your guide to spine surgery · spine care ph: 212-746-2152 fax: 646-962-0640 ali baaj, md...

Center for Comprehensive Spine Care

YOUR GUIDE TO SPINE SURGERY

The Weill Cornell Medicine


888-922-2257

WELCOME ………………………………………………………………………….……........................................3NEUROLOGICAL SURGERY......................…………….………………………………………………………... 4 AttendingSpineSurgeons……………………………………....................…………......4 AdvancedPracticeProviders...…………………….……………...............................5 SpineCenterCoordinator………………………..………………...............................5WHO’S WHO..…….........................……………….…………….….................................................... 6PREPARING FOR SURGERY ……………………………..………………..............................………….….... 7 TheMonthBeforeSurgery—YourChecklist……………………………………......………....…..7 PreoperativeEvaluationandPaperwork.…….….............................…………….7 Imaging…………………………………………….………...........................….………………7 Insurance.…………………………………………………………………….............……………… 7 Medications.……………………………………………………………………...................…….7 OverallHealth……………………………………………………………..............………………8 HomeSafetyEvaluation………………………………………..……….……........………….8 FamilyMember/CaregiveSupport…………………………...……………….............…9 PrivateRoom&PrivateDutyNursing.…………....………………………………..……..9 MyChart………………………………………………………………………............................9 TheDayBeforeSurgery………………………………………………………………..........….…………9 PreoperativePhoneCall……………………………………........………………….…………9 WhattoBringtotheHospital…………….…………………………….…..............…...10 TheDayofSurgery..……………………………………………..................................................10 Check-In.………………..………………………………………………..…....................…......10 InfectionPrevention……..………………………………..…………………..........………...10ANESTHESIOLOGY...………………..….……………..……………...…………..........................................11 AboutAnesthesia...................................................................................................11AFTER SURGERY.........…………………………………………………………………………..............……….….12 RecoveryRoom/PACU……………..…………………………………..….…………….……...12 TransfertoYourRoom….……………..............................................................12 WhattoExpectDuringYourHospitalStay………………….…………….…………….12 VisitingHours………………………………………………….………………..............……....12 DischargePlanning…………………………………………….………..……….......………….12 PostoperativeAppointment……………..……..………………………..............……….13 IncisionCare……………………………….……………………………….........…………......13 DeepBreathing……………………………………………….…………………................…14 PreventingBloodClots.……………………………………….……………………...………..14 PostoperativePainManagement……………………….……………….........………..15 Activity&Positions………………………………………….………..…………………....15-17 Driving.………………………………………………….......................................…………17COMMUNITY DIRECTORY...…………………………………….........................................................18 MedicalSupplyStores………………..…….….....................…………………………….…………18 Pharmacies…………………………………….….…...................................…………….………….18 HotelsandTemporaryHousing……………….……....................................………………19 Parking..……………………………………….……….........................……………………………………19 PlacestoEatatNYP…………………..……………………………......................…………………..19IMPORTANT CONTACT INFORMATION…………………………………………...........………………20-21MAPS…….……………………………………………………………………………………....................…………...22NOTES………………………………….…………………………...............................……………………..………23

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2 Your Guide to Spine Surgery

DearPatient,

OnbehalfofthephysiciansandstaffatWeillCornellMedicineCenterforComprehensiveSpineCare,thankyouforpartneringwithusandtrustinguswithyourcare.Millionsofpeoplesufferfromneckorbackpainatsomepointintheirlives.Sometimesthispaincanbeattributedtotrauma,aspinaltumor,oraninfection.Moreoften,thepainischronic,progres-sive,andunrelenting.Thispainoftenrespondstovarioustypesofintervention.

Theteamofphysicians,nurses,therapists,andstaffattheWeillCornellMedicineCenterforComprehensiveSpineCareprovidesstate-of-the-art,comprehensive,integratedcareforpatientswithbackpainandalltypesofspine-relatedconditionsandinjuries.Patientsreceiveacompletecontinuumofcare,fromdiagnosistotreatmentandrecovery.Whensurgeryispartoftheplan,thespinesurgeonsfromWeillCornellMedicine’sneurosurgeryfacultyofferworld-classsurgicalexpertiseinTLIFandotheradvanced,minimallyinvasiveprocedures.

TheCenterforComprehensiveSpineCarepridesitselfonathree-partplanforeachpatient:

Expert, Accurate Diagnosis. Toomanypeoplesufferfrombackorneckpainfromunknowncauses—orworse,duetoamisdiagnosis.Ourworld-classexpertswillpinpointtheexactcauseofyourpaintodeterminethemosteffectivetreatment.

Comprehensive Treatment. Ourteamapproachallowsustodrawonexpertisefromneurolo-gy,neurosurgery,rehabilitationmedicine,anesthesiology,andphysicaltherapy.Afterassess-ingyourcase,thespineteamwilltailoratreatmentplanthatmayincludephysicaltherapy,medication,interventionalpainmanagement,acupuncture,andmovementtherapies.Whensurgeryisrequired,weofferthemostadvancedminimallyinvasivetechniques,includinglateralaccesssurgerythatdramaticallyshortensyourrecoverytime.Weofferon-sitereha-bilitation,ledbyphysicaltherapistswhoseholisticspinerehabilitationincludestherapeuticexercise,manualtechniques,yoga,McKenzietechnique,andpooltherapy.

Patient/Provider Partnership. Patienteducationisoneofthehallmarksofourapproach.Weconsideryouourpartnerincollaborativelyplanningthemosteffectiveandcustomizedapproachtorestoringyoutohealth.

Theinformationinthisbookletisintendedtoprovideareferencetoguideyouthroughyoursurgicalexperience;itisbasedonwhatistypicallyexperienced.Itisimportantforyoutorememberthatyouareinchargeofyourrecovery.Thesooneryoubecomeactive,withintheactivityrestrictionsrecommendedbyyoursurgicalteam,thesooneryoumaystarttoreturntonormalactivity.Weknowthatchoosingaspinesurgeonisabigdecision;thankyouforchoosingourteam.Welookforwardtoworkingwithyoutoensurethebestexperienceandoutcome.

