Selected Podcast
What to Expect If You Need Spine Surgery
If you and your doctor agree that you need spine surgery, do you know what happens next? In this podcast, Dr. Kenneth Crandall, neurosurgeon at the University of Maryland Medical Center and the Spine Institute at UM St. Joseph Medical Center and member of the UM Spine Network, shares his expertise on what you can do to prepare for surgery, what happens during surgery, what kinds of results to expect and tips for a faster recovery.
Featured Speaker:
Kenneth Crandall, MD
Dr. Kenneth Crandall is a neurosurgeon who specializes in treating benign and cancerous tumors of the spine. He is also well-versed in the care and treatment of all aspects of spine disease, including degeneration, deformity, trauma, tumors and infections. His expertise stems from not only his outstanding education and experience, but his love of neuroscience and helping people that started at a young age. His philosophy for patient care is to partner with the patient to find the right option for them while maximizing management of the condition before considering surgery. Dr. Crandall is an assistant professor in the department of neurosurgery at the University of Maryland School of Medicine and sees patients primarily at the University of Maryland Medical Center as well as the Spine Institute at UM St. Joseph Medical Center. Transcription:
What to Expect If You Need Spine Surgery
Prakash Chandran: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.
My name is Prakash Chandran. And today, we'll be discussing what to expect if you need spine surgery. We're joined by Dr. Kenneth Crandall. He's currently a neurosurgeon at the University of Maryland Medical Center and at UM St. Joseph Medical Center, while also being an Assistant Professor in the Department of Neurosurgery at the University of Maryland School of Medicine.
Dr. Crandall, thank you so much for joining us today. I truly appreciate your time. So obviously, we're talking about spine surgery today and I wanted to get started by asking how a person can prepare their body to have the most successful outcome and how long before the surgery should they begin that preparation?
Dr Kenneth Crandall: Sure, no problem. It's my pleasure to talk to you about this important issue. So, first of all, you know, spine surgery is highly variable and there's a lot of different types of operations that we perform, so I think it's, of course, important to talk to your doctor about the things that may be specific to your operation. But in general, you know, it's a good idea to start preparing, you know, as soon as you find out that you're going to have surgery. And I think it's something that a lot of people take for granted, you know, the things that they can do before surgery to have a more successful surgery and a more successful outcome.
And, you know, there's sort of different categories and, you know, one of them is just your general health. You know, there's a lot of other medical conditions that can potentially lead to complications from spine surgery, such as diabetes, being overweight and smoking. So controlling diabetes, losing weight, doing what you can to exercise and get your heart and body healthy is going to make for a better outcome and, of course, stopping smoking. In addition, having a good diet, taking calcium and vitamin D supplementation will make your bones stronger. And then in addition, you're going to be told to potentially stop certain medications prior to the surgery such as blood thinners and things like fish oil, potentially other anti-inflammatory medications. And then you're also going to be given a list of preoperative tests and evaluations that you need to complete. So it's important to get those done in a timely manner, because if anything, you know, is found, that that may need to be addressed prior to surgery.
Prakash Chandran: Okay. Thank you for that comprehensive overview. So leading up to the surgery itself, talk to us a little bit more about how long a spine surgery actually takes.
Dr Kenneth Crandall: So it's highly variable. And one of my mentors used to tell patients when they ask that question, "It's going to take until it's done," because it's very dependent on how technically challenging it is when we're actually in there doing the surgery. But there's also a lot of factors that the patients and family don't realize go into before and after the surgery as well, such as the time it takes to be put to sleep, for the anesthesiologist to place all the lines that they need. A lot of times we monitor a neurologic function during the surgery, so those electrodes have to be placed as well, and then time to position the patient on the table. All of that can take anywhere from 30 minutes to even up to an hour and a half prior to actually when we start the operation, all of which time, you know, the family is waiting, thinking that the surgery is happening.
And then the surgery itself, some surgeries are more challenging than others. Some surgeries are more extensive than others. So we may find things in surgery, like excessive bleeding or maybe even a spinal fluid leak that may take time for us to fix or repair. And all of those things are normal occurrences during surgery that can add to the time. So we try to give general estimations for how long the surgery may take. But it's not necessarily a reason to worry if you're waiting for the end of the surgery and maybe it takes a little bit longer, but we also try to do a good job at updating families during the operation as well, to let them know what's happening.
