Your Guide to a Better Recovery



YOUR PATHWAY TO RECOVERY

A Patient’s Guide to

Spine Surgery



Volume 3, 3rd Edition • Patient Education Series
YOUR PATHWAY TO RECOVERY

A Patient’s Guide to Spine Surgery
DEVELOPED BY
Interdisciplinary Patient Family Centered Education Committee
SPECIAL THANKS TO
Members of the Spine Service
ABOUT HOSPITAL FOR SPECIAL SURGERY
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in
orthopedics, rheumatology, and rehabilitation. HSS has received Magnet
Recognition for Excellence in Nursing Service from the American Nurses
Credentialing Center and has one of the lowest infection rates in the country.
For the last three years HSS has received the HealthGrades Joint Replacement
Excellence Award. A member of the NewYork-Presbyterian Healthcare System
and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and
rheumatologic patient care at NewYork-Presbyterian Hospital/Weill Cornell
Medical Center. All Hospital for Special Surgery medical staff are on the
faculty of Weill Cornell Medical College. The Hospital’s research division is
internationally recognized as a leader in the investigation of musculoskeletal
and autoimmune diseases.

HOSPITAL FOR SPECIAL SURGERY
535 East 70th Street
New York, NY 10021
tel 212.606.1000
hss.edu

©2018 Hospital for Special Surgery



A Patient’s Guide to Spine Surgery
Dear Patient:
Welcome to the Spine Care Institute at Hospital for Special Surgery.
We are very pleased that you have chosen to have spinal surgery here.
We are committed to making your surgery and recovery comfortable
and successful.
We are pleased to provide you with this comprehensive overview of
your planned spinal surgery. This manual will act as your guide through
the perioperative period. We urge you to read and refer to it frequently.
Please bring it with you during any perioperative visits.
Additional information and patient education materials are also
available for your review on our website at www.hss.edu/spine.
Members of the Spine Care Institute are dedicated to improving spinal
surgery. We are active in the development of newer and less invasive
techniques to help facilitate a rapid recovery. For those of you who are
participating in our clinical research studies, we thank you. We welcome
all comments and input, which will help us improve our spinal surgery
protocols.
On behalf of all the members of the Spine Care Institute, it is our hope
that this educational booklet will help answer many of your questions
regarding your condition and treatment. We also hope it will make your
experience a pleasant one.
Please feel free to contact the patient education staff at 212.606.1263
if you have any questions or require additional information.

Frank Schwab, MD

Todd J. Albert, MD

Chief, Spinal Service

Surgeon-in-Chief and
Medical Director

Jack Davis, MSN, RN, ONC

Manager, Patient Education Programs
A Patient’s Guide to Spine Surgery

1



Table of Contents
Before You Come to the Hospital
Important Phone Numbers

3

A Closer Look at Spine Surgery

4

Before You Come to the Hospital

9

Your Diet and Preparing for Surgery

12

Preparing Your Home

13

When You Come to the Hospital

14

Your Surgery and Hospital Stay
The Day of Surgery

16

Patient Information Intraoperative Monitoring

20

Visitor Code of Conduct

25

Recovering in the Hospital

26

Rehabilitation and Mobility After Spine Surgery

33

Precaution Guidelines

35

Mobility Throughout Your Hospital Stay

38


Final Steps: At Home
Guidelines for Recovering at Home

43

Physical Therapy: Regaining Independence
with Activities of Daily Living

44

Strategies to Reduce Post Operative Swelling

46

Sexual Activity Following Spinal Surgery

47

Additional Discharge Instructions

50

Conclusion 51

2



Before You Come to the Hospital
IMPORTANT TELEPHONE NUMBERS
Hospital for Special Surgery Main

212.606.1000

Admitting | Patient Access

212.606.1241

Patient Education

212.606.1263

Case Management

212.606.1271

Spiritual Care

212.606.1757

Access Private Nursing Service

212.774.7187

Physical Therapy

212.606.1221

Food and Nutrition Services

212.606.1293

A Patient’s Guide to Spine Surgery

3



A CLOSER LOOK AT SPINE SURGERY
To understand spine surgery, you should be familiar with the
structure of the spine. The spine consists of 33 bones called
vertebrae that provide body structure and protect the spinal cord.
Linking the vertebrae are intervertebral discs and facet joints that
absorb shock and allow for movement and flexibility. As people age,
the discs between vertebrae lose water, decreasing the ability of the
discs to cushion the spine. This process is called disc degeneration
and can reduce the space through
which nerves exit, called the
intervertebral foramen.
These diagrams illustrate some
of the important structural
components of the spine.

4



TYPICAL SPINE PROBLEMS

Bulging Disc
A bulging disc occurs when one of the discs
between the vertebrae develops a weak area
which causes painful pressure on the spinal
canal.

Ruptured or Herniated Disc
Pressure causes the outer rings of the disc
to rupture and the soft nucleus to squeeze
through. This compresses and irritates the
spinal nerve root.

Arthritis
Aging, worn vertebrae and discs allow bone
spurs to form. This causes or worsens
narrowing of the spinal canal (stenosis), and
irritates the nearby nerve, producing pain.

Instability
As a disc degenerates and flattens, vertebrae
slip back and forth. This irritates the spinal
joints and creates or worsens stenosis,
irritating the nerve.

A Patient’s Guide to Spine Surgery

5



Spinal Stenosis
Spinal Stenosis is a condition that arises due to narrowing in
and around the spinal canal, thus resulting in nerve pinching,
which leads to persistent pain in the buttocks, limping, lack of
feeling in the lower extremities, and decreased physical activity.
There are several different types of spinal stenosis which can
effect all regions of the spine (cervical, thoracic, and lumbar
spine).

spinal canal

normal spine

spinal stenosis

Scoliosis
Scoliosis is a condition of the spine in which the spine curves to
varying degrees in an "S" shape, either to the right or left side.
There are three types of scoliosis: Idiopathic (of unknown origin);
Congenital (in which the bones are asymmetrical at birth); or
Neuromuscular (in which the scoliosis is due to a symptomatic
condition, such as cerebral palsy, muscular dystrophy, or
paralysis).

Your surgeon will direct you to a specific website
on hss.edu to review information concerning spinal
conditions and surgery.