NeurologicalSurgery@TheWeillCornellMedicineCenterforComprehensiveSpineCare

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Your Guide to Spine Surgery 3

TheWeillCornellMedicineCenterforComprehensiveSpineCarehasanexpertlytrained,experiencedteamoffull-timespinesurgeonsonfaculty.Weperformmorethan1,500spinaloperationsperyear,mostofthem

usingminimallyinvasivetechniques,encompassingallpathologies,agegroups,andcomplexities.

•Weservelocal,regional,national,andinternationalpatients.•Wetakeaninterdisciplinaryapproachtocomprehensivespinecare.•Wefocusonminimallyinvasivesurgery,computernavigation,complexanddeformityspinalsurgery.•Comparedtonationalaverages,spinesurgeryatWeillCornellMedicineandNewYork-Presbyteriancomparesfavorablyintermsofthejudiciousandsparinguseofspinalfusionsurgery,lengthofstay,bloodloss,lengthofsurgery,earlycomplications,andpatientsatisfaction.•Weareattheforefrontofbasicscienceresearch,clinicalresearch,andresearchtrials;ourresearch,combinedwithoursurgicalexcellence,positionsusasaleaderinnationalandinternationalspinalsurgery.N

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Roger Härtl, MDDirectorofSpinalSurgeryDirectoroftheWeillCornell MedicineCenterforComprehensiveSpineCare ph:212-746-2152 fax:646-962-0640

Ali Baaj, MDCo-Director,SpinalDeformityandScoliosisProgramph:212-746-1164fax:646-962-0640

Michael Virk, MD, PhDph:646-962-3388fax:646-962-0640

About the Weill Cornell Medicine Center for Comprehensive Spine Care

Attending Spine Surgeons

Eric Elowitz, MDViceChairmanforQualityandPatientSafety,WeillCornellMedicineNeurosurgeryph:212-746-2870fax:646-962-0640

Kai-Ming Fu, MD, PhDCo-Director,SpinalDeformityandScoliosisProgramph:212-746-2260fax:646-962-0640

Athos Patsalides, MD ph:212-746-2821fax:212-746-8111


Edward Butler, MSN, ANP-BCNursePractitionerOutpatient

Rebecca Cramer, FNP-BCNursePractitionerOutpatient

Amanda Fazio, MSN, FNP-BCNursePractitionerOutpatient

Oscar Lleva, MSN, FNP-BCNursePractitionerOutpatient

Shilpa Nilavarath, MSN, AGNP-CNursePractitionerOutpatient

Sherlie Pierre, RNRegisteredNurseOutpatient

Suzan Wollard, PA-CChiefPhysicianAssistantInpatient

Beth Higgins, PA-CSeniorPhysicianAssistantInpatient

Allison Basham, MSHSPA, PA-CPhysicianAssistantInpatient

Chloe Holland, PA-CPhysicianAssistantInpatient

Rebecca Wilcox, MCMS, PA-CPhysicianAssistantInpatient

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DuringyourcareatNewYork-PresbyterianHospital/WeillCornellMedicalCenter,youwillmeetanumberofhealthcareprofessionalswhoworktogetherasyourhealthcareteam.Youandyourfamilyarealsoanimportantpartofthecareteam.Weencourageyoutospeakupandletyour

needsandconcernsbeknown.

Doctors. Theremaybemanydoctorsinvolvedinyourcare.Inadditiontoyourattendingdoctor,whoisoftenyourpersonaldoctororthedoctorwhoadmittedyou,youmaybeseenbyothermedicalorsurgicalspecialists,aswellasfellowsorresidents.Afellowisadoctorpursuingfurthertraininginhisorhersubspecialty.Aresidentisadoctorwhohascompletedmedicalschoolandisenrolledinaresidencytrainingprograminaparticularspecialty.Residentsarealsoreferredtoashousestaffandworkunderthecarefulsupervisionofattendingdoctors.

Nurses. Theremaybemanynursesinvolvedinyourcareaswell.Theyworkcloselywiththedoctorsandothermembersofthehealthcareteam.ThePatientCareDirectoristhenursewhoisresponsibleforthesupervisionofallnursingcareonaparticularunitorunits.Aregisterednurse(RN),whoisdesignat-edasyourprimarynurse,plansandcoordinatesyouroverallnursingcareandassignstasksasappropri-atetoothermembersofthenursingteam.

Nurse Practitioners (NPs). Nursepractitionersareadvancedpracticeregisterednurseswhohaveobtainedlicensureandcertificationthroughadditionaleducationandexperiencewhoprovidecarethroughcollaborationwithyourattendingandteam.Nursepractitionersmaydiagnose,treat,andpre-scribetestsormedicationsforapatient’sconditionwithintheirspecialtyareaofpractice.

Care Coordinators. CarecoordinatorsareRNswhoseethatyourdoctor’sordersarecarriedoutappro-priately.Thecarecoordinatormayaskyouquestionsaboutyourcareandmedicalinsurancesothatyoucanreceivetheappropriatebenefitscoveredunderyourpolicy.

Unit Clerks. Unitclerksgreetpatientsandvisitorsastheyarriveontheunit,answerphones,respondtocallbells,andscheduletests.Theyareavailabletoansweryourquestionsanddirectyouwithintheunit.Iftheunitclerkdoesnotknowtheanswer,heorsheisresponsibleforfindingtheappropriatepersonontheunitwhocanhelpyou.

Physician Assistants (PAs). Physicianassistantsarehealthprofessionalswhoaremembersofyourhealthcareteam.Underthesupervisionofyourattendingphysician,theycandeliverarangeofmedicalandsurgicalservices,conductphysicalexams,diagnoseandtreatillnesses,orderandinterprettests,counselonpreventivehealthcare,assistinsurgery,andprescribemedications.

