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Emergency Neurosurgical Specialists

Surgery Instructions

Emergency Neurosurgical Specialists has developed detailed instructions to help you and your family prepare for surgery. We’ve also included exercises and tips for daily living after spine surgery to incorporate into your recovery plan.

Before Your Surgery

If there is time before surgery, you may be told to do the following to help your surgery go more smoothly:

  • Tell your doctor about any medications you’re taking. Medications that thin your blood such as aspirin, heparin, Coumadin, Plavix, and others will need to be stopped at least 7 days before your surgery.
  • Tell us if you are allergic to any antibiotics since you will receive a dose immediately before your surgery.
  • Don’t eat or drink anything after midnight before surgery including water, chewing gum, and breath mints.
  • If you smoke, you should stop now. Ask us for a nicotine patch. Smoking can be harmful to your cardiopulmonary status, can negatively affect fusion during back and neck surgery, and can make vascular problems in the brain much worse.
  • At least three to four weeks before surgery, stop smoking or cut down as much as you can.

Your Medical Checkup

You may need to see your primary care doctor and/or cardiologist to make sure you’re in good shape for surgery. Tell your doctor what medications you are taking including over-the-counter drugs like cold medicine and aspirin. Ask your doctor and surgeon if you should stop taking any medications before surgery. 

Getting Your Home Ready

To make life after surgery easier, you should get your home ready. Some suggestions are:

  • Put things where you can get them without reaching or bending.
  • Pick up clutter.
  • Tape down electrical cords.
  • Arrange for someone to help you with cleaning and household duties.

Your doctor may ask you to prepare by doing the following:

  • Provide a list of all medicines you take, including aspirin and anti-inflammatories.
  • Don’t eat six hours before check-in, or drink anything four hours before.
  • Arrange for a responsible adult to drive you home afterward.
  • Bring any requested x-ray, CT, or MRI images on the day of the procedure.

Your Family's Role

  • Support the patient by offering to help with daily tasks. Attend appointments, run errands, and cook.
  • Be a good listener and be sure to keep all family members involved, including children.
  • The healthcare team will want to prevent and control complications. But the timing of surgery may depend on you or your loved one’s condition.
  • Make sure all follow-up visits are kept and check that all medications are taken as directed. Be patient with mood swings, pain, or fatigue that your loved one may feel.
  • Talk to the doctor if any sadness does not pass with time. When your loved one is ready, find ways to help them return to normal daily activities. Patients may also suffer with memory loss, decreased ability to concentrate and multitask from brain surgery. Most, if not all, should improve with time.

Arriving, Checking In, and Getting Ready

You’ll most likely arrive at the hospital a few hours before your surgery. If you have not preregistered, you’ll be asked to fill out and sign some forms when you check in. These can include surveys about your pain. Your doctor also may give you a brief physical exam.

After you change into a gown, certain tests may be done. Then, one or more IV lines may be started. These lines provide the fluids and medications you need during surgery. If we are using monitoring (SSEPs and MEPs) during the surgery, the professionals performing the monitoring will introduce themselves and answer your questions. 


At the start of your surgery, you’ll be given general anesthesia. This medication will make you “sleep” through the surgery. An anesthesiologist or nurse anesthetist is in charge of the anesthesia. He or she may meet with you before the surgery begins to talk with you and answer questions.

After Your Surgery

Recovery will take time. You may feel more tired than normal for a few months or even a year.

It’s harder to cope some days than others, so be patient. If you feel sad or depressed, talk with a member of your healthcare team. Depression is common and can be treated. It’s normal to have fears or feel angry. Sharing with your family can also help.

When to Call the Doctor

Call your surgeon at once if you have any of the following:

  • Increased drowsiness
  • Ongoing nausea or vomiting
  • Extreme headaches
  • Seizure
  • Increased muscle weakness
  • Shortness of breath
  • Pain swelling in a leg
  • Fever of 101°F or greater
  • Burning during urination
  • Nasal drainage
  • Redness or drainage from the incision or an IV site


Therapy may be prescribed and therapists can work with you to improve balance, strength, speech, and daily living skills. If you are having problems with strength or movement, your therapist may suggest installing hand rails in hallways or bathrooms at home. 

If Other Treatment is Needed

After a craniotomy, medications are often prescribed to treat side effects and help you feel better. If you had surgery for a brain tumor, you may also have chemotherapy or radiation. 

After Your Hospital Stay

You may be able to go home as soon as you can walk, eat, and drink normally. Back home, family and friends may offer help and support. Accept help when you need it, but it’s important to strike a balance. Keep in mind that you’re striving to become independent again. 