Prakash Chandran: Yeah, that makes a lot of sense. Can you actually walk us through the surgery itself? Like tell us a little bit about who's in the room and how the procedure goes.
Dr Kenneth Crandall: Right. So during the actual surgery, you know, it's a team of people that are in the room. There's the anesthesiologists, there's the nurses, are both in the operating room, helping us positioning the patient and doing the other, things that need to be done in the operating rooms, including running the equipment, et cetera. There's staff nurses that are passing us equipment and the instruments that we use in the surgery. But then there's also someone assisting the surgeon and that could either be a physician's assistant or a nurse practitioner or, especially in academic centers, a resident or a fellow. And these are all highly trained, skilled team members that are very experienced in helping create for a successful operation.
Prakash Chandran: Now, I imagine that the answer to this will also be highly variable, but for the people that want to know how long they can expect to be in the hospital after the surgery, can you give them a general timeframe?
Dr Kenneth Crandall: Sure. So it is highly variable based on the surgery. Some surgeries that we do are very small and may even be an outpatient procedure where you go home the same day. Some are overnight where we want to keep an eye on you and then you get discharged the very next day. And some require very prolonged hospitalizations and potentially even placement to rehab.
But basically, things that we use to determine when someone can leave the hospital are whether or not you meet certain goals. First of all, you need to neurologically be doing well, you know, no new weakness or neurologic issues after the surgery, need to be eating, having normal bowel movements and the ability to go to the bathroom. A lot of times after these surgeries, we place a drain. And typically, we like to remove that drain prior to discharging someone home. And ultimately, we like people's pain to be under good control prior to leaving and going home, because we have more resources to deal with that while you're still in the hospital. And then we also usually have people work with physical therapy and occupational therapy. And they evaluate you to make sure that you're safe to go home or potentially you need some inpatient rehabilitation. But ultimately, everything that we do after the surgery in terms of when we send you home is all based on safety and whether or not we think that it's safe for you to leave the hospital and go home.
Prakash Chandran: Okay, that makes sense. Let's talk a little bit about the recovery period. You know, you mentioned the physical and occupational therapy while you're in the hospital. Does that typically continue afterwards? And are there other types of rehabilitation that are worth mentioning?
Dr Kenneth Crandall: As we've sort of talked about already, in the hospital, you're evaluated by the physical therapists and occupational therapists and they determine, you know, what you're potentially going to need after surgery. And that may include home physical therapy, that may include rehabilitation where you're actually being transferred to a rehab center somewhere. And it's partially based on what kind of surgery you had, how extensive the surgery was, and also what perhaps your preoperative functioning was. There's typically going to be limitations that are placed for a certain time postoperatively, such as activity limitations, weight lifting limitations. You may need to wear some sort of a brace, for example, like a cervical collar if you're having cervical surgery or potentially a back brace if it's back surgery. We typically recommend people continue to eat a good diet, continue to not smoke after surgery, continue to take calcium and vitamin D supplementation to keep your bones strong. And often, if you're having a fusion, we also recommend avoiding anti-inflammatories during the postoperative period as well.
Prakash Chandran: Now, a lot of people are going to be listening to this and they're going to be wondering what type of results they can expect. Now, obviously spine surgery treats a wide range of conditions, but can you broadly talk about some of the results that people see after spine surgery is complete?
Dr Kenneth Crandall: Sure. So there's a lot of different reasons why people have spine surgery. Sometimes it's just for neck or back pain, but often it's due to compression of nerves or the spinal cord, which can cause pain, numbness, and weakness in the arms and legs. And of course, as we've talked about, results are highly variable depending on the surgery itself. And also, surgery itself causes pain. So, you know, if you have neck pain and then you have surgery on your neck, the surgery itself is going to cause some pain for a prolonged period of time after surgery, which can sometimes cause people to become discouraged. So that's normal and it does get better with time. And other symptoms that people have such as leg pain, arm pain, weakness, a lot of times that gets better fairly quickly after the surgery, but that can also be variable because if those nerves have been compressed for a really long time, sometimes it can take awhile for them to recover. If you have spinal cord compression, that can also take a long time to recover, sometimes even months or years. And also sometimes we don't have patients that make complete recoveries after the surgery. And sometimes also the main goal of surgery is to prevent someone from getting worse as well.