Social Workers. Socialworkershelpyouandyourfamilymanageyourhospitalstayandplanforyourreturnhome.Thesocialworkercanaddresstheemotionalissuesthatcomewithbeinginahospital,providepatientandfamilycounseling,coordinatedischargeplanning,andofferinformationaboutsup-portgroups.

Dietitians.Registereddietitiansarealsoprofessionalmembersofthehealthcareteam.Theyplanforyourdietaryandnutritionalneedsduringyourhospitalstayaccordingtoyourdoctor’sorders.Ifyourequireaspecialdiet,yourdietitianprovidesyouwithinformationandteachesyouhowtofollowthedietbeforeyougohome.

Physical Therapists. Physicaltherapistsassessyourphysicalandfunctionalneedsandprovideyouwithexercisesandprogramstohelpyouregainstrength,restoreyourmobility,andimproveyourabilitytodohomeandworkactivitiesinpreparationfordischarge.

Occupational Therapists. Occupationaltherapistsprovidetherapydesignedtohelpimproveyourabilitytocarryoutactivitiesofdailyliving—suchasdressing,bathing,andgrooming—followingyourdischarge.

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The Month Before Surgery: Your Checklist

Preoperative Evaluation and Paperwork□Scheduleapreoperativeappointmentwithyourprimarycareprovider,cardiologist,and/orotherspecialistasdeterminedbyyoursurgicalteam.Theappointment,includingpre-testing,labs,andphysicalexam,mustbewithin30daysofsurgeryandmustbereceivednolaterthan5businessdayspriortosurgeryforreview.□Pleasecallthesurgeon’sofficetoprovidethedateoftheappointmentoncescheduled.

Toensurethatyouareinoptimalphysicalcondition,yourproviderwillcarryoutanyrequireddiagnostictests,historyandphysicalexam,andmayrefertootherspecialistsifrequired.□Preoperativeworkupmayincludelaboratorytests,history/physicalexamination,EKG□Youmayhaveotherevaluationsasneeded(forexample,cardiology,pulmonology,hematology)□Completea2pagePre-ProcedureScreeningToolandreturnittoyoursurgeon’soffice.□Disabilityand/orFMLAformscanbefaxedtoyoursurgeon’soffice(seepage20forfaxnumbers).Pleasenotesomeformscanonlybecompletedaftersurgery.

Imaging□ProvideacopyofyourMRI,CTscan,x-rayorotherimagingtoyoursurgeonatleastoneweekpriortosurgery.□Ifanynewimagingisneeded,pleasecontactthesurgeon’sofficetoarrange.

Insurance□Todiscussinsuranceauthorizationorfinancialresponsibilitypleasecontactthesurgicalcoordinatorassignedtoyoursurgeon.Usuallyinsuranceauthorizationisinitiatedabouttwoweekspriortothesurgicaldate.□Foranyhospitalrelatedbillingquestions:212-297-4545□Foranesthesiarelatedbillingquestions:212-746-3885

Medications□Somemedicationscanbeharmfulduringsurgerybecausetheyincreaseyourriskofbleeding. Discontinue 7 days prior to surgery:

• Anti-inflammatories(suchasibuprofen,Advil,Aleve,naproxen,meloxicam,diclofenac)• VitaminE• FIshOil• HerbalSupplements

□Ifyoutakearthritismedications,biologicagents,ormedicationforautoimmunediseases,pleasediscusswithyourrheumatologistandsurgeon’sofficetodetermineif/whenthesemedicationsmustbestopped.□Ifyoutakemedicationsthatcontainaspirinorbloodthinners(suchaswarfarin,Plavix,Eliquis,Xarelto),pleasediscusswithyoursurgicalteamandcardiologistbeforestoppingorstartingthesemedications.□Itisimportanttofollowyourcardiologist’srecommendationsexactly,asanyvariancecanputyouatincreasedriskfordangerouscomplications.□Pleasenotethatmostsurgeriescanbeperformedwhilecontinuing81mgaspirin.□Youmayconsiderstartingastoolsoftener2to3daysbeforesurgery.Oneover-the-counterexampleisColace,whichcanbetaken2to3timesperday.Ensuringadequatehydrationisanotherwaytohelpdecreaseyourriskforpostoperativeconstipation.□Pleasemake3copiesofyourupdatedmedicationlisttobringtothehospitalonthedayofsurgery.□Pleasecallthenursepractitionertodiscussanymedicalquestionsorconcerns.

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Surgerycanbeacauseofstressbothphysicallyandmentally.Physicalandmentalwell-beingisimportantandmayrequirelifestylechangestoensureyouareatyourabsolutebestbefore,during,andaftersurgery!

Weight Control• Itisuptoyoutomaintainahealthyweightpriortosurgery.Beingoverweightcanincreaserisksof

complications(includinginfection,woundhealingproblems,readmission,anddelayedrecovery).• Weknowthatyouarelikelyexperiencingpain,whichcanmakeexercisedifficult,butspeakwith

yourhealthcareproviderstoidentifyanymodifiedexercisethatmightbepossibleforyou.• Ensuringabalanceddietwithportioncontroliscritical!Perhapsseeinganutritionistmightbehelp-

fulforyoutolearnthebestwaytoensureyouaretakinginthecorrectnutrients.

Mental Well-Being • Youroutlookandattitudeplayasignificantroleinyourex-

perience,recovery,andoutcome.Anxietiesandworriescanoftencreatebarrierstohealingandsuccessfuloutcomes.Considermeditationorguidedimagerytoencourageposi-tivethoughtsandhealthy,productivecoping.

• Youmayconsiderseeingamentalhealthproviderwhocanhelpyoufurtheridentifypersonalbarrierstomentalwell-be-ing,perfecttechniquestoovercomestressfulsituationsinahealthier,moreeffectiveway,anddevelophealthycopingmechanisms.Weworkcloselywithafewmentalhealthcareprovidersandwouldbehappytoprovideyouwithnamesfromwhichtochoose.