6



TYPICAL KINDS OF SPINE SURGERY
Discectomy
A discectomy is the surgical removal of disc material which has
herniated, causing pressure on the nerve root or spinal cord.
Your surgeon will remove the central portion of the disc, called
the nucleus pulposis, thereby releasing the stress on the nerve.
Laminectomy
A laminectomy is the removal of a portion of the lamina (the boney
roof of the spine). This allows more room for the nerves of the spine
and reduces the irritation and inflammation of the spinal nerves.
The lamina does not grow back. Instead, scar tissue grows over
the bone, replacing the lamina protecting the spinal nerves.
Laminotomy
A laminotomy is decompression of only one side of the spinal canal
(left or right). In this procedure, a small portion of the laminar roof
over the spinal canal is removed, leaving the majority of the lamina
intact.
Microsurgical Laminoplasty
A microsurgical laminoplasty is the decompression of the spinal
canal using microsurgical techniques.
Fusion
For people whose spines are not stable, the surgeon places bone
graft between two or more vertebrae in order to promote the bone
to grow or fuse together. The bone used for bone graft is usually
taken from the bones of your own body (pelvis) at the time of
surgery. This bone graft acts as the cement that fuses the vertebrae
together. Occasionally rods, screws, or plates are used in addition
to bone graft.
Anterior Lumbar Spinal Fusion
The anterior (or frontal) approach provides excellent access to the
spine and enables your surgeon to restore a collapsed disc space.

A Patient’s Guide to Spine Surgery

7



An incision is made in the left or right flank region of the abdomen
and a portion of the disc space is removed and replaced with an
implant.
This can sometimes be combined with a Posterior Fusion (from the
back) which would be used if a more rigid stabilization of the spine
is required.
Cervical Spine/Neck Surgery
Surgery on the cervical spine may be performed to either
decompress or relieve the pressure on the spinal cord or to help
stabilize the cervical spine. There might be a need for a fusion
to add stability to the cervical spine. Cervical fusion may be
approached from the front of the neck (anterior) or the back of
the neck (posterior). Bone graft may or may not be used to help
stabilize the graft site. The bone graft may be allograft (donor bone)
autograft (your own bone) or bone graft substitute.
Your surgeon can describe your particular spinal operation to you.
Please feel free to ask questions about what your surgery involves.

8



THINGS TO DO
1. Before your surgery, you will be scheduled for an appointment with
an internist at HSS who will:
• Review and/or perform any necessary diagnostic tests.
• Perform a medical exam to make sure you are safe for surgery.
2. Unless you are told otherwise, continue to take medication
already prescribed by your own physician.
• Consult your physician regarding aspirin products.
Patients with cardiac stents should continue to take their aspirin
or other blood thinning products.
3. You will also be scheduled for presurgical testing approximately
1 to 3 weeks prior to surgery where:
• You will check in on the first floor to Patient Access Services on
the day of your presurgical testing.
• You may also have an appointment at Presurgical Screening. The
Presurgical screening staff will perform routine
diagnostic testing to be sure you are ready for surgery,
which may include; taking a blood sample for testing, a
urine specimen and an electrocardiogram (EKG).
• You should bring a list of current medications and a detailed
account of prior medical, surgical and family health history.
• The nursing staff will request and review information as part of
a comprehensive medical history to add to your patient database
profile.
• The nursing staff will provide instruction on preparation
for surgery.


A Patient’s Guide to Spine Surgery

9



4. HSS staff may make an appointment for you to attend the
preoperative patient education class. The class is approximately
60 minutes long. During the class, patient educators will:


• Review the surgical process.



• Discuss setting realistic expectations, patient safety, mobility,
pain management and the prevention of complications
(infection and blood clots).

• Provide information about:

-



Skin preparation, nutrition and diet restrictions
before surgery.

-

The preoperative patient phone call and how patients
obtain general presurgical information. The preoperative
phone call to the patient the day before surgery will include:

-

Diet instructions.

5. You may wish to review and plan your post-hospital care with
Case Management Services (212.606.1271) before admission.
The Preadmission Program offers patients and their families the
opportunity to receive assistance before the patient is admitted for
surgery. This program enables you to plan your hospitalization and
discharge needs in a timely, comprehensive manner.
6. Prepare for your return home from the Hospital. It helps you
maximize your options and make decisions in a more relaxed way.
8. A nurse from the Call Center will contact you one business day prior


10

All patients must call the Hospital’s presurgical information
line at 212.606.1630 and listen to a pre-recorded message
within 48 hours of your scheduled surgery for general
instructions and a review of the pre-Hospital process.



7. Please complete the Health Care Proxy form and bring it with
you on the day of admission. (Or bring one you may already have
previously completed.) This is a form authorizing another person,
designated by you, to make decisions with your physician about
your care, should this become necessary.
8. A nurse from the Call Center will contact you one business day prior
to your surgical date (Friday for Monday surgical cases) with more
detailed instructions, usually between 1:00 pm and 7:00 pm.
9. Wash the surgical area with the antiseptic soap solution at the end
of your last bath or shower before surgery. The solution should
be rinsed and removed after application. Do not shave surgical
area the day before or day of surgery. Specific instructions will be
provided at the presurgical screening appointment, the preoperative
education class and during the preoperative phone call.
10. Please DO NOT bring the sleep apnea machine. Patients with
sleep apnea are generally required to stay overnight in the
Post-Anesthesia Care Unit (PACU) to be monitored and observed.
Do not bring in the machine, but please bring in the mask, tubing
and settings.
11. The use of nicotine products (i.e., cigarettes, cigars, gum or
patches) has been shown to increase risk of complications following
surgery. They can inhibit bone and wound healing by decreasing
blood flow to the surgical site. They can also increase the risk
of deep vein thrombosis (DVT) a.k.a. blood clots. Please discuss
smoking cessation with your doctor.
12. You, your family member or support person will be instructed to
go to the Patient Access Services in the first floor lobby.

A Patient’s Guide to Spine Surgery

11



YOUR DIET AND PREPARING FOR SURGERY
The pre-surgical diet guidelines below are for general purposes only. Your
physician or surgeon may require you to follow an alternative plan. In that
case, follow your physician’s instructions rather than the guidelines below.

