Frequently Asked Questions Before Spinal Surgery

How do spinal conditions or degenerative spinal discs occur?

The spinal discs begin to degenerate from around the age of 25, and the degeneration increases with age. In addition, factors such as being overweight, occupations that require absorbing impacts, bending over, lifting heavy objects, and heavy smoking are risk factors that can accelerate the onset of the disease. Additionally, genetics play a significant role.

Is it true that even physically fit people can have degenerative discs or spinal conditions?

Degenerative discs and spinal conditions are a natural part of human aging. Research involving healthy athletes who showed no symptoms and underwent MRI scans found that 23% had spinal disc degeneration, and this percentage increases to 90% in people over 60 years old. Therefore, one should not worry when diagnosed with spinal degeneration.

* Ref: Lowrence Js. Disc degeneration: its frequency in Relationship to symptoms.
Annals Rheum Dis 1969;28;121 – 37.

Besides spinal degeneration, what other conditions require surgery?

Other conditions that may require surgery include spinal tumors, spinal infections, collapse due to osteoporosis, spinal deformation, etc.

When is surgery necessary?

Indications for surgical treatment may include any of the following:

• Inability to tolerate pain
• Symptoms of nerve damage, such as muscle atrophy or increasing weakness
• Loss of bowel or bladder control
• When a patient has undergone various treatments for 6 – 8 weeks without improvement or cannot return to normal daily activities

Is surgery avoidable? Are there non-surgical options?

Doctors often recommend other treatments first, such as physical therapy or intervention spine treatment, especially for degenerative spinal conditions or non-severe spinal conditions, to give patients a chance to recover without surgery. However, the effectiveness of each treatment varies, and surgery becomes the most effective option as a last resort, which is internationally recognized as the standard.

Is microsurgery an option for every case?

There are many different techniques for spinal surgery. Microsurgery is just one of the options. Spine surgeons at Bangkok International Hospital prefer to choose the smallest possible incision that results in successful treatment with minimal patient injury, ensuring a quicker return to daily activities.

How does endoscopic surgery compare?

Endoscopic surgery uses magnification during surgery, allowing clearer vision than the naked eye, which can improve surgical outcomes. However, some surgeries, like correcting spinal deformities, may not necessitate an endoscope. There are various endoscopes, including endoscope, microscope, or even magnifying glasses, each enhancing the surgeon’s vision. However, the surgical outcome depends not just on the use of a scope but on effectively correcting the pathology.

How long does the surgery take?

Typically, surgery takes 1 – 2 hours, but more complicated surgeries requiring metal insertion or multi-level surgery might take about 3 – 4 hours or longer for patients with complex diseases.

Can elderly patients undergo surgery?

Older patients can undergo surgery, but a thorough examination by a physician is needed to assess overall health and organ function, such as heart, kidneys, and lungs. If found to be sufficiently healthy, doctors will permit surgery.

How many days are required in the hospital after surgery?

Typically, patients might stay 1 – 2 days for minor surgery, and more extensive, multi-level surgery may require a 3 – 5 day stay. However, patients with lower physical strength, elderly, or those with other health issues, needing physical therapy, might require a 7 – 10 day stay or longer.

Is complete recovery possible after surgery?

Most patients at the Spine Institute, Bangkok International Hospital, are satisfied with the surgery outcomes. However, complete recovery depends on the nature and severity of the disease, duration of the condition before treatment, the surgical technique used, the surgeon’s expertise, and post-operative self-care.

How to ensure the success of surgery?

Incidents of non-recovery after surgery occur worldwide, but can be minimized by choosing a genuine spinal surgery specialist, selecting the correct surgical technique, and having a well-equipped treatment facility with attentive medical teams.

Why choose Bangkok International Hospital for surgery?

The Spine Institute at Bangkok International Hospital is staffed by a team of specialists in various spinal areas, allowing comprehensive treatment planning for patients with complex diseases and offering surgery equipment equivalent to international standards, increasingly attracting foreign patients each year.

Is there significant blood loss during surgery?

Generally, surgery does not result in significant blood loss, and transfusions are not necessary. However, surgeries involving extensive bone cutting or multiple levels may result in more significant blood loss, for which patients will be closely monitored and possibly given fluids or blood replacements.

How long are the surgical incisions?

The length of the incision depends on the number of levels, the technique used, and the thickness of the subcutaneous fat layer. Generally, a single-level surgery incision is about 2 – 7 cm long, and a two-level surgery may have an incision about 10 – 12 cm long. Smaller incisions may be possible with minimally invasive techniques.

Is post-operative pain severe?

Natural pain at the surgical site typically occurs within the first 1 – 3 days post-operation. The intensity depends on the surgery type and incision size. However, all patients receive pain management during and after surgery to minimize discomfort, closely monitored by an anesthesiologist for optimal pain relief, including the use of Patient-Controlled Analgesia (PCA), which is very effective for post-operative pain and considered a global standard.