• Therearealsofreeapplicationsforyoursmartphonethatmightbehelpful,quick,andeasytouseformeditationorguidedimagery.Someoptions(forbothiPhoneandAndroid)includeHeadSpace,Calm,Omvana,TheMindfulnessApp,andStop,Breathe,andThink.

Stop SmokingTheuseofnicotinehasbeenlinkedwithanincreasedriskofcomplicationsfollowingsurgery.Resourcesforsmokingcessation:

• NewYorkStateSmoker’sQuitline:1-866-NY-QUITS(1-866-697-8487)andnysmokefree.com• NewJerseyQuitline:1-866-NJSTOPS(657-8677)andnjquitline.org• QuitNowConnecticut:1-800-QUITNOW(784-8669)andquitnow.net/Connecticut

Home Safety EvaluationSomeimportantquestionstoconsideroraddressbeforesurgery:

• Stairs:Arethererailings?Doyouhavestairstogetintooroutofyourhome?• Havingafamilymember/caregiverpresenttoassistyouifneededishighlyrecommended.• Preparethehome:Removethrowrugs,cords,orotherobstaclesfromthefloortoallowfor

easyandsafewalking.• Avoidstepstoolsandladdersafterdischarge.Placenecessaryitemsincabinetsordressers

atalevelthatyoucaneasilyreach(nottoohigh/nottoolow).• Groceryshopping/mealprep/planningforafterdischarge• AssistiveDevices:Ifthereareanyassistivedeviceneedsidentifiedaftersurgerywhileinthe

hospital,theinpatientteamwillhelpcoordinateobtainingthese.Usually,therearenotanydevicestopurchasebeforesurgery.


NEW!

TheIntegrativeHealthandWell-beingprogramatNewYork-Pres-

byterianoffersafreeone-hoursessiontohelppatientsprepareforsurgery.Themind-bodytechniqueshavebeenshowntoreduceanxi-etybeforesurgeryandreducetheamountofpainmedicationneededafterward.Ifyouwouldliketoregis-terfortheclass,visitwww.nyp.org/integrativehealthandclickon“BookaGroupClass,”thenchoose“ClassSchedule”fromthetopmenu.

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ERYFamily Member/Caregiver Support• Whoisyourmaincontactperson?

• Thesurgeonwillspeaktoadesignatedfamilymemberorfriendaftertheprocedureiscomplete.Ifthispersonneedstobecalled,pleaseprovidephonenumbertosurgeonpriortosurgery.

• DuetotheFederalHealthInsurancePortabilityandAccountabilityAct(HIPAA),hospitalstaffcannotgivehealthinformationtomultiplepeopleoverthephone.

• Escortupondischarge:Youwillneedanadulttoescortyouhomeafteryourprocedure.Withoutanadulttoaccompanyyou,yourdischargemaybedelayed.It’simportanttoensureyoumakeithomesafely!

• Itisimportanttohaveafamilymember,closefriend,orcaregivertoassistinpreparationforsurgeryandthroughoutrecovery.Thefollowingareareasthatthispersoncanbehelpful:

• Transportationtoandfromthehospital—itisbesttoplantransportationaheadoftime• Providingsupportandassistancearoundhomeduringthefirstweekafterdischarge

Private RoomForsurgeriesthatrequiresolelyaone-nightstay,mostpatientsspendthenightonaspecialunit,whichhasthebenefitofprivateroom.However,ifyouwouldliketoplacearequesttoensureaprivateroomisreservedinadvance,pleasecall212-746-4259todiscussoptionsandfinances.ThereisnoguaranteeofaprivateroomunlessyouspeakwithAdmittingpriortoyouradmissiondate.

Private Duty NursingIfyouwouldlikeaPrivateDutyNurseorCompanion,youcancall212-746-4091.Privatedutyservicesareprovidedbyanindependentcontractorwhowillexpectpaymentpriortotheserviceandarenotincludedinthehospitalcharges.

MyChart PleasesignupforWeillCornellConnect/MyChart,whichwillallowyouonlineaccesstosomeofyourmedicalrecordsandtosendsecuremessagestoyourhealthcareteam.Visit:mychart.med.cornell.edu/mychart

The Day Before SurgeryPreoperative Phone Call•AnORnursewillcallyouthebusinessdaybeforesurgerytoconfirmyourprocedureandarrivaltime.•Duringthiscall,youwillalsoberemindedofthefollowinginstructions:

• DONOTeatanysolidfood(includingcandyormints)aftermidnightonthedayofyoursurgery.

• YOUMAYdrinkupto8ouncesofclearliquidsonthedayofsurgery,upto2hoursbeforeyourhospitalarrivaltime.*

• OK:water,sportsdrinks,applejuice,blackcoffee/tea(nocreamormilk)• NO:milk,cream,alcohol,ordrinksyoucannotseethrough(forexample,orange

juice)*If you have any history of delayed gastric emptying, please do NOT eat or drink any-thing after midnight the night before surgery.

• Takeallofyourusualmedicationswithasipofwaterpriortocomingtothehospital,unlessinstructedotherwise.

If you do not receive a phone call by 4 pm, please call 212-746-5299 if you are scheduled for surgery in Greenberg 3 West or 212-746-5582 if you are scheduled for surgery in the Starr F10 ambulatory surgery center. Your Guide to Spine Surgery 9


What to Bring to the Hospital: Important Checklist

Bring: □Advancedirectives□Completelistofcurrentmedications□Listofallergies□EmergencyContactInformation,includingphonenumber□CPAPmachine,inhalers,eyedrops,allParkinson’smedications,andanybrand-namemedicationforwhichyouwouldnotwantagenericsubstitute.*□Wearloose-fitting,comfortableclothing□Achangeofclothestowearhome□Insurancecard/information□Eyeglass,denturesorhearingaids,anyassistivedevicesyouuse(forexample,awalkerorcane).Pleaseensureallarelabelled. *If you are bringing medications, please bring them in the original bottles with original labels so that the hospital pharmacy can approve them to be utilized during your hospitalization–do NOT bring medica-tions unlabeled or in a daily pill organizer.