Fourteen Days Prior to Surgery
✓ Stop all nutritional and herbal supplements (vitamins/minerals/herbals)
✓ EXCEPTIONS – the following are Ok to continue: Calcium, Iron &
Vitamin D

The Day Before Surgery
✓ Follow your Regular diet
✓ Do not eat any solid food after midnight
(CLEAR FLUIDS ONLY after midnight)

Day of Surgery
✓ IF INSTRUCTED, drink carbohydrate-rich drink (Ensure® Pre-Surgery
Clear Nutrition Drink, 10oz) 3 hours before surgery, JUST PRIOR to
your arrival at the hospital. Chill, shake the product well, and consume
the drink all at once in 5 - 10 minutes.
✓ Take CLEAR FLUIDS ONLY up to 3 hours before surgery.
✓ DO NOT EAT OR DRINK ANYTHING AFTER ARRIVING AT
THE HOSPITAL.
CLEAR FLUID DIET (ANY MEAL)
ALLOWED

NOT ALLOWED

Water

Milk or Dairy Products
(including in coffee and tea)

Apple, Cranberry & Grape Juice
Gatorade
Black Coffee or Tea
Clear Broth
Gingerale and Seltzer
Jello and Italian Ice
Ensure® Pre-Surgery Clear
Nutrition Drink — (IF Instructed)

12

Citrus Juices
Prune Juice
Juices with Pulp
Any food or beverage not listed
in the “allowed” column



PREPARING YOUR HOME
Prior to surgery, you will need to prepare your home for recovery.
During the first few weeks at home you will begin to adapt what you
learned in the hospital to your own setting.
• Store items within easy reach. Take items you may need out of
low cabinets or shelves prior to surgery because you will not be able
to reach them after surgery.
• Prepare meals ahead of time and store in the freezer.
Have your favorite home delivery numbers handy!

Safety Checklist

Reduce clutter.
Remove loose wires and cords.
Rugs should be smooth and anchored to the floor.
Place non-skid tape or mats at the sink.
Use a night light in the bathroom.
Turn on lights when you get up at night.
Secure rugs and treads on the stairs.

A Patient’s Guide to Spine Surgery

13



WHEN YOU COME TO THE HOSPITAL
A Checklist for Your Stay
A legal picture identification (driver’s license, passport, birth certificate,
social security card, green card/permanent resident card, military ID).
A copy is acceptable.
Your hospitalization insurance cards
X-rays or laboratory reports (if instructed by the staff)
Any assistive device you use (e.g., cane, walker)
Your completed Health Care Proxy form
Paperwork, including consent forms, sent to you by your surgeon.
Also bring a list of your current medications with dosages and medical
information from your physician.
This manual: Spine Surgery Your Pathway to Recovery
Nonslip, flat, closed toe, joint-supportive athletic or walking shoes
Personal toiletries
A small amount of money for newspapers or other incidentals
One credit card to purchase necessary medical equipment, or
for transportation services
A book, magazine or hobby item to occupy time
Please remove contacts and wear eye glasses.

Please Do Not Bring
Medications, including narcotic substances (unless instructed by your
HSS pharmacist). Self-medication during your Hospital stay is prohibited.
It may lead to unsafe conditions like overdoses and/or drug interactions.
Valuables (except those mentioned above)
Jewelry: Remove and leave at home all piercings and jewelry,
including wedding rings to ensure your safety during your Hospital stay.
Otherwise, see a jeweler for assistance for removal if needed.
14



Please pack lightly as HSS staff cannot store multiple bags.
Please pack your belongings in a small bag. Belongings must
fit into a storage bag issued by HSS. Your belongings will be
secured and stored for you.
Please do not bring in any rolling suitcases or luggage.

A Patient’s Guide to Spine Surgery

15



Your Surgery and Hospital Stay
THE DAY OF SURGERY
Traveling to HSS
The Hospital is located at 535 East 70th Street on the Upper East Side
of Manhattan, between the East River and York Avenue. For physicians,
patients and families visiting from out of town, the Hospital is readily
accessible by automobile and taxi via all of the major bridges and
tunnel routes. Garage parking is available nearby; street parking is
subject to local restrictions. For public transportation options visit
hss.edu/public-transportation.
Map: Finding Your Way Around HSS
Main Hospital
535 East 70th St.

Ambulatory Care Center
475 East 72nd St.

The Pavilion
541 East 71st St.

Dana Center
510 East 73rd St.

E 75th St

E 75 St
HSS Research Insitute
515 East 71nd St.

BioDynamic Technologies
431 East 73rd St.

First Avenue

Belaire
525 East 71st St.

Spine Special
Therapy Procedures
Center Unit
429

th

York Avenue

Special Procedures Unit
429 East 75th St.
Spine Therapy Center
405 East 75th St.

East River
Professional Bldg
523 East 72nd St.

NewYork-Presbyterian
Hospital
525 East 68th St.

E 74th St

E 74th St

BioDynamic
Technologies

uptown/
downtown bus

River Terrace
519 East 72nd St.

Integrative Care Center
HSS ASC of Manhattan
(not pictured)
(not pictured)
635 Madison Ave. (59th St.) 1233 Second Ave. (65th St.)
M31

P

431

E 73rd St

Entrance To FDR South

E 73rd St

i

P

510

East River
Professional
Building

Dana
M31
Center
River
P M72 M15

P

Terrace

P

i

M31

York Avenue

First Avenue

M72
M15
Sotheby’s

i

M31

$

M72

i

EntranceP
i

541

M31 M31

P
i

M72

M72

$

E 70 St

Hospital for
Special
Surgery

$ Main Hospital

$

th

M31

M72

M15

P

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital

M72

$

M15

Bus i

Sotheby’s

P

Parking

M31

M15

M15

M15

P

P

M31

16

Pavilion

$ $

M15

M31

M72

$ The

P

M72 M72
535M15 M15

P
i

M72

Accessible
$
Entrance

525 :

M15 Ground fl Belaire
entrance

P P
M31
i P
517
i iP P

Helmsley
Medical
Tower

M15

M31

P

Parker
M72
House

M31

Entrance To FDR North
@ 62nd St

uptown bus

P

515
M15

P$

i

M31

P

$

Belaire

M31

P

M72
E 71st St

i

530

: 2nd FL Belaire Entrance

P
M15

M72

HSS
Research
Institute

E 71st St

P
P

$

523
524

M31

FDR Exit 13

P

E 70th St

P

E 72nd St

M72

M15

P
P
$

i

519

i

East River

475
E 72nd St

East
River
Place

FDR Drive

Ambulatory
Care
Center

1 East River Place

$

Bridge

405

M72

M15

Food at HSS

$



You and the person accompanying you should come to Patient Access
Services in the first floor lobby. When you arrive, the Patient Access
Services/Admitting staff will process your admission, issue your
identification bracelet and direct you to the Family Atrium.
The 4th Floor Family Atrium is a lounge area and central hub where our
patients and family members meet and wait for information following
surgery. It is equipped with comfortable chairs and offers amenities
that include a coffee bar, food cart, television services and computer
access. The area is equipped with Wi-Fi, and cell phone use is allowed.
Members of the nursing staff will greet and escort you and the person
accompanying you to the presurgical holding area. This is where you
will meet a physician assistant (PA) who will reassess your condition
and medical/surgical history. PAs are healthcare professionals
licensed to practice medicine with physician supervision. As part of
their comprehensive responsibilities, PAs conduct physical exams,
diagnose and treat illnesses, order and review tests, counsel on
preventive healthcare, assist in surgery, and prescribe medications.
PAs work closely with other members of the operating room (OR) and
anesthesia teams. They will finalize your presurgical preparations.