Keep Follow-up Visits

You may have an office visit seven to ten days after surgery. At this time, any remaining stitches or staples may be removed. You can expect to meet with your surgeon about every four weeks for the first few months. You may also have follow-up imaging tests to ensure your condition is stable. 

Start by Walking

Walking is a great way to rebuild your strength. Start out with short, frequent walks. Even if it’s just to get a glass of water, get up and walk each day. Gradually try walking greater distances, such as to the corner mailbox. 

Adjusting to Daily Life

Say “yes” when people offer to help, such as with cooking and housework. Arrange for childcare when you need a break. Have friends and family give rides and attend school games. If you’ve been told not to drive at this time, get help setting up rides. Talk with your social worker, case manager, or discharge planner. Ask your employer about cutting back your work hours if your schedule is too tiring, or try working at home where you can pace yourself. 

Your Family’s Role

After treatment, observation occurs. The team will want to see how well the surgery worked. Waiting for answers can be tiring. You may choose to let some people go home and rest. Then other family members can wait for news.

You will be shown a nearby room where you can wait during surgery. A craniotomy, for example, often takes three to five hours, or more. If possible, be sure one person is always in the waiting room to receive news. The doctor will talk with you when surgery is over. You’ll also be told when you can visit your loved one. 

If You Need Medications

Brain conditions often cause symptoms and your treatment is likely to produce some side effects. To help you feel better, your doctor may prescribe medications. Ask your doctor or pharmacist about possible interaction with other medications. Always take them as directed.


Steroids reduce brain swelling. Do not stop taking them without your doctor’s approval. Side effects can include water retention, weight gain, hair growth, insomnia, stomach ulcers, increased risk of infection, and mood changes.


Anticonvulsants help prevent seizures or convulsions. You will have blood tests to make sure you get the right dosage. Call the doctor right away if you have any of these side effects:  trouble breathing, rash, balance problems, or dizziness.

Other Medications

You may need other medications to manage symptoms and side effects. Talk with your doctor if you have problems with nausea, stomach acid, or pain. Medications may include: 

  • Antiemetics to control nausea
  • Antacids to control stomach acid
  • Laxatives or stool softeners to treat constipation
  • Medications to control pain
  • Hormones to replace the ones that your body isn’t producing or to treat certain types of tumors


Keeping the muscles in your legs, buttocks, and abdomen strong and limber helps reduce stress on your back after back surgery. Here are some simple stretching and strengthening exercises. Your doctor or physical therapist will tell you how often to exercise and how many repetitions to do. For safe and effective exercise:

Breathe Normally

  • Avoid twisting, bending, or arching your spine
  • Stop if you feel sharp pain

Buttocks Squeeze: Strengthens buttocks muscles.

  • Lie on your back with your spine aligned.
  • Squeeze your buttocks muscles together.
  • Count to five, then relax.

Partial Sit-Up: Strengthen the abdominal muscles.

  • DO NOT do partial sit-ups unless your doctor or physical therapist says you can.
  • Lie on your back, spine aligned and knees bent.
  • Brace your abdominal muscles and squeeze the buttocks muscles together.
  • Reach your hands toward your thighs and tighten your abdominal muscles to lift your shoulders off the floor. Focus your eyes on the ceiling; don’t bend your neck toward your chest.
  • Work up to holding for one minute, several times a day.

Heel Raise: Help to strengthen calf muscles.

  • Stand with your spine balanced.
  • Hold on to a counter, table, sturdy chair, or railing.
  • Rise on your toes, then lower your heels to the floor.

Calf Stretch: Helps make standing and turning easier.

  • Stand with your spine balanced. Step forward with one foot.
  • Place your hands on a wall or the back of a sturdy chair.
  • Keep both heels on the floor.
  • Bend your front leg until you feel the stretch in your back leg.
  • Count to 20, then switch feet. DO NOT arch your back.

Opposite Hand-Knee Push: Strengthens the muscles in your abdomen and thighs.

  • Sit with your spine in a neutral position. You may want to use a lumbar support.
  • Tighten your lower abdomen.
  • Lift your left knee and push against it with your right hand for 20 counts.
  • Don’t arch your back. Do the exercise again, using the left hand on the right knee.

Wall Slide: Help to strengthen your thighs.

  • Stand with your back against a smooth wall.
  • Put your feet 18-24 inches away from the wall and slightly apart.
  • Relax your shoulders.
  • If needed, place a rolled-up towel behind your lower back to keep your spine in a neutral position.
  • Slide slowly down until you’re halfway between sitting and standing.
  • Hold for at least ten counts, then slide back up.