In addition, all surgeries are associated with risk factors and complications. And if you unfortunately experienced a complication, be it an infection or a spinal fluid leak or a nerve injury or something, that can also complicate the recovery process as well..
Prakash Chandran: Okay, so taking a step back, it really seems like the best thing to do is first and foremost, for preparation, getting your body in the best place possible. So that means eating right, that means smoking cessation, really everything that you can do to have the most successful surgery. Then, it's about trusting the team and also the rehabilitation program that you're put in, so you can have the absolute best outcome. Is that more or less a high level assessment of how people should be thinking about going into spine surgery?
Dr Kenneth Crandall: Yeah. I think that's a wonderful summary of everything that we've talked about. Try to live a healthy life both before and after surgery and certainly have a good and detailed conversation with your surgeon before surgery, so you can set realistic goals and expectations, have all your questions answered and really understand, you know, the surgery that you're about to have.
Prakash Chandran: And final question, you know, I know that a lot of people will be listening to this and they're just a little scared or apprehensive about going in for the surgery itself. Given all of your experience in doing this, what's one thing that you wish more patients knew before they came into surgery?
Dr Kenneth Crandall: That's a good question. I mean, you know, I think that spine surgery can sometimes have a bad reputation. But if you, you know, are somebody who truly has gotten to the point where you need surgery and you find a surgeon that you have a good relationship with and you can trust, and you do all of the things that we talked about in terms of trying to make yourself as healthy as possible and listening to the instructions both before and after surgery, then you can really maximize the success of the operation that you're going to have.
Prakash Chandran: Well, Dr. Crandall, I think that's the perfect place to end. Thank you so much for your time.
Dr Kenneth Crandall: Sure. My pleasure.
Prakash Chandran: That was Dr. Kenneth Crandall, a neurosurgeon at the University of Maryland Medical Center and UM St. Joseph Medical Center, and also an Assistant Professor in the Department of Neurosurgery at the University of Maryland School of Medicine.
This episode is sponsored by the University of Maryland Spine Network. Connected by the renowned University of Maryland School of Medicine, the UM Spine Network is home to the state's leading spine experts. With convenient locations throughout the state, UM Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve. You can find more shows just like this one @umms.org/podcast .
Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again soon.
What to Expect If You Need Spine Surgery
Prakash Chandran: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.
My name is Prakash Chandran. And today, we'll be discussing what to expect if you need spine surgery. We're joined by Dr. Kenneth Crandall. He's currently a neurosurgeon at the University of Maryland Medical Center and at UM St. Joseph Medical Center, while also being an Assistant Professor in the Department of Neurosurgery at the University of Maryland School of Medicine.
Dr. Crandall, thank you so much for joining us today. I truly appreciate your time. So obviously, we're talking about spine surgery today and I wanted to get started by asking how a person can prepare their body to have the most successful outcome and how long before the surgery should they begin that preparation?
Dr Kenneth Crandall: Sure, no problem. It's my pleasure to talk to you about this important issue. So, first of all, you know, spine surgery is highly variable and there's a lot of different types of operations that we perform, so I think it's, of course, important to talk to your doctor about the things that may be specific to your operation. But in general, you know, it's a good idea to start preparing, you know, as soon as you find out that you're going to have surgery. And I think it's something that a lot of people take for granted, you know, the things that they can do before surgery to have a more successful surgery and a more successful outcome.
