ASC by Drs. ABC: Here Are The Top Questions To Ask
How many days will I be in the hospital?
Most patients are hospitalized for five days. Post-operative recovery is individualized but consistent. Usually the first day is from bed to chair, second day to chair multiple times, third day walk to hallway, fourth day walk up and down hallway, fifth day, up and down hallway, independent to bathroom and back, up and down some steps independently.
At Saint Peters Hospital, where we have performed the vast majority of our ASC surgeries, our patients stay in the pediatric ICU (PICU) or adult ICU in a private room their entire stay in a special arrangement with the hospital.
In an ICU setting, there is a higher level of care because of a higher medical staff to patient ratio, consisting of ICU doctors and nurses, and this provides consistent caregivers familiar with ASC.
Additionally, Dr. Cuddihy personally oversees your hospital care. A parent can stay in the room 24/7. Patients over the age of 26 will recover in the adult ICU (AICU), which also offers private rooms, specialized care, and consistent caregiving.
After hospital discharge, you are asked to stay local to the hospital area for three to five days depending on how far away you live, until your post operative visit, when the patient and family are ready to travel home.
How long will my surgery take?
Dr Antonacci’s surgical times are outstanding due to his meticulous expertise, specialized team support, and his pioneering less invasive techniques. Dr Antonacci has created a dedicated surgical team and does not work surgically with anyone in training such as fellows, residents, or students. Since approximately 2010, Dr. Cuddihy has been his surgical partner. Together this duo has performed all the ASC by Drs. ABC surgeries, assuring elite level care from start to finish.
All curves must be individualized, but generally Dr. Antonacci completes single thoracic curves in approximately 2 hours and single lumbar curves similarly.
With positioning, xrays, and other logistics added, patients are typically asleep in the operating room for 3-5 hours for single thoracic curves and 5-7 hours for double curves.
How soon will I notice improvement?
Patients typically notice significant improvement of their spine once they are fully standing out of bed (usually post operative day 2).
Because your spine may now be in a dramatically straighter alignment, the muscles, soft tissues and the brain need time to adjust.
Subtle realignment and rebalancing of the body in its new position continues to improve over months. (Also, see “How can I best prepare” below).
This is also why Dr. Antonacci co-designed and strongly recommends our ILAB pre and post rehabilitation program uniquely available only to patients of Drs. ABC, to optimize recovery.
When can I shower after my surgery?
Five (5) to seven (7) days after surgery, you may shower. Your incision will be sealed with a skin “glue” which will gradually fall off over weeks. Do not scrub over your wound area; just let the soap and water run over your wound as you wash the rest of your body. When done, pat your wound dry. You may need to cover the chest tube site with a little gauze and tape until healed.
Will I have to wear a brace after my surgery?
No. Dr Antonacci does not routinely recommend or use post operative bracing on his patients. However, there are individualized situations where this might be appropriate.
Where will my scar be located? How big will it be?
The surgical incision will be located on the side of the body. It is tucked under (and hidden by) the arm. It is typically about 5-7 inches long, with some variation depending upon the type of curve and individual anatomy. There are no incisions on the back and no involvement of the all-important back muscles, which in metal rod fusion surgery are functionally and permanently eliminated.
When can I go back to school/work and sport/activities?
Many patients feel well enough to attend school as early as 4 to 6 weeks, sometimes starting with half-days.
We do not release patients to anything more than walking though for the first 6 weeks. Your body needs time to heal on the inside after surgery.
During this time, you may go for several walks every day to build up your strength and do certain recommended gentle stretching movements. You may tire easily and need rest periods throughout the day.
You should never force your self to do something if you don’t feel up to it during this time. After your 6 week x-ray check up, patients are typically given the okay to do activities they feel up to doing including returning to sports.
It is important to recognize that while at 6 weeks our doctors give patients the go ahead to do sports and other activities, everybody heals differently and on a different time schedule. Additionally, the body needs time to heal, and usually core toning and stretching modalities are recommended during the 6 week to 4 month period to prepare your body for its usual level of preferred sport/activity. Many of our highly competitive athletes return to competition between three and six months. Dr. Antonacci is fond of saying however that until the incision color returns to your typical skin color, things are still healing on the inside. Listen to your own body.
How is pain managed after surgery?
Our approach to pain management is multimodal and individualized. Dr. Cuddihy, NP Maddie, and the PICU/AICU team work together to find what works best for each patient. Prior to surgery, patients are started on gabapentin one week in advance to set the stage for optimal pain control post operatively.
