vomiting or severe abdominal distention
• You require a script for further painkillers