Spine surgery Cervical lumbar spine surgery Pre-operative and post-operative general knowledge A. What should be noted before cervical spine surgery? The site and scope of cervical spine lesions are different, and there are two types of surgical methods, namely anterior surgery done by the front of the cervical spine and posterior surgery done by the back of the cervical spine. The following preparations should be made before surgery: 1. Heart, liver, lung, kidney function and X-ray, CT, MRI and other examinations should be done after admission. 2.In order to adapt to the need of body position during surgery, practice of surgical position should be done. Patients with anterior cervical spine surgery need to perform tracheal retraction training under the guidance of doctors to minimize postoperative throat discomfort. 3.In order to ensure the stability of the neck after surgery, the patient is usually given a trial neck brace before surgery, and can wear the neck brace to move around on the ground the day after surgery. 4.Most patients are not used to urinating and defecating in bed, so they should practice using the urinal in bed before surgery. Smoking will stimulate the airway and increase the amount of sputum, and practice coughing and chest expansion exercises in bed to avoid complications such as lung infection after surgery. Precautions and rehabilitation exercises after cervical spine surgery and after discharge 1. Wear a neck brace to limit neck activities on the day of cervical spine surgery and avoid cervical extension and flexion and rotation, including head twisting and nodding. Pay attention to keeping the neck neutral and upright when turning over, but avoid twisting the neck. 2, 4-6 hours after waking up from general anesthesia, you can eat and drink water, with easily digestible liquid food and semi-liquid food as the main food. 3.The pain of cervical spine surgery incision is generally mild, and most of them do not need analgesic pump. 4.The stitches are removed and discharged from the hospital at about 5 days after surgery. Those with intracutaneous cosmetic sutures do not need to remove the stitches, and those with posterior cervical approach can be removed about 10 days after surgery, either at outpatient clinics or community hospitals. 5.After a week or so after surgery, after the pain in the neck and collar basically disappears, you should start to practice the collar and back muscles under the protection of a neck brace, which is helpful to improve the blood circulation of the neck and collar muscles, prevent the disuse atrophy of the collar and back muscles, and promote the recovery of muscle strength. Exercises for the upper limbs include shoulder, arm and wrist activities and fist clenching exercises, as well as training of fine hand movements, such as threading needles, tying clothes buttons, holding chopsticks, etc., or enhancing hand strength and flexibility through exercise ball exercises. Exercises for the lower limbs include contraction exercises for the quadriceps, leg lifting and kicking, etc. Patients can also practice walking with the accompaniment or assistance of family members and escorts to enhance the strength of the lower limbs and restore the function of the lower limbs as soon as possible. If the patient has difficulty moving on his own due to heavy paralysis, the family or escort should actively massage the patient’s limb muscles and help the passive movement of limb joints to prevent disuse atrophy and joint stiffness. If available, the above-mentioned functional exercise under the guidance of a physical therapist will be more effective. 6. Within one year after surgery, neck trauma should be prevented, including riding in a car and braking sharply. At the time of discharge, it is better to lie flat on the car (legs can be bent and lower limbs flexed). Discharge should be fully communicated with the doctor, one is such as discharge with medicine, discharge record, receipt invoice, diagnosis and leave certificate, etc.; the second is to clarify the precautions after discharge and the time and place to come for review. 7. It is generally required to come to the hospital for review at the expert outpatient clinic of the main surgeon at three months, six months and one year after surgery. Patients after cervical spine surgery should pay attention to the rest and health care of the neck not only during the recovery period of the disease, but also after the patient’s symptoms are completely eliminated and the disease is cured, prevent overworking, pay attention to avoid wind and cold, strain and trauma, and strengthen the exercise of the collar and back muscles, which is not only conducive to the early recovery of the disease, but also helps to avoid the recurrence of symptoms after the patient is cured. Third, perioperative precautions for lumbar spine surgery 1, preoperative precautions: preoperative training of urination and defecation in the prone position, practice of abdominal massage to prevent postoperative abdominal distension and constipation, deep breathing and effective cough training, preoperative wake up training, as well as methods of exercise for the lower limb muscles and lumbar back muscles. 