We use a combination of opioid pain medications, anti-inflammatory medications, muscle relaxers, and other pharmacological modalities.
Opioid pain medication is delivered via patient controlled analgesia pump, allowing us to further individualize pain management for each patient. This pump allows the patient to deliver administer an additional medication dose (which is predetermined based on age and size for safety) as needed, based on their pain level.
The use of opioid pain medication is closely supervised, and each patient leaves the hospital with an individualized medication management plan which is managed by Dr. Cuddihy and NP Maddie.
We also use many nonpharmacological methods in conjunction with medications, including a TENS unit, hot and cold therapy, music therapy, meditation and visualization, and virtual reality. We also work closely with the Child Life Team at St. Peter’s to provide fun, age appropriate distractions to our patients. Patients who enrolled in the ILAB program prepare for the month before surgery to become active participants with respect to there mindset and body, and continue the program from week 6 to 3 months.
How can I best prepare for ASC surgery?
Dr Antonacci has long been a strong proponent of more holistic approaches to rehabilitation of surgical spine patients. He was among the earliest (since 2001) to recommend using specialized core neutral toning programs such as a modified spring-based Pilates instead of traditional physical therapy after spine surgery.
In recent years, Dr Antonacci specifically co-designed a pre-surgical and post-surgical program for our ASC by Drs. ABC patients based on the above concepts and applying it to posture and movement of the body before and after ASC. The concept is that with ASC, a life altering postural scoliosis correction occurs in one day, and this transformation may be best optimized by preparing the body both in mindset and through movement from several weeks before surgery to several months after surgery. Much like what is done for professional athletes—It is a combination of specialized coaching, including mindset preparation and core body movement conditioning. Known as ILAB, the program is designed to optimize the body’s spatial awareness, fluidity of movement of the body through space, and posture.
Dr. Antonacci specifically worked with two elite professional former dancers to design this program. The culmination of these years of formulation is our ILAB-ASC program. Participating in ILAB-ASC is not mandatory but is highly recommended. ILAB was designed as a holistic adjunct to ASC surgery and is a voluntary videoconference-based program.
ILAB starts three to four weeks before surgery with patient customized (mindset/movement) pre-hab sessions to prepare the body and mind for ASC surgery. There are very specific muscle imbalances common in scoliosis that are addressed. Then mind-body coaching rehab sessions resume 3-4 weeks after surgery and more specific physical rehab and movement conditioning begins again 6 weeks post-surgery.
Who should consider Anterior Scoliosis Surgery (ASC)
ASC by Drs. ABC now can treat virtually all types of scoliosis. Our candidates for muscle sparing, less invasive anterior scoliosis surgery correction have a variety of scoliosis types. Most have idiopathic scoliosis (adolescent, juvenile or infantile) or idiopathic “like” (i.e. post-syrinx decompression). But we have also treated those whose scoliosis is associated with a syndrome, a neuromuscular condition or is congenital.
Each case is individually evaluated and carefully considered. Our patients are generally between 4 and 50 years of age, with or without remaining spine growth and have a thoracic, thoracolumbar or lumbar curve(s) of 35 to over 90 degrees.
Patients are seeking correction without permanently sacrificing normal spinal motion as done by metal rod fusion, which fully destroys the spinal discs and function of the back muscles. Adults with advanced degenerative scoliosis or patients who have had prior spinal fusion are NOT candidates for ASC.
How long will I have to wait to get my surgery done?
Once you and your family decide that ASC is the best option and the insurance/financial specifics have been arranged through our office, surgery can most often occur 4-6 weeks later, with slightly longer wait times during the summer months.
Dr Antonacci and staff work diligently to arrange a mutually convenient surgery date to get patients back to living their best lives as quickly as possible, and Dr Antonacci operates 3 days per week to accommodate patients’ needs as much as possible.
Our typical process is that your preoperative evaluation is prepared by our PA Janet C. You then speak to Dr. Betz if it is determined you are a candidate for ASC by Drs. ABC.
If you decide to proceed to surgery, a zoom conference is scheduled for you with Dr. Antonacci to go over your entire case and plan, and you have a definitive preoperative visit in person the week of your surgery. Of course, personal visits prior to this are also always welcome if feasible for you.
We have found the zoom conferences to be particularly effective though, also considering that 75% of our patients are from outside our local region (NJ, NY, PA), and nearly 20% of our patients are international. Our staff are experts at taking you through the process no matter how far away you are coming from.