NOTE: Content from existing site
The decision to proceed with surgery is not easy and should not be taken lightly. You, as the patient, should consider all non-operative treatments prior to any surgical intervention. This being said, if the patient decides that surgery is the last and only option, please review this important pre-operative information.
Infection Information
Prevention of infection is an important concern for patient’s undergoing spine surgery. For this reason several precautions are taken to prevent this complication. These can include:
- A thorough review of the patient’s medical history. This may include pre-operative clearance by an internal medicine physician
- Use of a bacteriostatic wash prior to surgery
- Pre-operative IV antibiotics as well as consideration for post-operative antibiotics tailored to the specifics of the patient’s case
- Use of preventative operating room technique/products all designed to decrease the risk of infection
- Closure of the wound that includes sutures and a skin glue
- Post-operative dressings that can include an occlusive tape dressing (ex: Ioban) will be changed by Dr. Taylor’s staff only.
- Antibiotics, tailored to the patient’s needs
- Detailed discharge instructions
- Post-operative follow up that may include office visits, phone calls and home nursing care if possible
Dr. Taylor feels that the hospital or any hospital is by definition a contaminated environment. Dr. Taylor has this opinion because many of the multi-drug resistant organisms such as MRSA and VRE are highly prevalent in hospital environments. Because health care providers must care for individuals with these infections as well as individuals who are not infected, you are at a greater risk of developing a dangerous infection while you remain in a hospital. For this reason, once your pain is controlled on oral medications, you can ambulate safely, and you have successfully voided as it relates to bowel and urinary function you should, in Dr. Taylor’s opinion, leave the hospital and go to your home which is a much cleaner environment than the hospital. If you have any additional questions about Dr. Taylor’s feelings on hospital acquired infections please ask a member of the Taylor Spine Team.
Medical Evaluation
Pre-operative medical clearance may be required prior to a major surgical procedure. This may include evaluation by the patient’s own primary care physician or can be set up with a locally based St. Louis internal medicine physician. This evaluation typically includes a thorough history and physical, but may also include blood work, a chest x-ray and EKG. The results of the work-up may indicate the need for a more detailed cardiac evaluation. It is not unusual that this thorough assessment may lead to the discovery of an undiagnosed medical condition.
Along with a medical evaluation, patients may be required to undergo a work-up from anesthesia. This is to assess the patient’s risk of undergoing general anesthesia, which is the typical form of anesthetic used in spine surgery. The anesthesiologist may also evaluate the patient’s previous reaction to anesthesia and be able to address questions.
Patients are required to bring a detailed list of medications to a pre-operative appointment for review. It is imperative that Aspirin, NSAIDS (Ibuprofen, Aleve, Advil, Excedrin Migraine) be held 7-14 days prior to surgery. We ask that any over the counter herbal medications also be held 7-14 days prior to surgery, since some of the over the counter substances may have an effect on surgical success. Patient’s taking Coumadin and Plavix will also need to hold these medications both pre-operatively and post-operatively, but the specifics regarding the length of time will be discussed with each patient and the prescribing physician.
EMG Neurophysiological Monitoring
Intra-operatively patients may have electrical impulses tested to evaluate any changes that may occur when the procedure is being performed.
After the patient is under general anesthesia, small needles will be placed at multiple locations into the muscles of the skin. Electrical impulses can then be monitored throughout the procedure.
BMP or Bone-Morphogenetic Protein
This is a product used to promote fusion in spinal surgery. It has been approved by the FDA for use in the lumbar spine in anterior (through the abdomen) surgery, but has been used for a number of years in other areas of the spine including posterior approach lumbar surgery and cervical (neck) procedures.
Although Dr. Taylor has used BMP in an off label fashion for a number of years, it is associated with swelling and other complications about which the patient should be aware. Specifically after neck surgery, swelling can result in problems with swallowing and breathing that may result in the need for intubation, anti-inflammatory medications, tracheotomy and the need for other neck surgery due to the swelling of tissues. The FDA has published findings in July 2008 listing 38 reported cases in the past 4 years of complications, of varying degrees, related to the use of BMP products in neck surgery. This being said, it is important that the patient understand that regardless of the use of BMP, certain risks, including those listed above, exist with any spine surgery.
Please refer to the additional documents provided for more in-depth information on the risks and benefits of BMP in spinal fusion surgery.
BMP by BAT (pdf)
FDA Public Health Note (pdf)
Prevalence-BMP Article (pdf)