Hamstring Stretch: Stretches the muscles in the back of your thigh.

  • Lie on your back with one knee bent.
  • Tighten your abdominal muscles.
  • Put a towel or your hands around the back of the thigh of the straight leg.
  • Slowly pull the towel toward you, keeping the knee straight.
  • Hold for ten counts then switch legs. Raise the leg a little higher each day.
  • If you feel tingling or pain in your back or legs, you’re not yet ready to do this exercise.

Quadriceps Stretch: for the muscle on the front of the thigh.

  • Stand with your feet shoulder-width apart.
  • To keep your balance, hold on to the back of a sturdy chair or a nearby wall with your right hand.
  • Grasp your left ankle with your hand.
  • Pull your left heel toward your buttocks. Don’t arch your back or lean sideways.
  • Hold for 20 counts then switch legs.

Chest-Shoulder Stretch: Relaxes the chest and shoulders.

  • Stand facing a corner with your back in a neutral position.
  • Put one foot slightly in front of the other.
  • With arms bent at right angles, place your hands on the walls.
  • Keep the elbows at shoulder height.
  • Gently lean toward the corner. Feel the stretch across your upper chest.
  • Don’t arch your back.

Pelvic Tilt: Strengthens abdominal muscles.

  • Lie on your back with your knees bent and your feet flat.
  • Tighten your stomach and buttocks, and gently press your low back into the bed. This tilts your pelvis.
  • Hold for five seconds. Repeat 10 times.
  • Do this twice a day.

Tips for Daily Living After Spine Surgery

In general, standing puts less strain on your back than sitting. So be sure to get up and move around often during the day. These tips can show you how to stand and turn without twisting your back. Use these tips to make grooming and kitchen work safer.

Getting Dressed

Putting on and taking off socks, slacks, and underwear may be easier to do lying on your back. A tool called a dressing reacher can be of help. To make dressing and undressing easier, wear loose clothes and slip-on shoes with closed backs.

Getting Ready to Lie Down

Before you lie down, make sure that you have the things you need within reach. Gather items such medications, eyeglasses, reading material, glass of water, TV remote control.

Be sure to place them so you won’t have to twist your back to reach them. If you aren’t able to gather the items yourself, ask a family member or friend to help.

Other General Tasks

Washing at the Sink: While standing at the sink, bend your knees and hips. Keep your back in a neutral position.

Showering: Use a hand-held shower to wash your hair or bend at the knees and hips under the shower head to avoid arching your back. To avoid bending, use a long-handled scrub brush. Use liquid soap so you don’t need to pick up a dropped bar of soap.

Working in the Kitchen: Store food and tools you use often on the counters or the middle shelves of the refrigerator. While working, stand with one foot in front of the other or resting on a stool.

Sitting: Sitting puts more pressure on your spine than lying or standing. At first, avoid sitting as much as possible. As your back heals, you can sit for longer periods of time.

Driving or Riding in a Car: Adjust the seat so that your knees are level with or just below your hips. To get out of the car, pivot on your buttocks and swing your legs out, keeping your knees together. Don’t twist your spine. Use your leg muscles to stand. To get into the car, do the reverse.

Doing Desk Work: When you’re ready to go back to work, ask your physical therapist how to arrange your desk and workspace to protect your back.

Eating: Slide your chair as far under the table as possible. Don’t lean forward or put your elbows on the table.

Using the Toilet: Try using a toilet seat riser or portable commode.You can buy these at a drugstore or medical supply store.

Bending and Lifting: During the first weeks after surgery, avoid bending and lifting as much as possible. If in doubt about whether a task is safe for you, ask for help. You’ll learn safer ways to bend, learn the proper way to lift and find exercises to stretch your legs, so that you can use them to lift instead of using your back.

Grocery Shopping: Buy small amounts of groceries each time. Ask the checker to bag lightly and to use bags with handles. Put the shopping bags on the car seat, not in the trunk or on the floor.

Child Care: If you have small children, arrange for help while you’re recovering. Put the changing table on a raised surface, or adjust it to waist height. Use a reacher to pick up small objects, such as toys, from the floor. If you must lift a baby from a crib, lower the railing of the crib. Bring the child close to your body. Follow the lifting instructions.

Pushing and Pulling: Pulling is harder on your spine than pushing. So whenever possible, push, don’t pull. Also, avoid pushing anything heavy. 

Learn more about preparing for surgery in our patient education center.

Please let us know if you have any other questions about preparing for surgery and recovery. Our office number is (305) 325-4873.