How Recovery After Spine Surgery May Be Faster and Safer Than Ever Before.

Historically, patients who needed spine surgery could expect a long recovery process, often with a week-long hospital stay. Today, Enhanced Recovery After Surgery (ERAS) protocols are helping patients return to work and life faster and with better outcomes. For patients who are healthy and motivated to take an active role in their care, ERAS protocols offer many advantages over traditional spine surgery recovery, including:

• Fewer complications
• Shorter hospital stays (and sometimes no hospital stay)
• Less pain during and after surgery
• More positive patient experiences
• Better long-term results

ERAS protocols are evidence-based, meaning they've been peer-reviewed and proven successful in real-life surgeries. While the "fast-track" recovery strategies aren't new to orthopedic surgery, they've only recently been applied to spinal surgery under the care of experienced teams trained to implement modern ERAS principles. Teamwork is critical to expedited recovery, requiring collaboration between the patient and specialists across different disciplines before, during, and after the procedure.

 

Patients play a critical role in enhancing spine surgery recovery.

Under ERAS protocols for spine surgery, your recovery plan begins before you even step foot in the operating room. At MedStar Orthopaedic Institute in Baltimore, we provide every patient with preoperative education and counseling designed to educate the patient on what to expect. Many patients share that going through the program helps them to feel equipped to be active participants in the healing process.

Patients are also asked to participate in pre-surgery rehabilitation, or prehab. The prehab program improves the body's overall strength and function before surgery, allowing you to return to resume activity faster and more easily afterward. Every patient also benefits from a virtual consultation with our acute pain service. During the telemedicine visit, patients are asked about any current medications as well as their pain tolerance and goals. This information helps your care team anticipate your needs on the day of and the weeks after surgery.

Modifying lifestyle habits before spine surgery can also lead to an expedited recovery, and patients are encouraged to:

• Optimize their nutrition
• Achieve a healthy body mass index (BMI)
• Minimize or eliminate opioid, alcohol, and nicotine use

Patients don't have to make these changes alone, as each patient is matched to a care coordinator who will help you navigate your surgical preparation and recovery. Our care coordinators are specially-trained healthcare professionals who work closely with your physician and care team to help you return to your active life as seamlessly as possible. Together, you'll develop a plan for rehabilitation that will help you reach your goals after surgery. 

 

During surgery, your multidisciplinary team proactively manages pain and the risk of complications.

A lot has changed when it comes to back surgery. Traditionally, patients were required to fast before undergoing an operation on the spine. Now, evidence proves that food and drink help to prevent your gastrointestinal system from shutting down during a procedure. Your care team will give you instructions for when you should stop eating and drinking before arriving at pre-op. In general, most patients are able to drink clear liquids up to two hours before surgery and solids up to six hours beforehand. Some patients benefit from a carb-loaded drink given once they arrive for surgery.

There will be a team of medical professionals invested in your surgery, including your surgeon, an anesthesiologist, nurses, physical and occupational therapists, and counselors. When you arrive for your procedure, you'll meet with an anesthesiologist or nurse who will give you analgesics to help manage your pain and your body's stress response before you go into surgery. Whether you're having spinal fusion surgery or another type, back or neck surgery is major surgery that puts stress on the body. By using a combination of oral pain medication like Tylenol, non-steroidal anti-inflammatory drugs, and Gabapentin before the procedure begins, you're less likely to need opioid medications after surgery.

During surgery, your surgeon and anesthesiologist work together to minimize blood loss that could lead to anemia. You'll also receive a regional or local anesthetic (pain medication injections) directly to the surgical site, which helps to control pain during the procedure. This multimodal approach to pain control results in earlier mobility, less pain, and minimized need for narcotics to manage pain following surgery. And, unlike other surgical procedures, most patients don't need a catheter, eliminating your risk of developing a urinary tract infection (UTI).

 

Contemporary strategies for post-operative care significantly reduce nausea and vomiting, thereby speeding up recovery.

In the past, patients weren't allowed to eat or drink until a day after surgery which meant that their gastrointestinal function was at risk for a partial or complete shutdown. As a result, nearly 50 percent of patients experienced nausea and vomiting that led to a prolonged hospital stay and recovery.

ERAS principles after surgery encourage patients to eat and drink early, which helps to expedite the return of gastrointestinal function. In combination with other strategies, this helps to minimize nausea and vomiting and speeds up recovery because you can regain strength more quickly with good nutrition. Your anesthesiologist will continue to help control your pain using the same multimodal approach applied during surgery. Research suggests that patients who participated in ERAS protocols were dramatically less likely to need pain medicine one month after surgery.