Spine Surgical Procedures
Spine surgical procedures are performed at Christiana Hospital, Wilmington Hospital, and Christiana Care associated ambulatory surgery centers.
In 2006, the Christiana Care Health System designated a special center for spine surgery at Christiana Hospital. The Christiana Care Spine Center has a team of dedicated surgeons, nurses, anesthesia providers, and support personnel working together to give exceptional care before, during, and after surgery. The center offers state-of-the-art evaluation and treatment of disorders of the cervical, thoracic and lumbar spine. The most common reason for spine surgery is to treat back pain. Other reasons for spine procedures may include restoring neurological function (compression); removing pathologic lesions (such as tumor or infection); correcting deformity (abnormal alignment or spine fracture); correcting structure instability (abnormal displacement). The spine procedures may also include those performed by pain management specialists, for example, such as epidural steroids injection, spinal nerve stimulator placement, etc.
Who are the anesthesia providers who will give me anesthesia?
Your anesthetic will be provided by members of the “Anesthesia Care Team” composed of an Anesthesia Doctor, called an Anesthesiologist, and an Advanced Practice Nurse in anesthesia, called a Certified Registered Nurse Anesthetist (CRNA). All anesthesia doctors here are nationally board certified in the specialty of anesthesia or are board eligible. Members of your anesthesia team will be always with you during your anesthetic and will not leave your side until you are safely taken to the wake-up area know as the recovery room (Post Anesthesia Care Unit). The meeting with the anesthesia care team will take place on the day of surgery prior to your procedure. Before the day of surgery, all of your medical information will be processed by a team of pre-operative preparation personnel who will collect all of your medical data and prepare it for the anesthesia team members. If you have any remaining questions regarding your anesthetic, they may be answered at that time.
What kind of anesthesia will I receive?
The recommended anesthesia for your surgical procedure will depend on your medical history and the type of surgical procedure. For most spine procedures including discectomy, microdiscectomy, laminectomy, spine fusion with instrumentation and spinal lesions removal general anesthesia is needed to insure your safety and to provide your surgeon with the best operating conditions. During general anesthesia, you are completely asleep. The degree of your anesthesia sleep is measured by specialty monitors called BIS monitors which assure us that you are safely asleep and that you will have no awareness during anesthesia. Your anesthetic is designed to allow you to wake up into a comfortable state.
While you are asleep, your anesthesia team will be continuously monitoring your vital signs for your safety. And they will continuously give you anesthesia drugs intravenously and also through breathing tube along with oxygen. At the end of surgery, waking up occurs quickly by simply stopping the administration of these drugs.
For some spine procedures such as spinal nerve stimulator placement or epidural space steroids injection, general anesthesia is not required and a lighter type of anesthesia is sufficient. This lighter type of anesthesia is called Monitored Anesthesia Care (M.A.C.). During this type of anesthesia you will be in a relaxed state throughout the procedure and stay pain free. You may dose lightly but will not be deeply asleep.
What is TIVA?
TIVA stands for total intravenous anesthesia and it is one type of general anesthesia. In TIVA, the anesthesia agents will be administrated only via intravenous, not through the breathing tube. Occasionally your surgeon may request special monitoring technique called neurological monitoring during your spine surgery to protect integrity of spinal cord and nerve roots. The neurological monitoring will be handled in the operation room by specialists called neurophysiologista. To maximum the benefit of this type of special monitoring, anesthesia care team may choose to administrate TIVA during part or entire of the surgery.
How am I going to be positioned during the surgery?
Depending on the procedures and surgeon’s preference you may be positioned on supine position (lying on your back), lateral position (lying on your side) or prone position (lying on your belly). Prone position is the most common position in spine surgery. The anesthesia care team along with other OR staff including your surgeon will turn you into prone position after you are completely asleep. The anesthesia care team will make sure that your neck, arms, and eyes as well as other pressure sensitive areas are well protected during entire surgery.
Will I later have any undesirable effects from the anesthesia?
It is difficult to predict if you will have any undesirable effects after anesthesia. Every patient is different. However, fortunately, the common undesirable effects presenting after having anesthesia with surgery are not life threatening and are short lived.
You may have nausea and vomiting which we treat with fast acting drugs through the intravenous. However, we will significantly reduce the chance of this happening by giving you drugs to prevent nausea and vomiting before you awaken from your anesthetic. You may have a sore throat which can happen after you have general anesthesia. Although you will not be aware of this, during general anesthesia a plastic breathing tube is usually put in your mouth while you are asleep to assure your safety. If you have a sore throat, it generally will be mild and be gone after two days. You may have a feeling of fatigue after receiving anesthesia. This could last for several days and is due to several causes among them are residual small levels of anesthetic drugs, medicine for pain taken after surgery and the response of your body to the healing process.
What happens in the recovery room?
You will wake up from anesthesia just before you leave the operating room, but you will be somewhat sleepy. You will go to the recovery room known as the Post Anesthesia Care Unit (PACU) where you will become more alert. You should be comfortable, but as you spend time in the recovery room, you may begin to experience some discomfort from the surgical procedure as the anesthetic pain medications begin to wear off. Specialized, highly trained recovery room nurses will give you pain medication through the intravenous to help maintain your comfortable state. To assure your safety here, we will continue to monitor your blood pressure, your heart rhythm, your breathing, and your temperature as well as monitor the surgical site for its appropriate appearance. Anesthesia staff are immediately available to evaluate and treat changes from expected behavior. The surgeon would be contacted immediately to evaluate any changes associated with the surgical procedure. Your safe recovery from surgery and anesthesia is the primary goal of the recovery room team of nurses and anesthesia physicians. After one to two hours, usually you will be discharged from the recovery room to an area where you will get ready to go home or to an overnight room in the hospital