Do NOT Bring:□Valuables□Medicationsfromhome(exceptinhalersoreyedropsifneeded)□Electricaldevices(suchashairdryersandheatingpads)

The Day of Surgery: Check-In Arriveat525E68thStreetandcheckinatGreenberg3West.Ifyouarescheduledforsurgeryintheambulatorysurgerycenter,pleasearriveat525E68thStreetandcheckinatStarr9.(Forinformationaboutparking,seepage19.)

•Familymembers/caregiversareallowedtostaywithyouduringthistime.

•Followingcheck-in,youwillbeginmeetingwithmembersofcareteam,includingyoursurgeon,anesthesiologist,andnurses.

For Your Safety

Verification:Priortosurgery,youwillfrequentlybeaskedyourname,dateofbirth,andwhatprocedureyouarehavingdone.

MedicationReconciliation:Pleasebepreparedtodiscussyourcurrentmedicationsincludingname,dosage,howoftenyoutakethem,andwhenthelastdosewastaken.

Infection Prevention

Youwillbegivenanantibioticbeforesurgery;thiswillbecontinuedforaslongasthesurgeonfeelsitisnecessary.Handwashingandproperhygieneisstronglyencouragedtodecreaseriskofinfectionaswellasavoidingpeoplewithacough,cold,fever,orotherillness.

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YAbout Anesthesia

TheDivisionofNeurosurgicalAnesthesiologyconsistsof10facultymembers.Weareanexperienced

teamthathasexcellentcollaborativerelationshipswiththeneurosurgeons,neuroradiologists,neurophysiologists,andnurseswithwhomweworkonadailybasis.

Weareexpertsinthecareofpatientssufferingfromavarietyofneurologicdisorders,includingspineproblems.Wecareforbothminorandmajorspinalsurgicalpatients.Whetherapatientneedsavertebroplasty,anexcisionofaherniateddisk,alaminectomy,amultilevelspinalfusion,orplacementofspinalcordstimulators,wetailorouranestheticnotonlytoensurepatientcomfortandsafetybutalsotofacilitatetheuseofthelatesttechnologyinthemonitoringofspinalcordfunction.Wealsohavebeenattheforefrontofdevelopingsedationandpainreliefprotocolsforpatientsundergoingspinesurgery.

TheDivisionworkscloselywiththedivisionofPainMedicine(vistthewebsiteatpainmedicine.weillcornell.org)andthePre-AnesthesiaEvaluationClinic(anesthesiology.weill.cornell.edu/for-patients/what-to-expect).

ThePainTeamconsistsofboard-certifiedphysiciansandfullytrainedstaff,andtheydelivercomprehensive,multidisciplinarycareforindividualswithacute,chronic,andcancer-relatedpain.

ThePre-AnesthesiaEvaluationClinicprovidesconsultationservicestopatientsscheduledforelectivesurgery.Locatedonthe9thflooroftheDavidH.KochCenterat1283YorkAvenue(at68thStreet),thisunitisstaffedfrom8amto5pm,MondaythroughFriday.Patientsareseenbyappointment.

Recovery Room/PACU AftersurgeryyouwillbecloselymonitoredinthePost-AnesthesiaCareUnit(PACU),alsocalledtheRecoveryRoomastheanesthesiawearsoffandyouwakeup.YouareexpectedtostayinthePACUunderthecareofyoursurgicalteam,speciallytrainednursesandstaffuntilyouarestableandaroomisavailableforyou.Or,ifyouarehavinganambulatoryprocedure,untilyouarestablefordischarge.

Transfer to Your RoomIfyouareadmittedtothehospital,assoonasabedbecomesavailableyouwillbetransferredtoyourroomandwillcontinueyourrecoveryprocessthereuntildischarge.

What to Expect During Your Hospital Stay

Duringyourhospitalstay,youwillbecaredforbytheneurosurgeryteamunderthedirectionofthesurgeon.Thisteamincludesnurses,nursepractitioners,physicianassistants,surgeryresi-dents,anesthesiologists;itmayalsoincludephysicaltherapists,occupationaltherapists,social

workers,carecoordinators,nutritionandcustodialstaff,andvolunteers.

Yourdailyschedulewhileinthehospitalmaybesimilartothis:•Earlymorning:yourmedicalteamwillawakenandexamineyoutomakesurethatyouarerecov-eringproperlyfromanesthesiaandsurgery.Thiswillbebrief.•Morning:yourmedicalteamwillspeaktoyouaboutyourdailygoalsandwillupdateyouontheplansfordischarge.Anymemberofyourteammaybeaskedtocomebacktospeakwithyouprivatelyuponyourrequestifyouhaveconcerns.•Latemorning:ifyouarebeingdischarged,instructionsandprescriptionswillbereviewedwithyou.Dischargeisgenerallyaround10am.•Earlyafternoon:yourmedicalteamwillre-examineyoutoensureyouaremakingprogress.

Wewillstrivetomeetallyourneeds,andwewelcomeyourinput.Pleaseletthemedicalteamknowifyouhavequestions.

Visiting HoursIngeneral,visitinghoursarefrom9amto9pm.However,visitinghourscanvaryaccordingtothelocation,condition,andneedsofthepatient.Pleaselookforsignsindicatingspecialvisitinghoursonaparticularunit,oraskthenursingstaffonthatunit.Ourstaffwillworkwithpatientsandfamilies,especiallythoseinaroomwithtwobeds,toallowpatientstimetorestandsleep.

Discharge PlanningDischargeplanningbeginsearlyinyourhospitalstay.Thereareafewdischargeoptionsthatarethemostcommon,includingbutnotlimitedtothefollowing:

•Home,withorwithouthomecareservices•Rehabilitation(AcuteorSubacute)

Ifhomecareservicesorinpatientrehabilitationisindicated,theinpatientrehabilitationteamwillevaluateyouaftersurgery.Basedontheirfindings,theywillprovidearecommendationincollabora-tionwithyoursurgeon’steamfortoensureasafedischarge.Thesocialworkeranddischargeplanningteamwillworktoprovideoptionswithintherecommendation.Theywillworktogetherwithyouandtheteamtocarryoutthedischargeplan;theymayassistinarrangingtransportation,rehabservices,assistivedevicesasmedicallyindicated.Ifpossible,theseservicesanddevicesmaybeprocessedthroughyourinsurance.

