Getting Ready for Spine Surgery

Why we prepare so carefully

The result of a spine operation is decided partly in the operating room and partly in the weeks before it. Blood sugar, nicotine, nutrition, bone strength, and a few common medicines each change how well you heal, how likely an infection is, and how solid a fusion becomes. My team runs the same checklist for every patient so that nothing is discovered on the day of surgery, when it is too late to fix.

Step 1: The workup (as soon as surgery is scheduled)

Once we decide on surgery, the office orders your tests right away, not at the pre-op visit. Expect some or all of these:

• Blood tests: a blood count, kidney and liver tests, blood sugar average (HbA1c) if you have diabetes or are at risk, a nutrition protein (albumin), and vitamin D.
• A urine test that checks for nicotine (cotinine) before any fusion.
• An EKG, and for some patients a heart ultrasound or a visit with your cardiologist.
• A bone density test (DEXA) if you are over 65, have had a fracture, take steroids, or have another reason for weak bones. Weak bone changes how screws hold, so I want to know early. If treatment for osteoporosis is needed, it works best when started about three months before surgery.
• Clearance from your primary doctor, and from any specialist who manages a serious condition.
• A sleep apnea screen. If you snore loudly, stop breathing in your sleep, or are very tired during the day, tell us; it changes how anesthesia watches you after surgery.
• Up-to-date imaging. If your MRI is older than about a year, or your symptoms have changed, I may repeat it.

Step 2: Fix what can be fixed

These targets are not red tape. Each one is tied to a real difference in outcomes.

• Nicotine: none, in any form, including vaping and patches, for at least four weeks before surgery and until the fusion has healed. Nicotine starves the healing bone of blood and is the single biggest avoidable cause of a failed fusion. The urine test at your pre-op visit confirms it. If you need help quitting, ask; we will connect you with a program.
• Blood sugar: an HbA1c under 8 percent, and ideally under 7.5, before elective surgery. Higher levels sharply raise infection risk. Your primary doctor or endocrinologist can help you get there.
• Nutrition: a low albumin or a lot of recent weight loss means your body is not ready to heal. A dietitian visit and a short course of a nutrition supplement before surgery can correct it.
• Weight: if weight is adding to your risk, I will say so kindly and honestly. Even a modest loss before surgery helps the wound, the lungs, and the anesthesia.
• Strength: a few weeks of "prehab" with a physical therapist before a larger operation makes the recovery easier. Walking every day counts.
• Mood and sleep: untreated depression, anxiety, and poor sleep make pain after surgery harder to control. Tell me about them; they are part of the plan, not a reason to delay it.

Step 3: Medicines to pause (ask us before stopping anything)

The office will give you a written list for your own medicines. Common examples:

• Anti-inflammatories (ibuprofen, naproxen, meloxicam, celecoxib, high-dose aspirin): stop 7 days before surgery, and do not restart after a fusion until I say so, because they slow bone healing. Acetaminophen (Tylenol) is fine.
• Blood thinners (warfarin, apixaban, rivaroxaban, clopidogrel, and others): the exact plan comes from me together with the doctor who prescribes them. Never stop these on your own.
• Weekly diabetes or weight-loss injections (semaglutide, tirzepatide, and similar): hold the dose the week before surgery. Daily versions are held the morning of surgery. These slow the stomach and matter to anesthesia.
• Arthritis biologics and similar medicines (adalimumab, etanercept, infliximab, tofacitinib, and others): usually held for one dosing cycle before surgery and restarted about two weeks after, once the wound is healing. We coordinate with your rheumatologist.
• Prednisone: keep taking it. Do not stop steroids suddenly. Anesthesia may give an extra dose on the day of surgery.
• Supplements and herbal products (fish oil, vitamin E, ginkgo, garlic, turmeric, St. John's wort): stop 7 to 10 days before. Cannabis products: stop 72 hours before; they can increase anesthesia needs and pain afterward.
• Opioids: if you take them regularly, tell us the exact dose. We will build your pain plan around it, and I may ask you to sign a medication agreement at your pre-op visit.

Step 4: The pre-op visit

About one to two weeks before surgery, you will have a visit with me or my physician assistant, in person or by video. Every result should be back by then. At this visit we review your tests together, sign the consent, go over the pain plan and the expected hospital stay, and talk through your first six weeks at home: walking, lifting, driving, work, and who will help you.

Step 5: The week before

• Skin preparation: you will be given an antiseptic wash (chlorhexidine) to use in the shower for several days before surgery, and for a fusion, a nasal ointment or swab to reduce bacteria on the skin and in the nose. Follow the schedule exactly; it lowers infection risk.
• Do not shave near the surgical site for a week before surgery.
• Set up your home: move the things you use daily to waist height so you do not have to bend or reach. Clear loose rugs. Put a firm chair with arms where you will sit. Stock easy meals. Arrange a ride home and someone to stay with you the first night or two.
• Equipment: a walker, a shower chair, a raised toilet seat, and a "grabber" help after a larger operation. We will tell you which ones you need, and most are covered.
• Call us if you develop a cold, a fever, a skin infection, a urinary infection, or a new rash anywhere on your body in the week before surgery. Surgery may need to wait a short time, and it is far better to wait than to operate through an infection.

Step 6: The night before and the morning of surgery

• Follow the eating and drinking instructions from the hospital exactly. Usually: nothing solid after midnight, and clear liquids until a set time in the morning.
• Take only the medicines the anesthesia team told you to take, with a sip of water.
• Shower with the antiseptic wash. Wear clean, loose clothing. No makeup, lotion, jewelry, or nail polish on the fingers.
• Bring: a photo ID, your insurance card, a list of your medicines and doses, your CPAP machine if you use one, your glasses or hearing aids in a case, and the clothes you will go home in. Leave valuables at home.
• The surgical site is marked in the pre-op area with you awake. If anything seems wrong to you that morning, say so. Everyone on the team wants to hear it.

What to expect afterward

Your post-op playbook, chosen for your operation, explains the first six weeks: after decompression or endoscopic surgery, after lumbar fusion or disc replacement, after neck surgery, and after scoliosis surgery in a child or teen.

Learn more

OrthoInfo, Preparing for Low Back Surgery: orthoinfo.aaos.org (opens in a new tab)

American Society of Anesthesiologists, Preparing for surgery: asahq.org (opens in a new tab)

This playbook is general guidance for Dr. Wey's patients. Your own instructions from the office, the hospital, and the anesthesia team come first. If anything here does not match what you were told, what you were told wins: please ask us.