A Patient’s Guide to Spine Surgery

17



The nursing staff will complete your admission process, check your
identification band and assist you with changing into our hospital
gown. Your belongings, which should fit in one small bag, will be
labeled, and will remain with the security department until you are
sent to an inpatient room. You should ask the person accompanying
you to hold onto your eyeglasses and hearing aids for you, and to
return them to you following surgery.
The nursing staff will wash and prepare the surgical site area. They
will also start an intravenous (IV) line. The IV provides a route for fluids,
medications and blood products, if necessary. It is also the main route
for your antibiotics to prevent and reduce the risk of infection. The IV
bag and tubing will likely be disconnected after 24 hours when your
medication is complete and you have tolerated fluids and food. We will
keep the IV access secured until you are discharged.

18



A PA and other members of your surgical team will take your latest
information and perform some additional safety cross-checks and
tasks. They will review the surgical consent with you and have you sign
the actual consent paperwork. Your surgeon will confirm your identity,
review and then sign your surgical site with a surgical marker. These
steps are an important part of the process designed to ensure patient
safety.
Your surgeon will provide more specific details and will make
arrangements to meet with your family in the Family Atrium following
surgery, or will make other arrangements to contact them. Please
provide the surgeon with specific contact information as to where and
how your family can be reached.
The Family Resource Line (212.774.7547) can be utilized if you would
like further information on what to expect the day of surgery.
Please encourage your visitors to call if they have any questions.

A Patient’s Guide to Spine Surgery

19



PATIENT INFORMATION
INTRAOPERATIVE MONITORING
Intraoperative Monitoring by the Department of Neurology
Your surgeon may request Intraoperative Monitoring (IOM) as part
of your surgical procedure. This specialized service, provided by
the physicians from the Department of Neurology at the Hospital
for Special Surgery, is an additional tool to help keep your surgeon
informed about possible neurological complications during surgery.
The purpose of IOM is to reduce the risk of injury to the spinal cord
and to nerve roots during surgery by continuously monitoring the
ability of your spinal cord and nerve roots to transmit signals.
By using this procedure, we continuously monitor the function of the
spinal cord during the operation and are able to alert the surgeon if
there are problems arising in the nervous system. This is similar to an
EKG machine monitoring the heart during the surgery. In summary,
IOM can give your surgeon information about how well the nervous
system is functioning, including in those areas of your body where the
operation is taking place.
IOM is performed by skilled technologists, trained specifically to
manage this highly specialized procedure. The IOM signals obtained
by the technologist are monitored by a board certified neurologist
specially trained in intraoperative monitoring and neurophysiology,
either directly in the operating room or in a nearby control room.
About Costs
The fees for these services depend on the length of the operation and
on the type of services provided. The fees are billed separate from, and
in addition to, the hospital, your surgeon, and your anesthesiologist.
These charges will be submitted directly to your insurance company.
If you have any questions or concerns about the Intraoperative
Monitoring procedure, please contact our IOM Coordinator at
(212) 606-1047.

20



Hospital for Special Surgery
Intraoperative Monitoring Attendings:

● Ronald G. Emerson, MD, Director
● Dora K. Leung, MD
● Erin Manning, MD
● Brion D. Reichler, MD
● Teena Shetty, MD

A Patient’s Guide to Spine Surgery

21



Anesthesia
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. Oftentimes,
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.
The Operating Room: Surgery/Anesthesia
After your consultation with the anesthesiologist, you will be taken
to the operating room by a nurse. Once there, your anesthesiologist
will measure your blood pressure and heart rate and will begin giving
you sedative medication. Soon after initiation of general anesthesia,
your anesthesiologist will insert a breathing tube, which is necessary
and essential for your safety during surgery. In certain instances,
your anesthesiologist may decide to insert the breathing tube under

22



light sedation in order to ensure that you are breathing well and/or to
minimize stress on your spine. The surgery will begin after a deep stage
of anesthesia has been achieved.
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.
After Surgery
In the Post-Anesthesia Care Unit (PACU), also called the Recovery
Room, you will be given oxygen, and your vital signs (breaths, heart
rate and blood pressure) will be monitored. The team will also focus
on managing your pain so you will be comfortable when you begin
rehabilitation. Once in the PACU, the person that accompanied you
will be provided an update. To maintain patient privacy, as well as to
reduce the risk of infection, PACU visits are limited. These visits will be
facilitated through the Family Atrium patient liaisons. One visitor at
a time will be allowed during visits. Children under 14 years of age are
not permitted. Cell phone use and picture taking is not permitted in
the PACU.
When the anesthesiologist determines that you are sufficiently
recovered, your vital signs are stable and pain is well managed after
surgery, you will be transported to an inpatient unit. While most
patients are transferred to inpatient units, some remain overnight in
the PACU for additional monitoring and observation.

A Patient’s Guide to Spine Surgery

23



Spiritual Support
HSS formally recognizes the role that spiritual support can play in
coping with and recovering from physical illness. To help meet your
spiritual and emotional needs, HSS provides a chaplaincy service as
an integral part of the healthcare team. The chaplains are here to serve
you and your family. They provide pastoral support in any faith. Please
call 212.606.1757 to contact the HSS Spiritual Care Office.
Private Nursing Service
If you wish to have a private nurse during your Hospital stay, please call
212.774.7187 to arrange for this service.