And, you know, there's sort of different categories and, you know, one of them is just your general health. You know, there's a lot of other medical conditions that can potentially lead to complications from spine surgery, such as diabetes, being overweight and smoking. So controlling diabetes, losing weight, doing what you can to exercise and get your heart and body healthy is going to make for a better outcome and, of course, stopping smoking. In addition, having a good diet, taking calcium and vitamin D supplementation will make your bones stronger. And then in addition, you're going to be told to potentially stop certain medications prior to the surgery such as blood thinners and things like fish oil, potentially other anti-inflammatory medications. And then you're also going to be given a list of preoperative tests and evaluations that you need to complete. So it's important to get those done in a timely manner, because if anything, you know, is found, that that may need to be addressed prior to surgery.
Prakash Chandran: Okay. Thank you for that comprehensive overview. So leading up to the surgery itself, talk to us a little bit more about how long a spine surgery actually takes.
Dr Kenneth Crandall: So it's highly variable. And one of my mentors used to tell patients when they ask that question, "It's going to take until it's done," because it's very dependent on how technically challenging it is when we're actually in there doing the surgery. But there's also a lot of factors that the patients and family don't realize go into before and after the surgery as well, such as the time it takes to be put to sleep, for the anesthesiologist to place all the lines that they need. A lot of times we monitor a neurologic function during the surgery, so those electrodes have to be placed as well, and then time to position the patient on the table. All of that can take anywhere from 30 minutes to even up to an hour and a half prior to actually when we start the operation, all of which time, you know, the family is waiting, thinking that the surgery is happening.
And then the surgery itself, some surgeries are more challenging than others. Some surgeries are more extensive than others. So we may find things in surgery, like excessive bleeding or maybe even a spinal fluid leak that may take time for us to fix or repair. And all of those things are normal occurrences during surgery that can add to the time. So we try to give general estimations for how long the surgery may take. But it's not necessarily a reason to worry if you're waiting for the end of the surgery and maybe it takes a little bit longer, but we also try to do a good job at updating families during the operation as well, to let them know what's happening.
Prakash Chandran: Yeah, that makes a lot of sense. Can you actually walk us through the surgery itself? Like tell us a little bit about who's in the room and how the procedure goes.
Dr Kenneth Crandall: Right. So during the actual surgery, you know, it's a team of people that are in the room. There's the anesthesiologists, there's the nurses, are both in the operating room, helping us positioning the patient and doing the other, things that need to be done in the operating rooms, including running the equipment, et cetera. There's staff nurses that are passing us equipment and the instruments that we use in the surgery. But then there's also someone assisting the surgeon and that could either be a physician's assistant or a nurse practitioner or, especially in academic centers, a resident or a fellow. And these are all highly trained, skilled team members that are very experienced in helping create for a successful operation.
Prakash Chandran: Now, I imagine that the answer to this will also be highly variable, but for the people that want to know how long they can expect to be in the hospital after the surgery, can you give them a general timeframe?
Dr Kenneth Crandall: Sure. So it is highly variable based on the surgery. Some surgeries that we do are very small and may even be an outpatient procedure where you go home the same day. Some are overnight where we want to keep an eye on you and then you get discharged the very next day. And some require very prolonged hospitalizations and potentially even placement to rehab.
But basically, things that we use to determine when someone can leave the hospital are whether or not you meet certain goals. First of all, you need to neurologically be doing well, you know, no new weakness or neurologic issues after the surgery, need to be eating, having normal bowel movements and the ability to go to the bathroom. A lot of times after these surgeries, we place a drain. And typically, we like to remove that drain prior to discharging someone home. And ultimately, we like people's pain to be under good control prior to leaving and going home, because we have more resources to deal with that while you're still in the hospital. And then we also usually have people work with physical therapy and occupational therapy. And they evaluate you to make sure that you're safe to go home or potentially you need some inpatient rehabilitation. But ultimately, everything that we do after the surgery in terms of when we send you home is all based on safety and whether or not we think that it's safe for you to leave the hospital and go home.
Prakash Chandran: Okay, that makes sense. Let's talk a little bit about the recovery period. You know, you mentioned the physical and occupational therapy while you're in the hospital. Does that typically continue afterwards? And are there other types of rehabilitation that are worth mentioning?