2. Postoperative precautions: perform axial turning 6h after returning to the ward after surgery, take the sequence of lying on the left side at 45°, lying flat, lying on the right side at 45°, and change the position once for 2h. Keep the drainage tube unobstructed. Early postoperative active and passive training of the lower limbs, including ankle dorsiflexion and plantarflexion and active contraction of the quadriceps and triceps muscles, was performed. A chaperone is required to perform massage from the foot to the thigh of the affected limb. Effective coughing and sputum coughing should be performed. For those whose sputum is sticky and not easy to be coughed up, more water should be advised and fluid rehydration should be enhanced appropriately. Appropriate chest expansion exercise and deep breathing exercise should be done to promote blood circulation and regular back patting. 3, postoperative rehabilitation exercises: early postoperative straight leg raising training can reduce hematoma compression and adhesions around the nerve root, start doing straight leg raising exercises on the first day after surgery, and gradually increase the number and degree of straight leg raising. Wear a lumbar brace to get out of bed 2-3 days after surgery, pay attention to the movement of getting out of bed, stand firmly and walk slowly holding the bed, avoid over-twisting the waist or over-extension and over-flexion. The exercise method is to lay the patient prone on the bed, stretch the two upper limbs behind the back, lift the head and chest, make the head, chest and two upper limbs leave the bed, adhere to 3 to 4 times a day, gradually. Precautions before and after minimally invasive spine surgery 1. Stop using anticoagulants for at least 5-7 days for the purpose of reducing intraoperative and postoperative bleeding to form hematomas 2. Adjust blood glucose to less than 8 on fasting and less than 10 after meals. 3.No infectious diseases, such as cold, fever and periodontitis, etc. should exist. The surgical area must not have infectious skin diseases or unhealed skin wounds. Post-operative precautions 1.Post-operative bed time: Patients receive local anesthesia under surgery, no need for resuscitation and other processes, in addition, the surgical wound is only 8mm, therefore, bed is only to stop bleeding, two hours after surgery can be free to move. 2. Repeated period (recovery period or edema period): The third day after surgery will start to appear the so-called:? “postoperative reaction”, which is manifested by the reappearance of preoperative symptoms or even aggravation, or new symptoms such as numbness, pain, soreness and weakness can appear. The duration can be very short or very long, ranging from a few days to 3 months or even longer. About 30% of patients will have various symptoms during the “recurrent period” after surgery, which can be reduced or avoided by strictly following medical advice. The symptoms of the recurrent period are various, but generally they are low back pain, hip pain, numbness, swelling, or soreness at the incision site, etc. A few patients have symptoms on the opposite side, most of them appear or are obvious when standing or sitting, and most of them can be relieved by themselves. If the symptoms are not relieved by bed rest or continue to worsen progressively, the MRI should be reviewed to see if endplate inflammation is present, and the treatment plan should be changed and the treatment period will be extended. Special notice: the “recurrent period” is not a relapse or ineffective treatment, but can recover on its own. The purpose of medication and rehabilitation within 3 months after surgery is to reduce or shorten the recurrent period, but there is no way to make all patients free from the “recurrent period”, so please make sure to follow medical advice. 3, imaging changes lag: after surgery, the symptoms improve first, then we can see the MRI, CT and other imaging changes, that is, the so-called “imaging changes lag phenomenon”. Imaging changes are usually after six months, and the main factors affecting this are age, length of medical history, whether or not the patient has received other excessive treatment, and whether or not the patient has been treated. The main influencing factors are age, length of medical history, whether the patient has received other excessive treatment, degree of prominence, severity of the disease, etc. 4, contraindications: no alcohol, no overwork within 3 months after surgery. Do not engage in long-term bending or prolonged squatting work or activities, such as long meetings, grass pulling, etc., within six months. Do not lie in bed for a long time after surgery, and it is best not to lie in bed for more than 10 hours. Otherwise, the symptoms will be relieved slowly. Do not play computer games for a long time, surf the Internet or play cards for a long time within 6 months. 