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You have decided spine surgery is your best treatment option. You most likely are experiencing mixed emotions, excited for relief but also nervous. These are completely normal emotions when preparing for spine surgery. But there are things you can do to get your body optimally ready for the surgery and set yourself up for the best recovery. The months or weeks leading up to your surgery are crucial preparation time. From specific exercises to quitting smoking, the steps you take now can make a huge difference in healing and preventing potential complications down the road. We will walk you through the top dos and don’ts to prepare your body and mind so you can tackle spine surgery with confidence. 


Why is Preoperative Optimization Crucial? 

Over the years patients presenting for spine surgery have changed. Advances in techniques, technology, pharmacology, and increased life span have allowed patients with extremes of age, comorbidites, and medications to undergo spine surgery. These factors have lead to an increased focus on preoperative screening and optimization. Before your spine surgery Dr. Kalra will request you optimize your health to assist in reducing potential risks. This will include making important lifestyle changes and managing any chronic conditions:

    • Eat a balanced diet, work towards a healthy weight. Focus on proteins, fruits, vegetables, and healthy fats. Staying well-nourished will help your body to heal. Losing excess pounds will make surgery safer and improve your recovery. Work on a nutrition and exercise plan to reach your goal weight before the procedure.
    • Stop smoking and drinking alcohol. Smoking reduces blood flow, slows healing, and increases other health risks including post-operative infection. Quitting for at least a month, but ideally longer, can significantly improve your outcomes. Alcohol causes dehydration, thins your blood, and stresses your liver.  
    • Control blood pressure and blood sugar. Unmanaged high blood pressure or diabetes can lead to poor wound healing and other complications. Exercise, diet, and medications can help get these chronic conditions under control. These conditions need to be within a normal or safe range at least a few weeks prior to spine surgery. 
    • Pre-rehabilitation. Optimizing your physical functionality through physical exercise prior to surgery can improve your post-operative outcomes, function, and rehabilitation. The more strength and stamina you can build prior to surgery the more you will be able to do after surgery.  
    • Improve sleep & reduce stress. Improved sleep and reduced stress often go hand and hand. Working on specific strategies like sleep hygiene, meditation, bedtime routines can help you prepare physically and mentally for spine surgery. 

Preoperative optimization gives you the best chance of a successful and timely recovery. Making these lifestyle changes in the months or weeks before your procedure can have significant benefits, getting you ready for improved spine health and mobility.


Improve Your Nutrition and Weight Loss

Good nutrition is key to preparing for spine surgery and recovery. In the months or weeks leading up to your surgery, focus on eating a balanced diet high in nutrients like protein, iron, vitamin C which promote healing. Reducing portion size, limit high sodium, and high sugar foods. Losing excess weight will make your spine surgery safer and recovery easier. Everyone knows there is countless advice and approaches on how to lose weight. The traditional advice of consuming less calories and being more active is a great starting point. Below are some tips to get started, however you should consult your primary care physician, cardiologist, or a medical weight loss specialist before significantly altering your diet, especially if you have comorbidities or take medications. 


    • Cut down on calories. Figure out how many calories you need per day to lose a few pounds per week. You can use an app or track what you eat to make sure you stay under your desired caloric intake. A free body weight planner from the National Institutes of Health (NIH) will allow you to make personalized calorie and physical activity plans to reach a goal weight within a specific time period. Enter your personalized information and potential or actual surgery date to start on the framework for your preoperative weight loss plan. 
    • Choose healthier cooking methods. Instead of eating fried and ultra processed foods, try grilling, broiling, steaming, or baking your foods. Eating food with natural ingredients or when possible organic foods are best. Instead of vegetable oils or margarine use olive or avocado oil to cook foods. Reduce or eliminate heavy sauces, season your food with spices or lime/lemon juice. 
    • Stay hydrated. Drink plenty of water and unsweetened beverages to stay hydrated. These can also help you feel fuller without taking in extra calories. You may be surprised to learn that our brain is made up of 74% water, our bones are 22% water, and our blood is 83% water. This means it is important to stay hydrated so our organs and body function optimally. The National Academy of Medicine suggests an adequate intake of daily fluids to be thirteen cups for men, and nine cups for women with one cup equaling eight ounces. Higher amounts may be necessary for those with high physical activity levels or for those exposed to warm climates like our summers in Texas. 
    • Get moving. Exercise is key for both weight loss and preparing your body for surgery. Walking, swimming, yoga, Pilates, and light strength training are all good options. Push for at least 20-30 minutes of moderate exercise most days. Be sure to speak with your primary care physician, cardiologist, and/or a personal trainer before starting a new exercise plan. Stay focused on your goals, ask others to join you for their support. If you have not worked out for some time or are struggling with increased exercise, remember each time you exercise you will build endurance and stamina. Although making exercise and increased physical activity a component of your everyday life is optimal, you may need to look at this preoperative time period only, setting a more short-term goal of exercising a certain number of times each week leading up to your spine surgery.


