Surgical options are discussed with patients during a consultation visit. Patients may decide at this visit to schedule surgery, or call TSC to schedule surgery after taking time to consider options.

Once the decision to schedule surgery has been made, TSC staff including secretaries, nurse clinicians and business office representative will assist in scheduling the surgery. The secretaries work with patients to set a date and time for the surgery; nurse clinicians begin the education and preparation of patients; and a representative of the business office will begin insurance pre-certification of the surgical procedure.

A nurse clinician works with each TSC physician. These nurses coordinate the preparation and education of all surgical patients. Patients receive educational materials and support throughout the preoperative process. This educational process is tailored to meet individual patient needs.

All patients undergoing surgery will need a history and physical done by their family physician. Many patients will donate or have blood donated for them as they prepare for surgery. Other preparations may include additional diagnostic testing, consultations with medical specialists or brace fittings.

The day before surgery, patients will complete surgery preparations that may include skin and/or bowel cleansing and diet restrictions.

The nurse clinician provides the details of these preparations and guides patients as they prepare for surgery.

Most patients are instructed to arrive at the hospital on the day they are scheduled for surgery. The nurse clinician or secretary will instruct patients on arrival times.

As a part of the surgery discussion, the physician will give an estimate of the length of the hospitalization. However, discharge from the hospital is more dependent on the achievement of certain goals than an estimated number of days. These goals include pain management, tolerance of activity and an understanding of discharge teaching.

No two hospitalizations are alike. Pathways, which outline the usual course of a hospital stay, are given to most patients. Physicians and nurse clinicians will also describe what patients may expect while hospitalized.

Discharge planning ordinarily begins before admission to the hospital. Patients may be asked to complete a discharge assessment form before surgery. This assessment will help clinic and hospital staff identify patients who may need additional care at discharge. This additional care may include transfer to a transitional care facility, home care, physical therapy and/or equipment for home care. Most patients will not need any additional services and are able to care for themselves at discharge.

Follow-up varies with each surgery. Most patients are seen in the clinic six weeks after surgery. Additional follow-up will be determined at this first visit. Patients may be seen at intervals for up to a year or more depending on the type of surgery performed. The physician and staff instruct patients regarding the follow up required by their surgery.

Contact the physician's staff at any time with questions or concerns after discharge from the hospital. During business hours.

Monday through Friday, 9:00am to 5:00pm, call (011-886-4) 2320-8712 to speak to a nurse clinician.

After business hours, on weekends and holidays, an on-call physician may be reached by calling
(011-886-4) 2320-8712.

It is best to call during business hours for routine questions, appointment scheduling and prescription refills. Any of the following occurrences should be reported immediately:

• INCISIONAL PROBLEMS - Infections following incisions are rare, however these symptoms may
  indicate an infection and should be reported immediately:
  redness or inflammation
  increased pain or tenderness
  localized warmth
  drainage from the incision
  opening or pulling apart of the incision
  body chills and/or excessive sweating
  fever over 100?F or 38?C
• PAIN - Pain is to be expected after surgery, but excessive pain, ANY new or unusual pain at incision - or anywhere, should be reported. Calf pain or tenderness, chest pain or shortness of breath may indicate the presence of blood clots and should be reported IMMEDIATELY.
• CHANGES IN MOTION and/or SENSATION - Any significant change in sensation should be reported, for example, numbness or tingling not relieved by rest or position change. Also call if any inability to move extremities or changes in muscle coordination is experienced.
• URINATION and BOWEL MOVEMENTS - Experiencing a loss of bowel or bladder control (urination or defecation without warning) or any burning or urgency with urination should be reported immediately.

As with any spinal surgery, there are major and minor things that can go wrong. The worst complications are also the most rare, including death, spinal cord injury, and major injury to the lung, heart, or blood vessels in the chest. Each of these would be expected to occur no more often than one in several thousand surgeries. More minor (and more frequent) complications could include infection, pneumonia, minor bleeding, prolonged need for a chest tube, incisional pain, numbness along an intercostal nerve distribution on the chest wall, and failure of the fusion (pseudarthrosis).