24



VISITOR CODE OF CONDUCT
When visiting our patient care units, we ask that you follow the visitor
code of conduct for the safety and well-being of our patients.
1. Please be advised that all visitors under the age of 14 are
not permitted.
2. Limit the number of visitors to two at a time for each patient.
3. Sleeping in patient rooms is not allowed. Please note,
semi-private rooms are not equipped to accommodate
visitors wishing to spend the night
4. If the patient you are visiting is sharing a room, please
be mindful of the other patient’s privacy and need for quiet.
5. Plan on spending just a short time visiting. Although the visit
is almost always welcome, it can be very tiring for the patient.
6. Carry on a cheerful conversation in a soft tones.
7. Please silence your mobile phone while visiting.
8. Do not visit if you are unwell, particularly if you have cold or
flu-like symptoms or if you have had a stomach upset in the
last 48 hours.
9. For the patient’s safety, please do not assist patients out
of bed. Please contact a clinical staff member for assistance.
For any questions related to the Visitors’ Code of Conduct
please contact us at 212 774 7547.
Quiet Time
Please help to promote healing by observing quiet time from
10:00 pm to 6:00 am.
During that time, please use soft tones while communicating with
your loved ones. Please silence your phones and minimize the volume
on your TVs.
Thank you and speedy recovery!

A Patient’s Guide to Spine Surgery

25



RECOVERING IN THE HOSPITAL
Managing Pain
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 and physical
therapy.
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.
How Does it Feel?
Pain management begins with you. Since no objective tests exist to
measure what you are feeling, you must help the staff by describing
the pain, pinpointing its location, and judging its intensity, as well as
reporting any changes. Pain may be constant or sporadic, as well as
sharp, burning, tingling, or aching. A pain scale is used to help you and
the staff gauge the level of pain and effectiveness of treatment.
People used to think that severe pain after surgery was something
they “just had to put up with.” While it is reasonable to expect some
discomfort following surgery, the current treatment options greatly
reduce the level of pain most patients have.
Your description will help us provide you with a plan of care. Even under
your personal Pain Management Program, your pain level may change
at times. Be sure to tell your nurse if it becomes worse.

26



You will be asked to rate how much pain you have on the Pain
Scale below:

PAIN SCALE
0
1 2 3 4 5 6 7 8 9
10
No Pain

Worst Pain Ever

Your Treatment Plan
Pain control following surgery is an important part of your care.
The pain management team will use a multi-faceted approach to
manage your pain. This may include a combination of oral medications,
injections, IV medications, and catheters connected to computerized
pumps with a button that is controlled by the patient (Patient
Controlled Analgesia or PCA). We try to refrain from giving injections,
but sometimes this is unavoidable. The goal is to try to recognize and
treat your pain quickly, which allows you to participate in the exercise
program.
The plan is to transition you to oral pain medications. Usually the oral
pain medication is an opioid or narcotic, but whenever possible, an
anti-inflammatory medication will be ordered as well. This transition is
usually a smooth one, enabling you to progress with your activities with
minimal discomfort.
If you have had a spinal fusion operation your surgeon may request
that you refrain from taking anti inflammatory medications for a period
of time following surgery. Inflammation is part of the healing process
and these medications may slow your fusion healing process.
Every patient’s experience is unique. So, if you need pain medication,
tell your nurse as soon as the pain starts. Keep in mind that your pain
is easier to control if you do not allow it to become severe before taking
pain medication. Usually medications are available every three to four
hours as needed. Sometimes turning and repositioning can relieve
pain, so let the staff know about what makes you more comfortable.
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27



It is extremely important that you inform your
anesthesiologist about any problems encountered
with medications of any type in the past and if you
are currently using prescription medications for pain.

Regardless of which pain relief method is started, if you are not getting
pain relief, please notify your nurse or doctor. We want you to be as
comfortable as possible while you heal. Being able to participate in your
own recovery activities is a goal of the recovery process.
What Is Patient-Controlled Analgesia
(PCA)?
PCA is a type of pain medication delivery
system which utilizes a microprocessor
(computerized pump) to give a prescribed
amount of medication at desired intervals.
A special pain management team
consisting of anesthesiologists, nurses
and pharmacists supervises your use of
the medication.
The pump is programmed to deliver a
pain medication either when you push the
button (demand dose) or by a continuous
flow (basal rate). It can be attached
PCA Pump
through either your intravenous line
or epidural tubing in your back during your surgery. It is called “Patient
Controlled” because, if needed, you can press a button attached to the
pump to give yourself a dose of pain medication.
Precautions against an overdose have been incorporated into PCA. The
pump is programmed not to deliver the dose of pain medication requested
if it is not time to safely do so. There is an hourly limit of medication
available. The PCA system automatically records both the doses delivered
and denied. Your nurse checks this machine frequently and records the
28



amount of medication used. If you are having pain after using your PCA
hourly limit, tell your nurse. The nurse can call the anesthesiologist or
other members of the pain management team who will check on you and
adjust the medication or PCA settings as needed.
The nurses regularly check on you to evaluate your level of pain relief and
assess for side effects. An anesthesiologist visits daily when you are on the
PCA pump, even if your pain management is going well. If any problems
arise, an anesthesiologist is on call 24 hours a day, 7 days a week.

Oral Medication
After surgery, as pain decreases, you will be given oral pain medication
to control any discomfort and pain.
Cold Therapy
The application of cold has been shown to reduce swelling and pain
associated with inflammation at the surgical site. Ice packs or cold pads
should be applied for 20 minute intervals every 3 to 4 hours on a daily
basis for the first few weeks following surgery.
Deep Breathing
It is extremely important to perform deep breathing exercises after
surgery to rid your airway and lung passages of mucus. Normally, you
take deep breaths almost every hour, usually without being aware of it,
whenever you sigh or yawn. When you are in pain or are drowsy from
anesthesia or pain medication, your breathing may be shallow. To ensure
that you take deep breaths daily, the nursing staff will provide you with a
device called an incentive spirometer, along with instructions on its use.

A Patient’s Guide to Spine Surgery

29



How to Use the Incentive Spirometer
1. Hold the incentive spirometer in an upright position.
To start, breathe out (exhale) normally. Then close your
lips tightly around the mouthpiece.
2. Take a slow, deep breath in (inhale). Breathe in as deeply as you
can. When you breath in, try to keep the yellow cup in the BEST
to BETTER flow range. The white piston in the main chamber
moves up slowly when you breathe in to measure how deep your
breaths are. Try to move the white piston as high up as you can.
3. Relax, remove the mouthpiece and then breathe out normally.
The white piston will slowly fall to the bottom of the chamber.
4. Rest for a few seconds. Repeat this exercise at least 10 times
every hour while you are awake.
Inhaling raises
the white piston

30



Preventing Blood Clots
After surgery, blood clots, called deep vein thromboses (DVT), may
form in the leg veins. In rare cases, these leg clots travel to the lungs,
where they may cause additional symptoms. To prevent and reduce the
incidence of clot formation, mechanical devices (foot or calf pumps)
are used while you are in the hospital to squeeze the leg muscles, thus
maintaining blood flow in the veins.
Leg Swelling
For the first month after your lumbar spinal surgery, prolonged sitting
with your legs in the down position will tend to worsen swelling of the
feet. Try not to remain in one position for longer than 45 minutes at a
time. Periods of walking should be alternated with periods of elevation
of your legs. Lying down for an hour in the late morning or afternoon
will help reduce swelling and give your body the rest needed for
healing.