Stop Smoking and Drinking Alcohol

Now is the time to pause and hopefully kick these habits. You should stop smoking and consuming alcohol as soon as you decide on spine surgery. Although the length of time you have prior to your surgery may vary, you should stop smoking and drinking alcohol at least two weeks before spine surgery. 


    • Tobacco. Smoking reduces blood flow, slows wound healing, and increases the risks of surgical complications such as infection and blood clots. The nicotine in tobacco products causes blood vessels to constrict, limiting oxygen supply to your tissues, bones, and organs. If your spine surgery involves a fusion, nicotine limits bone growth and often impedes a successful fusion. Quitting smoking, even just temporarily, will boost your circulation and help your body prepare for the demands of spine surgery. 
    • Alcohol. Alcohol dehydrates your body and thins your blood, making increased bleeding more likely during your surgery. Alcohol also stresses your liver, which helps metabolize medications and nutrients needed for your recovery. Giving up alcohol, even temporarily, leading up to your spine surgery will allow you to rehydrate, your blood to normalize, and your liver function to improve. 


Controlling Underlying Medical Conditions

Before surgery it is critical to get any underlying health issues under control. Unmanaged conditions such as diabetes, high blood pressure, or heart disease can complicate surgery and slow your recovery. Dr. Kalra may refer you to or request you schedule an appointment with your Endocrinologist or Cardiologist to manage these issues and determine when it is safe for you to proceed with spine surgery. 


    • Diabetes Management. If you have diabetes closely monitor your blood sugar levels and take all medicine as prescribed in the month before surgery. It is critical that you work with your doctor to achieve strong control of your diabetes, as high blood sugar can negatively impact wound healing and increase risk of infection. Be especially diligent about checking your blood sugar in the days leading up to surgery, the day of your surgery, and during the post-operative period. 
    • Blood Pressure Control. High blood pressure that is not treated properly can lead to excessive bleeding during surgery. Meet with your doctor to review blood pressure medications and make any needed changes to keep your blood pressure readings within a healthy range. Your doctor may decide to switch or increase your medications prior to surgery to optimize your blood pressure. On the day of your spine surgery, your anesthesiologist will also monitor your blood pressure and may provide temporary medications to keep your blood pressure stable. 
    • Heart Health Optimization. If you have a heart condition like coronary artery disease, heart arrythmias or heart failure, you will need to be cleared by your cardiologist before spine surgery. Your cardiologist may order tests like an EKG or stress test and may adjust or change your cardiac medications to improve your heart health prior to spine surgery. Be sure to bring a list of medications that includes the dosages, to your preoperative appointments so your surgical team and anesthesiologist have a complete understanding of your health. 


Build Up Strength and Endurance, Prehabilitation 

Similar to rehabilitation after surgery, prehabilitation before spine surgery is important to build your strength and endurance. Your body will go through a lot during surgery and recovery, so preparing ahead of time will help you heal faster. You can start an exercise routine focusing on core and back strengthening, cardio, and light weight training. If your insurance will cover prehabilitation at a formal physical therapy clinic, or if you can pay cash, a physical therapist will know targeted exercises to help build your strength and endurance for your specific spine surgery. 


    • Core and Back Exercises. Exercises that target your core muscles, this includes your abdominals, hip flexors, glutes, and back muscles, will help prepare you for spine surgery.  Build up on sets and repetitions slowly to avoid injury. These exercises may help increase flexibility and range of motion in your back. 
    • Cardiovascular Exercise. Strive to get your heart pumping with thirty minutes of cardio at least three times a week. Walking, jogging, biking, swimming are all great options for cardiovascular exercise. Cardio helps strengthen your lungs and increase stamina. Start slow and build up your endurance over weeks. Strong lungs and stamina will help you recover faster from surgery. If you are taking medications, have a heart condition, or are seeing a cardiologist you should consult them before starting a new exercise routine. 
    • Light Weight Training. In addition to cardio, add light weight training with dumbbells or resistance bands. Working your legs, glutes, chest, and arms. For example doing squats, lunges, shoulder press, bicep curls, or triceps extensions. Start with a few pounds or minimal weight and build up gradually. Weight training improves muscle strength which aids in daily activities and mobility during your recovery. 


