Pre-preparation for Surgery

• History – It is important for you to inform your doctor about your past medical and surgical history, your current regular medication especially blood thinning agents, such as aspirin, warfarin and drug allergy.
• Neurological examination – Physical and neurological examination may be performed as a baseline for post-operative comparison.
• Investigations / Tests – Diagnostic imaging studies of the spine, such as CT, MRI, spine angiography etc may be performed to provide your surgeon with anatomic details for surgery.
• Informed consent – Your neurosurgeon will discuss the potential benefits, risks and complications that may result from the surgery, any alternative treatments, operative procedure, peri-operative investigations and estimated duration of surgery to you. If the doctor uses term not familiar to you, please clarify with him. You will have to sign a consent form to show that you have understood what was told to you and have agreed for the procedure. You will also need to sign consent for receiving blood transfusion if needed.
• Financial counseling - You will be advised on the estimated cost of the surgery, implant (if any) and expected length of stay in hospital.
• Pre-operative education – It is normal to be fearful of the surgery and experience anxiety. You will be referred to nurse clinician who will provide explanation on what to expect before, during and after the surgery.

Pre-Admission Counselling and Evaluation (PACE) Clinic

Before any surgery, you will need to be assessed by an anaesthetist at the Pre-Admission Counselling and Evaluation (PACE) clinic. Please inform the anaesthetist if you have any medical illnesses or any of the following:

• History of allergy or reaction to any medication, drugs, or food.
• History of bleeding or clotting disorders.
• You are taking blood thinning drugs (e.g. warfarin, aspirin, Clopidogrel). If you are taking any of these medicines, the doctor at PACE clinic will advise if/when you need to stop taking them before the surgery.
• Traditional Chinese Medicine (TCM) or supplements (e.g Cordyceps, Ginkgo Biloba, Lingzhi, goji berries) may affect blood clotting and increase the risk of bleeding. You should stop taking TCM and supplements one month before your surgery.
• You are a smoker or have recently stopped smoking.

Most spinal surgery is done under general anaesthesia. This will be further discussed by the anaesthesiologists at the pre-admission clinic.
Sometimes, the doctor at PACE clinic may refer you to other specialists to investigate/optimise your medical condition(s) before surgery. This can result in postponement of your surgery.

Day of admission/surgery

• Bring along your own toiletries and all current medication.
• DO NOT bring valuables to the hospital.
• DO NOT drink/eat anything 6-8 hours prior to your surgery – hospital staff will call you with instructions the day before your surgery. You can still brush your teeth and rinse your mouth, just remember not to swallow any water.
• Do shower before coming to the hospital. 
• For your safety, you will be asked to remove your dentures, glasses, jewellery, hearing aids and nail polish. Please store them in containers or a plastic bag labeled with your name.
• Your family members may remain with you until you leave for the surgery.
• Depending on the type of surgery, the length of operation may range from 4 to 6 hours or possibly longer.  If there are other emergencies, your surgery may be delayed or postponed.
• Your family members may wait for you outside the ward waiting area while you are in surgery. They may leave their contact numbers with the ward staff so that they can be informed when you are out of the operating theatre.
• You will be asked to remove all your undergarments and change into an operating gown and to empty your bladder before you leave for the operating theatre.
• The operating theatre staff will fetch you on a trolley to the operating theatre.
• If you are unwell on the day of your surgery, please call the number given by PACE.

During surgery

You will receive medication(s) in the operating theatre to make you sleep unless your neurosurgeon has told you otherwise.

After you are asleep, one or more of these catheters/tubes may be inserted:

• Breathing tube – Breathing tube will be inserted into your throat to help you breathe during the surgery.
• Monitoring devices – Wires will be attached to your hand and body. These are connected to automated machines that will continuously check your breathing, heart rate, blood pressure and oxygen saturation throughout the surgery.
• Intravenous (IV) line – One or more intravenous lines for medications, fluid administrations or blood transfusions will be inserted before or during surgery.
• Arterial catheter (IA) – A catheter may be inserted into an artery in your wrist in order to measure your blood pressure more accurately and allow blood sampling to be taken.
• Urinary catheter – A urinary catheter may be inserted into the bladder to drain and monitor the urine output.
• Intra operative spinal cord and nerve monitoring (IOM) – May be used by your surgeon to monitor spinal cord and nerve root function during your surgery.