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Postoperative Appointment

Upondischargefromthehospital,pleasecallyoursurgeon’sofficetoscheduleyourfirstpostoperativevisit.Itisusuallyabout2to4weeksaftersurgerybutmayvarybasedonyourspecificcase.

Incision Care

IMPORTANT NOTE: If a plastic surgeon was involved in your surgery, all incision instructions will be provided by the plastic surgery service. In that case, please disregard the instructions below and contact your plastic surgeon.

The Basics

•DONOTapplybandages,lotions,orointmentstothesurgicalwound.•DONOTscratchorscrubthewound.•DOkeeptheincisioncleananddry. Showering After Surgery

• Youwillbeinstructedonwhichpostoperativedayyoucanremovethedressingandshowerwiththeincisionexposed.Itusuallyrangesfrom3to5daysaftersurgery.

• Atthattimeremovethedressing,letsoapandwaterrunovertheincisiondaily,andpatdrywithacleantowel.

• DONOTsubmergeinwater(pool,tub)untilyouareclearedtodosoatyourpostoperativeap-pointment.Usuallyitisrecommendedtoavoidsubmergingtheincisionareafor2to4weekspostoperativelyoruntilwellhealed.

• Iftherearedrains,incisionopening,orscabsthistimeframemaybeextended.

Sutures/Staples/Drains

• Iftherearestaplesorsuturesusedtocloseyourincision,theywillberemovedbythePAorNPatyourtwo-weekpostoperativeappointment.

• Ifexternalsuturesorstaplesarenotused,theskinisclosedwithinternalmeltingsutures,glue,andsteri-strips(smallwhitepaperstrips)areusedtoclosetheincision.Itisokaytogetthesteri-stripswetduringshoweringoncethedressingisremoved.

• Ifyouweredischargedwithdrainsinplace,pleasekeepadailylogofdrainageamounttobereviewedatyourfirstpostoperativevisitwiththeplasticsurgeon.


Deep Breathing

Yoursurgicalteamwillencouragedeepbreathingfollowingsurgery.Sometimesthisrequirestheuseofadevicecalledanincentivespirometer(examplepicturedatright).Ifyouareinstructedtousethisdevice,pleasefollowthedirectionsandfrequencyexactly.Thisisveryimportantinensuringyourlungsareinflatingproperlytopreventanyfluidcollectioninthelungspostoperatively.

Ifyoureceiveanincentivespirometerinthehospi-tal,pleasetakeithomeortorehabtouseforthefirsttwoweeksaftersurgery.

Preventing Blood Clots/Deep Vein Thrombosis

Deepveinthrombosis(DVT)isabloodclotinadeepveininyourleg.DVTcanhappenwhenyourbloodisflowingslowlybecauseofillness,surgery,orjustbeinginthehospital.DVTcancauselegswelling.DVTcanalsobreakoffandgothelung(pulmonaryembolismorPE).Bloodclotsthatgotothelungcanmakeithardtobreatheandareoneofthemostseriouscomplicationsaftersurgery.

Onewayyoucandecreaseyourriskforbloodclotsfollowingsurgeryisbychangingpositionatleastevery45to60minutes,avoidingprolongedsitting,andgettingupandwalkingearlyandregularly.

CompressionsystemsliketheoneshownatrightarealsousedtopreventDVT.Asequentialcompressiondevice(SCD)consistsofsoftsleevesthatwraparoundthelowerlegsandinflatewithairtomassagethelegs.Thisgentleoff-and-onsqueezinghelpsbloodflowsmoothlyanddecreasesriskforDVT.

SCDsareorderedbyyourdoctorandarepartofyourtreatmentaftersurgery.YournursewillhelpsetupyourSCDs.YoushouldwearyourSCDsanytimeyouareinbed.Takethemoffbeforemovingtoachair,orwhilewalkingorbathing.

If you feel pain or “pins and needles” in your legs, tell your nurse right away, as this could be a sign of DVT.

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Postoperative Pain Management

•Painmedicationswillbeprescribedtotakeasneeded.Weanthesemedicationastolerated.• Besuretofollowbowelregimenincludingstoolsoftenersandlaxativeswhiletakingthis

medication.Ensureadequateoralhydrationandfiberintakeastolerated.• Itmaytakeuptoaweekaftergeneralanesthesiatoresumenormalbowelmovements.• Ifyoudevelopanyabdominalpain,nausea,orvomitingcalltheofficeimmediately.

•Musclerelaxersmaybeprescribedformuscletensionandspasm.Pleasetakeasdirected andweanastolerated. •Tohelpeasediscomfort,youmayapplyaheatingpadoriceasneeded20minuteson, 20minutesoff.Avoidapplyingdirectlytoskin.Toavoidanyskindamageplaceatowel orclothbetweenyourskinandtheheatingpadorice.•Nervemedications:Ifyouweretakingmedicationslikegabapentin,Neurontin,orlyricaPRIOR tosurgery,pleasecontinueyourpreoperativedoseaftersurgery.Thesemedications areusuallycontinuedfor1to2monthsaftersurgeryandshouldbeweanedoffunder medicalsupervision.ThesemedicationsmustbetakenconsistentlyandareNOTtobetakenasneeded;donotstopmedicationsuddenlywithoutspeakingtoyourproviderfirst.•Ifyoualreadyhaveapainmanagementprovider,postoperativefollow-upwillbeimperativewith thatprovidersothattheymayprescribeyourpainmedicationsasappropriateforyou.•Occasionally,painmedicationsarerequiredforlongerthan6weekspostoperatively.Ifthatisthe case,youmaybereferredtoapainmanagementprovider.