Dr Kenneth Crandall: As we've sort of talked about already, in the hospital, you're evaluated by the physical therapists and occupational therapists and they determine, you know, what you're potentially going to need after surgery. And that may include home physical therapy, that may include rehabilitation where you're actually being transferred to a rehab center somewhere. And it's partially based on what kind of surgery you had, how extensive the surgery was, and also what perhaps your preoperative functioning was. There's typically going to be limitations that are placed for a certain time postoperatively, such as activity limitations, weight lifting limitations. You may need to wear some sort of a brace, for example, like a cervical collar if you're having cervical surgery or potentially a back brace if it's back surgery. We typically recommend people continue to eat a good diet, continue to not smoke after surgery, continue to take calcium and vitamin D supplementation to keep your bones strong. And often, if you're having a fusion, we also recommend avoiding anti-inflammatories during the postoperative period as well.
Prakash Chandran: Now, a lot of people are going to be listening to this and they're going to be wondering what type of results they can expect. Now, obviously spine surgery treats a wide range of conditions, but can you broadly talk about some of the results that people see after spine surgery is complete?
Dr Kenneth Crandall: Sure. So there's a lot of different reasons why people have spine surgery. Sometimes it's just for neck or back pain, but often it's due to compression of nerves or the spinal cord, which can cause pain, numbness, and weakness in the arms and legs. And of course, as we've talked about, results are highly variable depending on the surgery itself. And also, surgery itself causes pain. So, you know, if you have neck pain and then you have surgery on your neck, the surgery itself is going to cause some pain for a prolonged period of time after surgery, which can sometimes cause people to become discouraged. So that's normal and it does get better with time. And other symptoms that people have such as leg pain, arm pain, weakness, a lot of times that gets better fairly quickly after the surgery, but that can also be variable because if those nerves have been compressed for a really long time, sometimes it can take awhile for them to recover. If you have spinal cord compression, that can also take a long time to recover, sometimes even months or years. And also sometimes we don't have patients that make complete recoveries after the surgery. And sometimes also the main goal of surgery is to prevent someone from getting worse as well.
In addition, all surgeries are associated with risk factors and complications. And if you unfortunately experienced a complication, be it an infection or a spinal fluid leak or a nerve injury or something, that can also complicate the recovery process as well..
Prakash Chandran: Okay, so taking a step back, it really seems like the best thing to do is first and foremost, for preparation, getting your body in the best place possible. So that means eating right, that means smoking cessation, really everything that you can do to have the most successful surgery. Then, it's about trusting the team and also the rehabilitation program that you're put in, so you can have the absolute best outcome. Is that more or less a high level assessment of how people should be thinking about going into spine surgery?
Dr Kenneth Crandall: Yeah. I think that's a wonderful summary of everything that we've talked about. Try to live a healthy life both before and after surgery and certainly have a good and detailed conversation with your surgeon before surgery, so you can set realistic goals and expectations, have all your questions answered and really understand, you know, the surgery that you're about to have.
Prakash Chandran: And final question, you know, I know that a lot of people will be listening to this and they're just a little scared or apprehensive about going in for the surgery itself. Given all of your experience in doing this, what's one thing that you wish more patients knew before they came into surgery?
Dr Kenneth Crandall: That's a good question. I mean, you know, I think that spine surgery can sometimes have a bad reputation. But if you, you know, are somebody who truly has gotten to the point where you need surgery and you find a surgeon that you have a good relationship with and you can trust, and you do all of the things that we talked about in terms of trying to make yourself as healthy as possible and listening to the instructions both before and after surgery, then you can really maximize the success of the operation that you're going to have.
Prakash Chandran: Well, Dr. Crandall, I think that's the perfect place to end. Thank you so much for your time.
Dr Kenneth Crandall: Sure. My pleasure.
Prakash Chandran: That was Dr. Kenneth Crandall, a neurosurgeon at the University of Maryland Medical Center and UM St. Joseph Medical Center, and also an Assistant Professor in the Department of Neurosurgery at the University of Maryland School of Medicine.
This episode is sponsored by the University of Maryland Spine Network. Connected by the renowned University of Maryland School of Medicine, the UM Spine Network is home to the state's leading spine experts. With convenient locations throughout the state, UM Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve. You can find more shows just like this one @umms.org/podcast .
Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again soon.