After the OR
Immediately following the operation all patients are brought to post-op area. Here they are closely watched. Following the post-op the patient is brought either the ICU or returned to their room. This decision is made by the anesthesiologist and depends on the condition of the patient and the severity of his/her surgery. The greater the surgery the more likely the patient is to spend the night in the ICU. In very severe surgeries the patient is sometimes left sedated until the next morning. This is an additional safety measure and gives the patient some pain relief.
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. Not doing so risks a poor outcome of their surgery. Even though the patient may feel very good, patients should never engage in activities that exceed a reasonable pain threshold in therapy or activity after surgery.
Although most patients wake up from with their back pain gone or nearly gone, yet still having discomfort from the surgery. However, patients with a long history of pain are more likely to feel pain either due to previously damaged/irritated nerves, pain chronification or the development of pain sensitivity due to long exposure to pain. Pain is also a matter of subjective perception. Although no surgeon can fix damaged/irritated nerves, pain management after surgery is known to help patients with their perception of pain. If the patient is in too much pain, the patient should notify the nurse, your patient coordinator and/or the doctor.
Pain management after surgery is an ongoing effort. All pain medications are provided by the hospital to control exactly what pain medication the patient is receiving. 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. However, if they do not work, the may order different medications.
It is absolutely mandatory to restrict your pain medication to those ordered by the hospital doctors. 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, taking unknown pain medication worsens pain control. 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 will 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 gently restricts the motion of the spine – it does not 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. We know this is not the case world-wide. The orthesis also helps other implant patients deal with soft tissue and distraction pain.
A small minority of ADR patients are susceptible to distraction pain up to a year, possibly two, after the OR, although normally the period of distraction is shorter than this or non-existent in most patients. "Distraction" comes from the intervertebral disc space being reestablished by the surgery and the implant. Muscles and ligaments must re-adapt to the restored 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. This is also experienced by fusion patients.
A final evaluation is done 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 and there is no need to return to see the professor for regular follow-ups.