Activity

•Walkfrequentlyandasmuchastolerated.Thisisaveryimportantaspectofrecovery!• Startwalkingthesamedayordayfollowingsurgery.• Thegoalistoworktowardsonehourperday.Startwithshortfrequentwalksandplanfor

frequentrest.• Startwithshortfrequentwalksandgraduallyincreasethedurationandfrequencyofyour

walksastolerated.•Restrictionsareeffectiveimmediatelyaftersurgeryforatleastsixweeks:

• Avoidbendingortwistingatthewaist/neck.• Avoidliftingmorethantenpounds.• Avoidsittingforlongerthan60minutesconsecutively.Standevery30to60minutesforat

leastashortwalk.• Listentoyourbodyandrespectyourlimits,whichmaychangedaytoday.

•Ifabraceorcollarisrecommended,wearasinstructedbyyourhealthcareteam.Ifyouhave concernsaboutthefitofyourcollarorbrace,pleasecallSteveHallat212-737-1645.•Pleasespeakwithyoursurgicalteamregardingphysicaltherapy.

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Sleeping Positions Youmaysleepinanypositionthatiscomfortableforyou.Herearesomesuggestionsthatyoumayfindhelpful(butremembertheyaremerelysuggestions!)

On Your BackPlaceapillowunderyourheadandanotherpillowunderyourknees.

On Your SidePlaceapillowunderyourheadandanotherpillowbetweenyourknees.


•Walkeveryday;shortfrequentwalksworkingtowardgoalof1hourtotalperday,indoorsoroutdoorsifsafeforyou

•WalkingontreadmillOK

•Maystartphysicaltherapyforextremitystrengtheningifrecommended

•NOliftingmorethan10pounds

•NOrepetitivetwisting,turning,bendingatthewaist/neck

•Mayresumelow-intensityexerciseonelliptical,stationaryrecumbentbicycle,orswimmingifyouweredoingthispriortosurgery.Startslow,increaseinmoderationastolerated

•Maystart/continuephysicaltherapyforextremitystrengtheningifindicated

•NOliftingmorethan10pounds

•NOrepetitivetwisting,turning,bendingatthewaist/neck

•Continuetowalkeveryday

•Maystartunrestrictedphysicaltherapywithafocusoncoreandextremitystrengthening

•OKtostartresumingnormalactivity—startslowandincreaseinmoderationastolerated

•Continuetowalkeveryday

•Normalactivityastolerated

•Maycontinuephysicaltherapyasneeded

•Focusoncorestrength-ening

•Continuetowalkevery-day

*Restrictions may vary by patient or surgery performed. Review with your medical provider.

*

Proper Sitting Position•Ensurefeetaresupportedonthefloor.•Thespineshouldbesupported—apillowmaybehelpful.•Changepositionsfrequentlythroughouttheday.

Moving In and Out of Bed: “Log Rolling” Technique

1.Bendyourknees. 2.Rolltooneside. 3.Useyourarmstopushyourselfup.

Carrying Objects•Holditemsclosetoyourbody.•Bendwithyourhipsandkneesinsteadofyourback.

Remember:Avoidliftingmorethan10poundsforatleastthefirstsixweeks!

Driving•Youmayrideasapassengerwhenyoufeelready.Startwithshortdistancesandseehowyoufeel.•Ifalongertripisnecessary,planforfrequent(every30to60minutes)breakstostopandwalkaround.Thiswillhelppreventmusclefatigueorsorenessandalsohelppreventbloodclots.•Drivingisgenerallypermittedabout4to6weeksaftersurgeryandonceyouarenolongertakinganypainmedications.

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RYMANHATTAN

HealthSourcePharmacyandSurgicalSupplies13022ndAvenue,NewYork,NY10065Phone:212-794-8700

FalkSurgicalSupplies11671stAvenue,NewYork,NY10065Phone:212-744-8080

NuCarePharmacy&Surgical17891stAvenue,NewYork,NY10128Phone:212-426-9300AND2509thAvenue,NewYork,NY10001Phone:212-462-2525

ChelseaMobility&MedicalEquipment 3278thAvenue,NewYork,NY10001Phone:212-255-5522

QUEENS

BrandMedicalSuppliesInc 6637MyrtleAvenue,Glendale,NY11385Phone:718-381-4700

JonesSurgicalCo.,LLC 101-21MetropolitanAvenue,ForestHills,NY11375Phone:718-261-9500

J&KSurgical&MedicalSuppliesCorporation 15823HoraceHardingExpy,Flushing,NY11365Phone:718-358-6897

BROOKLYN

MedicalSupply123 798McDonaldAvenue,Brooklyn,NY11218Phone:718-431-0521

H&JMedicalSupply 236065thStreet,Brooklyn,NY11204Phone:718-236-0707

BRONX

A&GMedicalSupply 1040MorrisParkAvenue,Bronx,NY10461Phone:718-823-4700

MedstopPharmacy&SurgicalSupplies 1330JeromeAvenue,Bronx,NY10452Phone:718-552-2278

TriumphMedicalSupplyLLC 1506CastleHillAvenue,Bronx,NY10462Phone:347-810-6787

Medical Supply Stores

WalgreensPharmacy525East68thStreet(inNYP)SuiteF01-170212-249-6451

CVS11723rdAvenue212-988-8319

Pharmacies

Goldberger’sPharmacy12001stAvenue212-734-6998

DuaneReadePharmacy1327YorkAvenue212-737-6240

TowerChemistsPharmacy12921stAvenue212-628-1900


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RYAffiniaGardensHotel215East64thStreetPh:212-355-1230Fax:212-758-7858