A Patient’s Guide to Spine Surgery

31



TIPS FOR A SUCCESSFUL RECOVERY AT HSS
Physical Therapy
• Participate in physical therapy daily.
• A physical therapy schedule is available by 8:30 am 7 days a week.
Ask your nurse when you are scheduled for therapy so you can be
prepared and ready to participate.
• Please note that your scheduled PT time is approximate.
Patient Safety and Falls Prevention
• Do not get out of bed by yourself! Always ask for assistance.
• HSS has developed a Safety and Falls Prevention pamphlet that
you should read. If you don’t already have one, ask your therapist
for a copy.
Bathroom Privileges
• Once you are able to tolerate being out of bed for at least
20 minutes, you will be safe to use the bathroom with assistance.
• If possible, use the bathroom prior to physical therapy so you can
use your treatment session to improve functional mobility.
• Bedside commodes or bedpans are alternatives to getting out of
bed to use the bathroom.
Inpatient Unit Visiting Hours
• 24 hour visitation permitted.*
• 2 visitors per patient at a time.
• Visitors under the age of 14 are not permitted in inpatient units,
PACU or pre-op areas.
• Sleeping in patient rooms is strictly prohibited.
• For patient safety, please do not assist patients out of bed.
Contact a clinical staff member for assistance.
*Visitation subject to restrictions based on patient care needs.

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REHABILITATION AND MOBILITY
AFTER SPINE SURGERY
Your rehabilitation program will begin once you are medically stable
and there are orders from your doctor to begin post-operative mobility.
This is based on the type of spinal surgery you have had. You might be
getting out of bed a few hours following surgery. For some patients,
rehabilitation will begin the day of surgery, for others it will start the
day after surgery. Everyone will begin rehabilitation within 24 hours of
surgery or per your surgeon’s plan.
It is critical to understand that motivation and participation in your
physical therapy program is a vital element in the success of your
surgery and your overall recovery. It is imperative that you play an
active role in your recovery and rehabilitation from the start!
Rehabilitation Team
The rehabilitation team consists of:
• Physical Therapists
• Physical Therapist Assistants
• Occupational Therapists
• Mobility Technicians
The goals for physical therapy are to:
• Help regain independence with mobility.
• Establish an independent home walking program.
• Educate on proper body mechanics and spine precautions.
• Assist with discharge planning.

CALL DON’T FALL

Always make sure to ring your call bell for staff assistance
getting in and out of bed.
• A staff member must remain within your reach while
maintaining your privacy and dignity during toileting.

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33



Beginning to Walk
Walking is the #1 exercise following any spinal surgery.
Your therapist will assist you in sitting up with your feet over the
bedside (we call it dangling). You will then stand with the use of a
walker and the continued help of your therapist.
As the days progress, you will increase the distance and frequency of
walking. Most patients progress to a straight cane within a few days
after surgery.
Looking Ahead
Before leaving the hospital, you will be instructed in a home exercise
program.
Remember, you make the difference!
Your participation in a physical therapy program is essential to the
success of your surgery. The more committed and enthusiastic you
are, the quicker your improvement will be.

Physical Therapist:
HSS Inpatient Rehabilitation Department: 212.606.1221

34



PRECAUTION GUIDELINES
Understanding the Dos and Don’ts Following Spinal Surgery
Precautions are in effect during your recovery period, which is
approximately six weeks. Maintain your precautions until they
are discontinued by your surgeon.




Do
1) Do listen to your body while performing functional
movements or activities. Gradually increase your
activity level, being sure to also rest as needed during
the day. Know what your limits are.
2) Do walk and gradually progress the distance and
frequency as tolerated.
3) Do wear your brace if prescribed by your surgeon.
4) Do sit in a sturdy chair with arms in order to ensure
good posture.

Don’t
1) Don’t lift heavy objects. Be sure object weighs less
than five lbs (e.g. one gallon of milk).
2) Don’t force any extremes of motion, especially with
bending, twisting, or rotating.
3) Don’t sit for more than 30-45 minutes at a time.
4) Don’t spend a prolonged time in any position during
the day. Change positions frequently to avoid
discomfort and strain on your back.
5) Don’t sit in low, soft chairs or recliners.

A Patient’s Guide to Spine Surgery

35



BACK PRECAUTIONS

36



PROPER POSITIONING AFTER YOUR SPINAL SURGERY

Sleeping Positions

pillows under head

pillows under knees

pillow under head

pillows or blanket
between knees

A Patient’s Guide to Spine Surgery

37



MOBILITY THROUGHOUT YOUR HOSPITAL STAY
EXERCISE
• You can perform ankle pumps and quad sets while in bed
• 10 repetitions of each exercise every hour
• It is normal to experience some stiffness and mild soreness in various
muscles while you exercise as your body adapts.
1) Ankle Pumps: Purpose: To promote blood circulation in the lower legs
• Lie on your back with
both legs straight.
• Bring your feet upwards,
“toes to your nose,” moving
them from the ankle.
• Now point both feet downwards,
like pressing on a gas pedal.
• Make sure to move the feet and
ankles up and down through the
full range of motion.
2) Quadricep Set: Purpose: To help strengthen the front thigh
muscles (quadriceps).
• Lie on your back with a small
towel under the knee on the
operated side. A towel under
the knee is optional, and may
improve comfort.
• Slowly tighten your thigh muscle
(quadriceps) by pushing the
back of your knee down into
the bed.
• Do not let your heel come off the bed.
• Hold this contraction for five seconds, and then slowly release.
• Rest between each contraction.
38



SITTING POSITION
• Do not sit for more than 30-45 minutes at a time.
• It is important that you start sitting out of bed for short
periods of time as soon as you can tolerate it.
• Be sure that feet are supported on the floor.
• Support your spine on the back of the chair or with a pillow.

