Start with the right questions
Before you set a date, make sure you understand the plan. It is fair to ask your surgeon:
- What exactly will be done, and at which levels of the spine?
- What symptoms is the operation most likely to help, and which ones may not change?
- What are the main risks for someone like me?
- How long will I be in the hospital, and when can I expect to drive and return to work?
- What would happen if I waited or chose not to have surgery?
Write the answers down or bring someone to take notes. If you are still unsure, a second opinion is a normal part of planning a major operation.
Get as healthy as you can before surgery
Spine surgeons pay close attention to a few health factors, because they affect healing, infection risk and, for fusion surgery, whether the bones grow together.
Stop smoking and all nicotine
Nicotine narrows blood vessels and slows bone and wound healing. Studies of spinal fusion have found higher rates of failed fusion in people who smoke. This applies to cigarettes, vaping, chewing tobacco and nicotine gum or patches. Stopping at least four weeks before surgery, and staying off nicotine while you heal, gives your body a better chance. Your primary care doctor can help with a plan to quit, and the free line 1-800-QUIT-NOW can help too.
Bring blood sugar under control
If you have diabetes, high blood sugar raises the risk of wound infection. Your surgeon may check your A1c, a blood test that reflects your average sugar over the past few months. If it is high, surgery may be delayed a short time while you and your doctor work on it.
Check your bone health
Weak bones can make it harder for screws and implants to hold, especially in fusion and deformity correction surgery. Your surgeon may order a bone density scan or blood tests, particularly if you are over 50, have had a fracture from a minor fall, or have used steroid medicines for a long time. If your bones are thin, there are medicines that can help strengthen them, and sometimes they are started before surgery.
Eat enough protein and stay active
Your body needs protein, calories and vitamins such as vitamin D to heal tissue and bone. If you have lost weight without trying, or if your appetite has been poor, tell your surgeon. Walking every day, as your pain allows, keeps your heart, lungs and legs in better shape for recovery. Some people benefit from a few sessions of physical therapy before surgery to learn exercises and safe ways to move.
These steps are sometimes called optimization. Dr. Higginbotham was the first author of a 2024 national survey of spine surgeons on nutrition, function and bone health before spine surgery, published in the Journal of the American Academy of Orthopaedic Surgeons, so this part of planning gets real attention in our office.
Review every medicine you take
Bring a full list, including vitamins, herbal products and anything you take only once a week. Some medicines may need to be stopped or adjusted before surgery:
- Blood thinners such as warfarin, apixaban, rivaroxaban or clopidogrel. Never stop these on your own. The doctor who prescribed them will help decide when and how to pause them.
- Anti-inflammatory pain relievers such as ibuprofen, naproxen and aspirin, which can increase bleeding. Many surgeons ask you to stop these about a week before surgery.
- Some diabetes and weight-loss medicines, including weekly injections such as semaglutide. Anesthesia teams may ask you to hold them for a period before surgery because they slow how fast the stomach empties.
- Certain supplements, such as fish oil, vitamin E, garlic and ginkgo, which can affect bleeding.
You will get written instructions. If two doctors tell you different things, call and ask before surgery day.
Pre-surgery tests and visits
Most people need some testing a few weeks before surgery. This may include blood work, a urine test, an EKG, and for some people a chest X-ray. If you have heart, lung or kidney problems, you may need a visit with your primary care doctor or a specialist for a medical clearance. Some hospitals also hold a pre-anesthesia phone call or visit.
Set up your home and your help
You will likely be moving slowly for the first couple of weeks. A little setup goes a long way:
- Arrange a ride home from the hospital and someone to stay with you for the first few days.
- Move things you use every day to between waist and shoulder height, so you do not have to bend or reach overhead.
- Clear loose rugs, cords and clutter from walkways to prevent falls.
- Consider a shower chair, a raised toilet seat, a grabber tool and slip-on shoes.
- Stock easy meals and fill any prescriptions you can ahead of time.
- Set up a place to rest on the main floor if stairs are hard.
- Plan for pets and children, and line up help with yard work and driving.
Work and paperwork
Talk with your employer early about time off. Many people with desk jobs return within a few weeks, while heavy or physical jobs, such as farm, warehouse or construction work, may need a longer break. Bring any leave or disability forms to your pre-surgery visit so they can be filled out in time.
The day before and the morning of surgery
- Follow the eating and drinking instructions you are given exactly. If you eat when you were told not to, surgery may be postponed for your safety.
- You may be asked to shower with a special antiseptic soap the night before and the morning of surgery.
- Do not shave near the surgical area.
- Take only the morning medicines you were told to take, with a small sip of water.
- Bring your ID, insurance card, medicine list, any brace you were given, and comfortable, loose clothes.
- Leave jewelry and valuables at home.
When to call us
Let our team know before surgery if you develop a fever, a cold, a skin rash or a cut near the surgical area, or if you start a new medicine. Call too if you are unsure which medicines to stop or when. It is much easier to sort these out a few days ahead than on the morning of surgery.
Common questions
How far ahead should I stop smoking before spine surgery?
The sooner the better. Many surgeons ask for at least four weeks off all nicotine before surgery and throughout healing, especially before a fusion.
Do I need to lose weight before surgery?
Not always. Weight can affect wound healing and recovery, and for some people with a very high BMI a surgeon may suggest working on weight first. It is a conversation to have with your surgeon.
Should I do exercises before surgery?
Staying active helps. Daily walking and simple strengthening, within the limits of your pain, can make recovery easier. Ask whether a few therapy visits before surgery would help you.
Sources
- Getting yourself healthy before surgery, MedlinePlus (NIH)
- Smoking and surgery, MedlinePlus (NIH)
- Berman D, et al. The effect of smoking on spinal fusion. Int J Spine Surg. 2017.
- Higginbotham DO, et al. Perioperative nutritional, functional, and bone health optimization in spine surgery: a national investigation of spine surgeons' perceptions and practices. J Am Acad Orthop Surg. 2024.