Diagnosis treatment and recovery before an elective spinal procedure

Arrange a conference with the patient and his or her significant others before surgery. Important points to cover during this meeting include:

• Review patient's specific spinal problem and treatment alternatives

• Review pertinent diagnostic studies

• Explain specific surgical procedures using spine models (incisions, bone graft, implants, Food and Drug Administration [FDA] status of spinal devices)

• Discuss realistic expectations and goals of surgical treatment (pain relief, deformity correction, neurologic improvement, likely outcome of procedure)

• Discuss possible surgical complications, obtain informed consent, and document this process in the medical record

• Confirm arrangements for blood donation, cessation of aspirin and antiinflammatory medication, cessation of smoking, spinal monitoring, review of wake-up test (if needed), and orthosis (if needed).

• Order any additional imaging studies required for preoperative planning

• Review final recommendations and evaluations by consultants (anesthesiologist, internist, cardiologist, pulmonologist)

Outline events on the day of surgery for the patient and family: check-in procedures and waiting area, duration of surgery, and patient's postoperative location and status (ICU vs. step down vs. standard floor vs. outpatient; discuss need for postoperative ventilatory support (when appropriate). Arrange for hospital tour (if appropriate) Review anticipated hospital course/discharge arrangements: length of stay, discharge planning concerns, work-related issues, psychologic support during recovery period, and chemical dependency issues related to use of narcotic medication

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