It is important to change positions throughout the day.
Avoid prolonged time spent in any position during the day.

REMEMBER!
Do not get out of bed without assistance!!

A Patient’s Guide to Spine Surgery

39



TRANSFERS
A “log rolling” technique will be used to get in and out of bed:

Bend your knees

Roll to one side

Push yourself up using your arms

Your physical therapist will also instruct you in sit-to-stand transfers
from your bed/chair as well as tub/shower and car transfers.

40



AMBULATION
Walking will be one of the major focuses of physical therapy.
• Walking is the main exercise after spine surgery
• Avoid hills, ramps, and uneven surfaces
Walking will begin with a rolling walker, and you will progress to
a cane or no device when you are comfortable and safe. Safe
negotiation of stairs will also be reviewed prior to your discharge
home. It is helpful to have a handrail to hold onto for safety.

OCCUPATIONAL THERAPY
In order to prepare you for returning home, an Occupational
Therapist will instruct you in functional activities, such as bathing,
showering, and toileting.
General information can be found in the Rehabilitation Network
section of the www.hss.edu website.

A Patient’s Guide to Spine Surgery

41



PREPARING TO RETURN HOME
The majority of patients who undergo spine surgery are discharged from
the Hospital once they reach their discharge goals. Many patients are
discharged home following their hospitalization.
How the Hospital Can Help
As soon as you decide to have spinal surgery, you must look ahead
and plan for discharge and home recovery. Preparing enables you
to concentrate on your main task—getting well. To help you plan
for discharge and home recovery, the Hospital’s Case Management
Department is available at your request.
A Case Manager is available to you prior to surgery to address any
concerns you may have about your discharge from the Hospital.
The case manager will review the alternatives available to you
based on your medical condition, home and healthcare needs,
care arrangements you have already made, geographic location,
insurance coverage, and financial situation.
Some of the ways the Hospital Social Work Case Manager can
assist you include:
• Helping you to cope with illness or disability
• Discharge planning
• Assessing your eligibility and advising you on benefits you may
be entitled to, including SSI (Supplemental Security Income), SSD
(Social Security Disability), Medicaid, and New York State Disability
The Social Work Case Manager will discuss your post-discharge needs
in consultation with your surgeon and other members of your primary
healthcare team. Your involvement is essential in formulating
a discharge plan that will suit your needs.


42



Final Steps: At Home
GUIDELINES FOR RECOVERING AT HOME
Please do not hesitate to contact your surgeon with any questions you
have about the following instructions.
Consult with your internist about duration and dosage of iron (ferrous
sulfate) after your discharge.
Caring for the Surgical Site
1) A clean, dry dressing can be applied over the incision until your
staples, sutures, or steri-strips are removed. The surgical wound may
be open to air, unless a brace is ordered. A light gauze dressing with
paper tape may be placed over the wound to protect it.
2) After suture or staple removal, leave the incision uncovered unless
instructed otherwise.
3) Please inform your surgeon if you notice increasing redness
or drainage from your incision.
Pain Medication
1) Take your pain medication as prescribed, but expect to use
less after the first week or so.
2) Take your pain medication before the pain becomes severe.
Use cold therapy and other measures to help reduce discomfort.
3) If your pain medication seems weak or you are experiencing
unpleasant side effects, do not hesitate to call your surgeon’s office.
4) If you are taking pain medication, avoid alcoholic beverages.
5) It is important to notify your team if you require additional pain
medications. The surgeon and nurse practitioners will customize
your plan to meet your needs. Call the surgeon’s office before your
supply runs too low, 1-3 days before you are likely to run out.
No medications will be refilled on weekends.

A Patient’s Guide to Spine Surgery

43



PHYSICAL THERAPY: REGAINING INDEPENDENCE
If you experience discomfort during your ongoing physical therapy,
take your pain medication at least 45 minutes prior to your subsequent
therapy sessions. This will allow enough time for the medication to
take effect.
1) Walking is the main exercise when you leave the Hospital; monitor
the walking distance and gradually progress distance and frequency
as tolerated.
2) Use long-handled devices if you need to, in order to avoid excessive
strain on your body.
3) A referral will be made for a home physical therapist on an
as-needed basis.
4) At your follow-up visit, your surgeon will determine if you need to
have outpatient physical therapy. This can be provided at HSS, if you
can arrange transportation to our physical therapy center on 70th
Street. If this is not convenient, we can make a referral for outpatient
physical therapy at a physical therapy center in your community. To
obtain services at these facilities, you will need a prescription from
your surgeon, and in most cases, authorization from your insurance
provider.
ACTIVITIES OF DAILY LIVING (ADLS)
Toileting
A raised toilet is recommended for ease of getting on and off the toilet
and to ensure you’re comfortable.
Showering
You are allowed to shower once your surgeon has cleared you to do so.
Please follow the instructions provided by your surgeon’s team in order
to protect your incision.
Your physical therapist will be able to provide you with instructions and
tips on showering according to your bathroom set-up.

44



Shoes
Rubber-soled shoes that can be slipped on are recommended because
you will be unable to bend over to tie your shoes after surgery. Elastic
laces are available for sneakers so that they can be more easily slipped on.

Dressing
The use of adaptive equipment for dressing may make you feel more
comfortable and will allow you to maintain your precautions.
sock aide

elastic shoelaces

shoe horn

reacher

long handled sponge








You may purchase these items from your local surgical supply store, online, or from our vendor.
We recommend that items are purchased prior to surgery.
To order items from our vendor, BioDynamic Technologies, please visit the website
https:/
/www.biodynamictech.com/shop/
You have the option of having the items shipped to your home or a family member/friend
can pick up at BioDynamic Technologies conveniently located close to HSS.

BioDynamic Technologies: 431 East 73rd Street NY, NY 10021 on the Northwest corner of 73rd Street and York Avenue.

A Patient’s Guide to Spine Surgery

45



STRATEGIES TO REDUCE
POSTOPERATIVE SWELLING
Swelling is common after surgery. The more swelling you have, the
more pain you may have, and the more difficult it may be to move.
Therefore, it is important to minimize the harmful effects of swelling
to enhance your recovery.
To reduce swelling, apply cold therapy to either side of the surgical site
for the first two weeks for 20 minute intervals. After two weeks, ice for
20 minute intervals before and after walks, when soreness or pain is
present, or after exercise.
If you advance your activity too quickly or overdo it, your neck or back
may become more swollen.
Here are some suggestions that will help reduce swelling if it occurs:
• Daily naps, during the late morning or late afternoon, are
helpful in enabling your body to heal.
• Move your ankles up and down (ankle pumps).
• Limit your sitting time to 45 minutes to an hour at any given
time. Get up, walk around, and then return to sitting.
• Ice your neck or lower back—ice may be in the form of ice chips
or cubes wrapped in bags or towels, or commercial cold packs.