Practice Good Sleep Hygiene 

Getting quality sleep should be a top priority in the weeks leading up to your spine surgery. Your goal should be seven to eight hours of sleep per night to allow your body to rest and recover. Going into a surgery well rested will help you heal faster and potentially reduce complications. To improve your sleep hygiene, start by establishing a relaxing bedtime routine. One helpful way to prioritize and utilize good sleep practices is the 10, 3, 2, 1, 0 sleep rule. This sleep rule states:


    • Eliminate caffeine ten hours before sleep
    • Stop alcohol three hours before bed
    • Stop working two hours before bed
    • Stop screen time one hour before bed
    • Hit snooze zero times in the morning 


These techniques help to eliminate variables that could delay the start of sleep. Another technique to optimize sleep is working towards a consistent sleep schedule. Try going to bed and waking up at the same or similar times each day. Try to avoid napping during the day as this can interfere with nighttime sleep. 


Relieve Stress

You experience a form of stress when changes occur that result in physical, mental, or emotional responses. This process is normal, as it is a result of hormones being released that cause many different feelings: a racing heart, nausea, sweating, shortness of breath, excitement, or motivation. How you react to stress is what determines if it is a good or bad stress. You may be experiencing stress, anxiety or even fear in the days leading up to your spine surgery. Remember these are common and normal emotions however controlling how you respond to them is important as anxiety increases your blood pressure, heart rate, decreases your pain tolerance, and unsettles your nervous system. Studies have illustrated the importance of being an informed patient and the role it plays in stress and anxiety reduction. This is where having a surgeon like Dr. Kalra and his team will put you at ease with your decision to proceed with spine surgery: 


Amazing Experience. I have had quite a few surgeries, so I am not new to needing intervention. Dr. Kalra did everything in his power to make sure I understood everything that would or could happen before, during and after surgery. Before surgery we tried PT, injections and medication first because he didn’t want to run straight to surgery (huge plus in a doctor). He also took his time to explain my MRI’s to both my husband and I which is important to me because he included my husband in all decisions and important moves. The day of surgery during pre-op he came and spoke to me about exactly what would happen from the moment I went under to the moment I would wake up. After surgery his office called me at home to make sure I was taken care of and made sure I did not need anything. All follow ups have been quick, simple and purposeful.” Ashley F. 


I’ve had 20 years of pain stemming from my L5-S1. I am now on the road to recovery and can say that I am able to live a much better life after my surgery. My experience was very easy, but the surgery was difficult, none of the difficulty was created by Dr Kalra or his staff. Any time I needed to talk to someone, make an appointment, or get questions answered, I was always able to reach someone, and I got what I needed. I truly believed this process would be impossible. I was sure something would go wrong, and that I would suffer forever, but it did not go this way. Dr. Kalra is skilled. He knows his craft, and is way ahead of the curve when it comes to being a comforting presence.” Patrick G. 


I could not have hoped for a better experience. Dr. Kalra is essentially everything you could hope for in a doctor. He spends time with his patients, listening to their concerns, and explaining them in a way that is consumable for you to understand. He gives you all of your potential options, and always reminds you that the decision is yours to make, and he is here to support you. Finally the results have been amazing. My back feels the best it has in 10 years. He has made it possible again to get on the ground and play with my children, when it felt like it would never happen again.” Aaron M. 


Excellent neurosurgeon and practice. I can not say enough good things about my experience with Dr. Kalra and his team! He is extremely caring, personable, professional, accessible, and I truly sense he cares about his patients and helping them achieve their treatment goals. Dr. Kalra performed a 360 spinal fusion on me a year ago, and I was able to achieve complete pain relief in my lower back after 20 years of debilitating pain. Thank you again for helping me gain my life back, Dr. Kalra and your whole team!  Rebecca S. 


With spine surgery or any situation in life, experience and knowledge can make all the difference. Dr. Kalra and his team work tirelessly to ensure you are educated and know what to expect before, the day of, and after your spine surgery. After determining if spine surgery is your best treatment option rest assured as Dr. Kalra and his team strive to treat every patient as if they were a neighbor, friend, or family.  

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board-certified spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physician colleagues from 2017-2023. If you have unanswered questions about a recommended spine surgery, need a second opinion, or would like to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or  request an appointment on our website.