5. Suggestions: You should keep in touch with your primary care doctor within 1 year after surgery in order to guide medication and rehabilitation exercises. Medication: It is recommended to use neurotrophic drugs, blood-strengthening drugs and anti-inflammatory and analgesic drugs for 3 months after surgery to facilitate the smooth passage of the “recurrent period”. Follow-up: After the surgery, you should come back for review and follow-up at the first month, three months, six months and one year. After the surgery, there should be proper functional rehabilitation exercises, which should be done gradually and according to the doctor’s prescription. If recurrence is caused by various factors such as poor rehabilitation and improper exertion, you can undergo minimally invasive surgery again because minimally invasive surgery, unlike open surgery, leaves a lot of scarring that hinders the second surgery or makes the second surgery more difficult. V. Why rehabilitation is needed after lumbar spine surgery Patients need to consider several issues after lumbar spine surgery: 1. how to give the best protection to the operated site so that the fused segment can be fused and stabilized as soon as possible; 2. surgery solves the nerve compression and static stability of the lumbar spine, then how to increase the muscle strength of the lumbar region without affecting the healing of the fused segment, that is, to increase the dynamic stability of the lumbar spine. 3.How to understand good living habits and the mechanical mechanism of using good body in order to reduce the unfavorable factors of the lumbar region and prevent the degeneration or instability of the adjacent segments of the operated segment due to biomechanical changes. Many measures of physical therapy can well address common postoperative problems, such as pain at the surgical site and nearby areas caused by scar adhesions, nerve root pain; muscle strength imbalance, reduction in joint mobility, poor posture, etc., and do their best to help patients reduce their pain and restore their function. VI. Frequently asked questions after lumbar spine surgery When after lumbar spine surgery, patients may have some questions. Below we list some common questions and answers and offer a few suggestions for rehabilitation. Studies have shown that the faster a patient resumes normal activities, the better the outcome of the surgery. 1. Will I have pain after surgery? There may be some pain after surgery. Patients can take some pain medication when needed. Resuming normal activities and exercising your low back muscles will help your recovery and reduce pain. 2.When should I start moving around? You should start to move as soon as possible after surgery. You can usually start to move in bed after waking up and stabilizing after surgery. 3.When can I resume normal activities? Functional exercise should be performed as soon as possible after surgery. When the patient is discharged from the hospital and goes home, he/she should also continue to exercise, gradually increase the intensity of the exercise and get used to it. There may be some discomfort at the beginning, but the situation will gradually improve with persistent exercise. Within 4-6 weeks after surgery, patients should avoid bearing heavy weights of 10 kg or more. 4. When can I participate in sports? Contact sports like soccer and rugby should be avoided because other athletes may hit the patient. Generally, sports can be played after 10 weeks of surgery. However, it is best to do exercises such as walking, biking, and light workouts before engaging in contact sports. Jogging is allowed and the time and distance of running can be gradually increased. 5.When can I participate in work? Participating in work as early as possible after surgery can help patients recover. Usually it takes 6 weeks before and after the surgery not to participate in work. If the patient’s job is sitting, he or she can return to work after 4 weeks of surgery. If the patient’s job is standing or manual labor, the patient can return to work after about 8-12 weeks of surgery. In short, the patient should not be in a hurry, but should gradually increase the intensity of work to meet the work requirements. 6.How long can I sit? It is recommended that you should not sit for too long in the early postoperative period. Sitting for a while and walking for a while can change the posture and make it less uncomfortable. 7.When can I drive? When the patient feels no discomfort and is confident that he or she can drive and can cope with the complexities of driving. It is recommended not to drive for a period of time after surgery because the anesthetic effect may make the patient less responsive when driving. If the patient has significant leg weakness or persistent numbness in the legs and feet, it is recommended to wait a while before driving. 8. Important information (1) Functional exercise should be started as early as possible after surgery, as this will effectively reduce the patient’s pain; (2) Early return to work is generally beneficial for the patient, helping the patient’s recovery and leading to better clinical outcomes.