46



SEXUAL ACTIVITY FOLLOWING SPINAL SURGERY
Patients and their partners may have concerns about sexual relations
after spinal surgery. The following information may answer some
questions, but please feel free to ask your surgeon, physical therapist,
or nurse if you have other concerns.
Will I be able to resume sexual activity?
The vast majority of patients are able to resume safe and enjoyable
intercourse after spinal surgery. However, as you know, the spine is an
integral part of many forms of intercourse. Therefore, following spine
surgery, you must review the process.
When can I resume sexual intercourse?
Time must be allowed for the surgical incision and muscles within your
back to heal and the pain to alleviate or disappear. However, there are
various types of spinal surgery, and rates of recovery from each may
vary. You should not resume intercourse by any method that utilizes
your back until your doctor gives you permission. Do not hesitate to
discuss your concerns regarding your readiness.
What positions are safe for me during intercourse?
Proper body alignment, which should be observed during all activities
of daily living, also governs sexual intercourse. You must avoid twisting
or bending your back. So first, think about how this affects your
present method(s) of intercourse. If a change is necessary, begin
thinking about alternatives. There are, of course, many ways of
providing sexual gratification to both persons.
What should I tell my partner?
Good communication between you and your partner is essential,
because both of you may have to adopt new position(s) for intercourse.
We suggest you discuss this with your partner before the time arises.
Review how proper body alignment of your back limits movement, and
how it affects position(s) for intercourse you have traditionally used.
Perhaps you can discuss practical alternatives in advance. In any case,

A Patient’s Guide to Spine Surgery

47



bringing up the subject early will make adopting new methods easier
when the time comes. You may want to experiment.
Take the initiative!
To have concerns about sexual activity after spinal surgery is
completely normal. Your eventual method(s) must protect your back,
while providing pleasure for you and your partner. We hope that you
will feel comfortable in taking any new initiatives necessary to meet
your mutual needs. However, if you or your partner have questions,
please feel free to discuss them with your surgeon, nurse, or physical
therapist.
Finding a “Safe” Position
Following spine surgery, every safe position for sexual relations
must be based upon maintaining proper body alignment. Note the
practically of the positions below. Just as importantly, note how the
person who has had back surgery utilizes pillows and/or folded
towels to help maintain proper body alignment. Think about how
you can adopt them to help set up and maintain proper alignment
in your desired positions.
Note the folded towel under his back, the cushion under the knees,
and the pillow under the head to maintain alignment and comfort.
She is supporting her weight and controlling movement with her arms
and legs. The partner must obviously restrain from stressing his back
with too much motion.

48



In this illustration, the folded towel under the stomach and the
support under each of her spread legs helps to maintain alignment.
The partner supports their own weight and controls their movement
with their arms and legs. Restraint should be exhibited to prevent
jarring the back.

Note that while lying on the side, the pillow is underneath the head,
the towel is under the waist, and pillows are under the upper knee to
help maintain a comfortable body alignment. The partner’s weight is
not a problem, but again, restraint should be used to prevent jarring
of the back.

A Patient’s Guide to Spine Surgery

49



ADDITIONAL DISCHARGE INSTRUCTIONS
• You may have physical therapy at home if it is prescribed by your
surgeon. If so, the physical therapist will come to your home and
will advance your exercises and walking program as tolerated.
• Gradually increase your walking distance daily. A daily walking
program on level surfaces is an essential component of your home
exercise program. Avoid hills, steep ramps, and uneven surfaces.
• Once your mobility has improved, you may consider continuing
physical therapy at an outpatient physical therapy center to
continue to increase strength and endurance.
• You can stop using your assistive device when you can walk
relatively pain-free and without a limp, or when advised to do
so by your physical therapist or surgeon.
You will receive additional information regarding physical
therapy from your surgeon’s office.

50



CONCLUSION
The Patient Education staff and members of the Spine Service at HSS
hope that you find this booklet helpful on your journey to recovery.
Spine surgery is indeed a journey. Its endpoint—improved health and
mobility—is well worth the effort. We stand ready to assist you every
step of the way. If you have any questions, please feel free to ask any
member of our staff. Your well-being is our first concern. We encourage
you to seek out additional information that is located on the HSS
website at www.hss.edu. There will be many opportunities to review
the material provided in this booklet. During each visit, the staff will
reinforce the information and will likely provide additional and more
specific instructions. In addition, our Patient Education staff will review
the information during the pre-operative education class and will
respond to any questions that you may have.
Can We Help Someone Else?
Now or later, you may have family members or friends who may
need the services of an orthopedist (in any specialty area) or a
rheumatologist. An easy way for them to get in touch with Hospital
for Special Surgery is to call the HSS Physician Referral Service at
1.800.854.0071.

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51



Providing Feedback to HSS
You may be able to help us!
Hospital for Special Surgery has achieved a national reputation for
excellence in orthopedics, rheumatology and patient-centered care.
All of us on the HSS team strive to provide you with the care you need
to achieve the best health outcomes.
Feedback from our patients has been a critical component in achieving
this excellence. We listen. And we respond…especially when we learn of
new opportunities for further improvement.
Another important part of achieving excellence is to know when things
go right! We also want to know when our staff members
provide outstanding care.
When you have a moment to reflect, we would appreciate your
feedback. You can, of course, send a letter or note to any HSS staff
person, or to your doctor. You already know your doctor’s address.
He or she appreciates hearing from you.
To address a Hospital staff person whom you know, you can write to
that person at the Hospital’s address below. Or, you can contact us
through the Hospital’s website. Otherwise, please feel free to address
your feedback to:


Louis A. Shapiro, FACHE

President & Chief Executive Officer

Hospital for Special Surgery

535 East 70th Street

New York, NY 10021
Thank you for choosing Hospital for Special Surgery for your surgery.

52





535 East 70th Street
New York, NY 10021
tel 212.606.1000
www.hss.edu

Hospital for Special Surgery
is an affiliate of Weill Cornell
Medical College.

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