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SI Surgery Preop & Post Op Instructions:
Please bring the following to your initial exam:
· Typed list of all medications including dosages
· Typed list of all allergies
· Reports from all of the following tests taken within the past year: blood tests, CT scans, MRIs, x-rays, EMGs (nerve studies), bone density exams, discograms, injections. Please hand carry MRI and x-ray films to your appointment (CD viewers are OK). Also note that certain tests may need to be repeated.
· We would also prefer a recent history and physical by your physician with medical clearance for surgery especially if you have a medical problem or are over the age of 40.
The following medications, herbs and vitamins should be discontinued at least two weeks prior to surgery as they may cause excessive bleeding during surgery.
· Blood thinners
· Aspirin
· Vitamin E
· Garlic
· Ginseng
· Gingko Biloba
· Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) exp. Ibuprofen, Naproxen, etc… |
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) can also interfere with bone fusion. If your surgery includes bone fusion, avoid these drugs for 2 weeks before surgery and at least 6 months after surgery.
In some studies, Fosamax (a drug for osteoporosis) has also been shown to interfere with bone fusion. It may be wise to use other medications for 6 months following bone fusion surgery. Please check with your primary physician.
Smoking also severely interferes with fusion and causes difficulties with anesthesia. It is essential that you stop smoking before and after surgery.
If you are already taking large doses of narcotic we might have to ask for the help of a pain specialist to adjust these large doses after surgery.
Please also follow the instructions below very carefully prior to your surgery.
· The evening before your surgery, take 1 fleet enema (available over-the counter). Sacroiliac surgery requires to visualize the bone of the sacrum with XRs. This is difficult if your bowels are not empty.
· After midnight before surgery, do not eat nor drink anything unless your physician tells you to take your medications with a small sip of water.
For your pre-admission testing (bloodwork, etc.), please report to the pre-admission department behind the escalators in the lobby area. At this time they will also tell you where to report the day of surgery.
If you are a woman of child bearing age and have not had a hysterectomy or tubal ligation, a pregnancy test will be necessary to verify that you are not pregnant. The surgery requires a significant amount of XRs and this could be harmful for the baby.
Post-Operative Instructions
Diet: As usual
Activity:
Progress as tolerated or follow physical therapy protocol
Symptoms to report to physician:
Unusual swelling, redness or continued drainage of wounds, increasing pain, increasing weakness or numbness.
Medications:
Following surgery you will be prescribed enough pain medications to keep you comfortable. For those of you traveling from a distance you may be given an intramuscular injection prior to your travel in order to tolerate a long trip home.
We will usually wean pain medications a few weeks after surgery (we are not registered as a pain management practice). If you require pain management that is complex, requires high doses of narcotics or necessitates longer periods of time, it may be necessary to enroll the help of a pain specialist as we are not registered as a pain management center.
Wound Care:
During surgery your wounds will be closed with staples, stitches or a special skin glue. What determines the type of closure is the length of the wound and whether or not there is significant oozing of blood. Because a fusion necessitates cutting the bone to raw bone in order for the new bone to grow, this may cause some blood to seep through the wound. In that case, the glue cannot be used and we would most likely use staples (or to a lesser extent stitches).
· If the wound closure is with skin glue, clean it with soap and water only. Do not use alcohol or hydrogen peroxide as this will dissolve the glue.
· If the closure is with staples or sutures, clean the wound daily with hydrogen peroxide and cover it with fresh dressings in order to keep it dry. Keep covered with a dressing until stitches or staples are removed.
Do not take a bath until the wounds are well-healed (usually 2 weeks). Take a shower once a day only. You may leave the wounds open to air if there is no drainage.
Have a family member check the wounds daily for unusual swelling, redness, odor and especially drainage. Please notify us if any of the above are present following surgery.
Expect to have minimal swelling at the wound sites.
Considerations for sacroiliac bone fusion:
Smoking severely interferes with bone fusion. Nicotine constricts the small blood vessels and decreases the blood flow to the graft site. Bone fusion requires good blood flow in order to be successful. The success rate of fusion decreases markedly in smokers. It is therefore essential that you stop smoking for sacroiliac fusion to be successful.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) can also interfere with bone fusion. If your surgery includes bone fusion, avoid these drugs for at least 6 months after surgery.
In some studies, Fosamax (a drug for osteoporosis) has also been shown to interfere with bone fusion. It may be wise to use other medications for 6 months following bone fusion surgery. Please check with your primary physician.
Additional Information:
It is not unusual to have swelling or spasms of the muscles just above the wound. This can be painful and often feels like a hard lump to palpation. This will usually correct itself with time and can be treated with physical therapy as necessary (using ultrasounds).
If the piriformis has not been surgically relaxed, too much activity can irritate it and cause pain after sacroiliac surgery. This can be helped by decreasing activity (especially walking) and taking frequent breaks. Physical therapy can also help (usually using ultrasound and stretching).
During your stay at the hospital your doctor, physical therapist, and social service will collaborate to determine any special needs you might require at home.
If at any time there is an emergency, please call 911 or go to the nearest emergency room. The ER physicians may contact us at (678) 312-2700.
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