As with hospitals in the US, the care of the patient is the primary responsibility of the hospital from admission to discharge. This is why it is very important for the doctor to work with good hospitals. Of course, Prof. Dr. Bertagnoli is responsible for the surgery. The municipal hospital in Bogen next to the ProSpine clinic and St. Elisabeth’s hospital in Straubing work closely with Prof. Dr. Bertagnoli to maintain high standards of patient care. However, the German system is a little bit different than the US system. Some of our US medical professionals, who come as patients, see this right away, but this difference has no affect on the quality of care. The dedication and professionalism of the nursing staff is the largest factor in patient care, and we know our hospital nursing staff excels in these areas.

After the OR, the patients are sent to the Post-Op until they are ready either for the normal ward or for the ICU. The anesthesiologist makes the decision to release from the patients from Post Op to the ICU and from the ICU to their rooms. Sometimes the patients stay overnight in the ICU. The most conservative and cautious criteria are used in making this decision.

Part of patient care after the OR is dependent on the patients. The patient must follow the instructions of the doctors and nurses for the best results. Unfortunately, some patients don’t follow these instructions and they risk a poor outcome of their surgery. Patients should never exceed a reasonable pain threshold in therapy or activity after surgery.

Although many patients wake up from with their back pain gone, pain management remains a concern after surgery. We do not want the patients to be in pain after surgery. Pain medication is provided. If you are in too much pain, you should notify the nurse, your patient coordinator and your doctor. However, we cannot know in advance which pain medication will work for you, so some rotation of pain medication may be necessary. If you have current pain medication, which works, the ProSpine doctors will most likely prescribe the same pain medication as you have taken previously.

It is absolutely mandatory to restrict your pain medication to those ordered by the ProSpine doctor, which may well be what your US doctor has already prescribed. Taking additional medication on top of the prescribed one is extremely risky. Doctors cannot be responsible for side effects or overdoses, which result from such a combination of prescribed medication and self-medication. Furthermore, it worsens pain control, if such combinations are applied. This is because the ProSpine doctor and the nurses will judge further analgesic needs based on how much of the prescribed medications were required. Taking your own medication “out of the drawer” will, of course, render under-estimation. So don`t do it! Talk to the doctor and the nurses.

The doctor does not release you from the hospital until you are able to take care of yourself. This is German law.

Our implant patients (cervical or lumbar) wear a flexible orthesis (collar/corset) after surgery. This is mainly to protect soft tissue, and to keep you from unintentional extreme movements. The orthesis restricts the motion of the spine – it does make you stiff like a plaster cast would. Thus, the (minimal) risk of early possible implant migration is further reduced. To date, we have had no migration issue with an implant migration related to post-op patient ambulatory movement. The orthesis also helps other implant patients deal with soft tissue and distraction pain.

Lumbar patients are especially susceptible to distraction pain up to a year after the OR, although normally the period of distraction is shorter than this or non-existent in many patients. "Distraction" comes from the intervertebral disc space being reestablished by the surgery and the implant. Muscles and ligaments must re-adapt to the new intervertebral spacing. Hence, muscle relaxants, warmth, and gentle physio stretching helps. How long a patient experiences distraction pain depends on many factors, such as how long they have had their condition, age and unknown individual factors.

A final evaluation is done at the ProSpine practice before the patient leaves the country. A schedule of follow-ups, which the patient should do after they have returned home, is also given the patient. Normally, it is three months, six months, one year, and then two years. Follow-ups consist of x-rays and questionnaires.