TheBenjamin125East50thStreetPh:212-715-2500Ph:212-320-8002Fax:212-715-2525

TheBentley500East62ndStreetPh:212-644-6000Fax:212-207-4800

ComfortInnCentralParkWest31West71stStreetPh:212-721-4770

ComfortInnMidtown129West46thStreetPh:212-221-2600

DoubletreeMetropolitanHotel569LexingtonAvenuePh:212-752-7000Fax:212-758-6311

DrakeHotel440ParkAvenuePh:212-420-0900Fax:212-371-4190

FitzpatrickHotel687LexingtonAvenuePh:212-355-0100Fax:212-308-5166

FranklinHotel164East87thStreetPh:212-369-100Fax:212-369-8000

TheGracieInn502East81stStreetPh:212-528-1700Fax:212-628-6420

HabitatHotel130East57thStPh:212-753-8841

HelmsleyGuestFacilityNewYork-Presbyterian1320YorkAvenuePh:212-472-8400Fax:212-535-8524

NewYorkMarriottEastSide525LexingtonAvenuePh:212-755-4000Fax:212-751-3440

Hotels & Temporary Housing

Parking

TheGreenbergPavilionGarage525East68thStreet212-746-2015

HelmsleyMedicalTowerGarage507East70thStreet212-746-1974

LaurenceG.PaysonHouseGarage426East71stStreet212-746-1977

ThePhippsHouseGarage1285YorkAvenue212-746-1979

TheGardenCafé212-746-6368MondaythroughFriday,6amto8pmSaturdayandSunday,7amto8pm“B”Levelofthemainhospitalbuilding

Places to Eat at NYP

AuBonPainMainLobby:24hoursaday/7daysaweekStarrPavilionLobby:M-F,7amto3pmPerelmanHeartCenterAtrium,4thFloorGreenberg: M-F,7amto7pm


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Dr.RogerHӓrtlOffice:212-746-2152Fax:212-746-8387

NursePractitioner:RebeccaCramerSurgicalCoordinator:AlbaBriceño

Office:646-962-9755Fax:646-962-0640

Dr.Kai-MingFuOffice:212-746-2260Fax:212-746-8387

NursePractitioner:AmandaFazioSurgicalCoordinator:JenenaWiltshire

Office:646-962-9754Fax:646-962-0640

Dr.AliBaajOffice:212-746-1164Fax:212-746-8387NursePractitioners:

AmandaFazio/EdwardButlerSurgicalCoordinator:AlbaBriceño

Office:646-962-9755Fax:646-962-0118

Dr.EricElowitzOffice:212-746-2870Fax:212-746-8387

NursePractitioner:EdwardButlerSurgicalCoordinator:JenenaWiltshire

Office:646-962-9754Fax:646-962-0640

Dr.MichaelVirkOffice:646-962-3388Fax:646-962-0117

NursePractitioner:ShilpaNilavarathSurgicalCoordinator:JenenaWiltshire

Office:646-962-3783Fax:646-962-0640

Dr.AthosPatalisadesOffice:212-746-2821Fax:212-746-8111

NursePractitioner:OscarLlevaSurgicalCoordinator:SharonRamos

Office:212-746-5183Fax:212-746-8111

Neurosurgery Team

Weill Cornell Medicine Center for Comprehensive Spine Care888-922-2257


Anesthesiaquestions:212-746-3885

GiftShop:212-746-4230MondaythroughFriday7:30amto9pm

SaturdayandSunday9amto9pm

Hospitalbillingquestions:212-297-4545

InformationDesk:212-746-4690MondaythroughFriday7:30amto8pm

Saturday,Sunday&Holidays,8amto8pm

InternationalServices:212-746-4455

MedicalRecords:212-746-0530

PatientServicesAdministration:212-746-4293

PastoralCare:212-746-6971

PrivateRoom–Admitting:212-746-4250

PrivateDutyNursing:212-746-4091

24-hourEmergencyOn-CallChaplain212-746-5100,pager#17205

PetTherapy:212-746-4690

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Hospital Numbers

Nursing Station Phone Numbers

Greenberg2North 212-746-0335Greenberg2South 212-746-0334Greenberg2West 212-746-0317Greenberg2SW: 212-746-0344 NeuroscienceIntensiveCareUnit(ICU)

Greenberg4Central 212-746-0322Greenberg4North 212-746-0320Greenberg4South 212-746-0323Greenberg4West 212-746-0399Greenberg5Central 212-746-0313Greenberg5North 212-746-0314Greenberg5West 212-746-0312Greenberg5South: 212-746-0311 IntensiveCareUnit(ICU)

Greenberg6Central 212-746-0310Greenberg6North 212-746-0309Greenberg6South: 212-746-0308 PediatricIntensiveCareUnit(PICU) Greenberg6West: 212-746-0318 NeonatalIntensiveCareUnit(NICU)

Payson2 212-746-5342Greenberg7Central 212-746-0303Greenberg7North 212-746-0301Greenberg7South 212-746-0306Greenberg7West 212-746-0315Greenberg8Central 212-746-0325Greenberg8North 212-746-0326Greenberg8South 212-746-0327Greenberg8West 212-746-0328Greenberg10Central 212-746-0329Greenberg10North 212-746-3625Greenberg10South 212-746-0330Greenberg10West 212-746-0573Greenberg11North 212-746-0331Greenberg11South 212-746-0332Greenberg14North 212-746-9814Greenberg14South 212-746-9815Baker15 212-746-7884Baker17 212-746-1411Greenberg2North: 212-746-5333 Dialysis

M-2: 212-746-9877 InterventionalNeuroradiology


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Your Guide to Spine Surgery 23Rev03-2019

Center for Comprehensive Spine Care240 East 59th Street, 2nd FloorNew York, NY 10022888-922-2257comprehensivespine.weillcornell.org

525 East 68th Street (at York Avenue)New York, NY 10065212-746-5454www.nyp.org

Copyright2019WeillCornellMedicine

Dr.RogerHӓrtl212-746-2152

Dr.EricElowitz212-746-2870

Dr.AliBaaj212-746-1164

Dr.Kai-MingFu212-746-2260

Dr.MichaelVirk646-962-3388 Dr.AthosPatalisades212-746-2821

Our Neurosurgeons

your guide to spine surgery · spine care ph: 212-746-2152 fax: 646-962-0640 ali baaj, md...

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