What are the side effects of spinal surgery?

As with any major surgery, side effects can occur in various systems such as:

• Side effects from anesthesia may include sore throat, hoarse voice, confusion, headache.
• Circulatory system side effects may include unstable blood pressure, risk of blood clots.
• Medication side effects during treatment may include drug allergies.
• Respiratory system side effects may include phlegm build-up, infection, or pulmonary edema.
• Infection at the surgical site, significant blood loss, or hematoma.
• Side effects from the metal or synthetic implants may include displacement or fracture.
• Side effects on tissues and nerves may include numbness or muscle weakness.
• Failure of fusion resulting in pain and possibly requiring repeat surgery.

However, choosing surgery by a skilled medical team in a facility with modern medical equipment, attentive care according to standards, and patient cooperation can significantly reduce these risks. The risk of complications in current spinal surgery is much lower, making the outcomes quite satisfactory.

What are the types of metals used for spinal support, how do they differ, and what are the pros and cons?

Patients may be advised to use metal for spinal support, classified by the country of manufacture as either foreign or domestic. By material, they can be either stainless steel or titanium, with titanium being preferred due to its strength and MRI compatibility. The choice of screws for spinal stabilization will be explained by the doctor for the best decision. Metal screws help solidify the spine to allow natural bone fusion, increasing successful joint fusion from 60-70% to 90-100% without metal.

What are the complications of metal spinal support?

• Improper positioning of the metal, causing pressure on nerves and surrounding tissues.
• Metal displacement or loosening after some time post-surgery.
• Metal breakage after prolonged use and unsuccessful joint fusion. However, using an O-ARM computerized X-ray to create 3D images during surgery with a Stealth Navigation System helps avoid metal misplacement and reduces nerve complications.

Will long-term metal insertion cause problems? How long does the metal last? Is removal necessary, and does the metal rust?

Metal inserted into the body is thoroughly tested to be biocompatible, safe for lifelong use without causing harm.

With metal implants, how does cold weather affect the body?

There’s a common belief that metal implants cause cold sensations, especially in chilly weather. However, studies show that metal implants do not affect body temperature or cause abnormalities.

How to mentally prepare for surgery?

• Acceptance and understanding of the current condition, treatment options, and necessity of surgery are crucial.
• Full awareness of surgical procedures and post-surgery expectations aids in cooperation when asked to perform certain actions by doctors or nurses.
• Repeated identity confirmation by staff through name and surname is a standard for patient identification before procedures like blood drawing, blood or fluid administration, and pre-surgery marking.
• Trust the medical team and nurses to perform their duties to the best of their abilities, as they are trained to care for patients like family.
• Patients might be encouraged to stand or walk despite significant pain, aiming to prevent or minimize other complications.
• Most surgical patients report satisfaction and good outcomes. In cases of complex diseases, revision surgeries, or chronic conditions with extensive pathology or permanent nerve damage, surgery might not resolve all issues.

How to prepare the body for surgery?

• Get enough sleep before surgery. Avoid smoking or drinking alcohol before hospital admission.
• Have a relative who can care for the patient and communicate with the staff.
• Bring ongoing medication and inform if allergic to any medication.
• Avoid bringing valuables to the hospital. Remove jewelry and accessories before surgery.
• Wear loose-fitting clothes and shoes that are easy to put on and take off.
• Ensure personal hygiene by bathing, shampooing, brushing teeth, trimming nails, and removing nail polish.
• Avoid makeup, hairpins, or contact lenses.
• Deposit dentures with a relative. Inform the doctor about loose teeth.
• Avoid food and water for at least 6 – 8 hours before surgery.

Should regular medications be discontinued?

• Medications to continue until the morning of surgery include:
  • High blood pressure medication
  • Heart medication
  • Asthma or bronchodilator drugs, etc.
• Medications to discontinue before surgery include:
  • Diabetes medication should be skipped on the morning of surgery.
  • All medications affecting blood clotting, such as Aspirin, Plavix, Coumadin, Heparin, including herbal medicines, Ginkgo Biloba, Ginseng, should be discontinued at least 7 days before surgery.

Why meet a rehabilitation medicine specialist and physical therapist before surgery?

To learn

• Preparation before surgery, especially correct lung expansion training, to prevent post-surgery complications.
• Correct postures and activities for spinal surgery patients in every movement – standing, walking, sitting, lying down in daily life and at work, choosing the right spinal support or training to use walking aids properly and safely, and their maintenance.

To reduce

• Pain from spinal pathology, muscles, and nerves through physical therapy techniques, methods, and tools.

To improve

• Balance of strength, endurance, and flexibility in muscles for effective, correct, and continuous daily activities.

For more information
Call: 0 2310 3000 or 1719
Email: info@bangkokhospital.com