1. Surgical Checklist
Prior to surgery
□ Obtain a complete list of your medications with dosages.
□ Stop all anti-inflammatory medications 10 days prior to surgery.
□ Discuss all anti-coagulant medications with our surgical
coordinator or physician.
A Patient’s Guide to
□
□
Obtain brace fitting appointment.
Obtain pre-operative testing, such as blood work, EKG, and
Posterior Lumbar Interbody
chest x-rays. Fusion (PLIF)
□ Purchase bandages for wound care at home.
□ Receive phone call confirmation of surgery time one day prior to
surgery.
Day of surgery
□ Shower with anti-bacterial soap.
□ Do not eat nor drink after midnight the day before surgery.
Home medications can be taken with a small sip of water the
morning of surgery.
□ Bring brace and any/all films to surgery.
After surgery
□ Resume all previous medications EXCEPT anti-inflammatories
(consult physician concerning anti-coagulants).
□ Confirm or obtain your post-operative appointment.
If you have any questions, please contact our surgical coordinator.
Important Dates
Pre-operative Appt:
Brace Appt: 25 Thurber Boulevard, Unit 6
Operative Appt: Smithfield, RI 02917
Post-operative Appt: Tel: (401) 404-2975
Fax: (401) 404-2976
www.bsnidoctors.com
(401) 404-2975
Fax: (401) 404-2976

2. Introduction
OUR LADY OF FATIMA HOSPITAL
200 High Service Avenue, North Providence, RI 02904
From I-95 North: Take Route 146 North to the Mineral Spring Avenue (Route 15) exit. Turn left
What is a lumbar fusion? onto Mineral Spring Avenue and continue to the fifth traffic light. Turn left onto Smithfield Road
A lumbar fusion is a surgical procedure that joins two or more vertebral and continue straight for ¼ mile.
bodies together. We accomplish this with the use of different forms of From I-95 South: Take the Branch Avenue exit. Turn right onto Branch Avenue to Douglas Pike.
bone, which act as the bridge between the two vertebral bodies. Take a right onto Douglas and then the first left onto Lubec Street. Follow Lubec Street to the light
and take a right onto Smithfield Road. Follow Smithfield road to the stop sign, then take a left onto
Instrumentation is typically utilized to hold everything in place until High Service Avenue. Our Lady of Fatima Hospital is on the right.
bony growth (fusion) is obtained.
From I-295 North/South: Take the Route 44 East exit (Centerdale). Follow Route 44
What kinds of conditions necessitate a lumbar fusion? approximately five miles. Turn left onto High Service Avenue. Our Lady of Fatima Hospital is
located approximately ¼ mile ahead on the left.
Lumbar fusion is used for any condition that is associated with spinal
From Rt. 146 South: Take the Mineral Spring Avenue Exit (Route 15). Turn right onto Mineral
instability. Spinal instability is the abnormal motion of the bones in the
Spring Avenue and continue to the fifth traffic light. Turn left onto Smithfield Road and continue
spine. This instability may cause pain, numbness, and/or muscle straight ahead ¼ mile to Our Lady of Fatima Hospital.
weakness in the lower back, hips, and legs. These conditions include
NEWPORT HOSPITAL
degenerative disc disease, spondylolisthesis (a slippage of one bone on 11 Friendship Street, Newport, RI 02840
another), and spinal stenosis.
From Points North: Take I-95 South to Exit 9 (left exit) onto Route 4 South, which becomes Route
1 South. Take exit onto Route 138 East, and go over the Jamestown and Newport (Pell) bridges.
Take the second exit off the Newport Bridge and go left at the light off the exit ramp. At the second
traffic light, take a right onto Broadway. Go through the next traffic light and take the next left onto
Powel Avenue.
From Points East: Take 24 South to Route 114 South. Follow 114 South (West Main Rd.) through
Portsmouth and Middletown into Newport onto Broadway. Proceed south on Broadway to the
traffic light at Friendship St. Take the next left onto Powel Ave.
From Points West: Take Route 95 North to Route 138 East. At intersection with Route 1 (traffic
light) turn left onto Route 1 North. After approximately 2 miles, take exit for Route 138 East.
Continue on Route 138 East over the Jamestown and Newport (Pell) bridges. Take the second exit
off the Newport Bridge and go left at the light off the exit ramp. At the second traffic light, take a
right onto Broadway. Go through the next traffic light and take the next left onto Powel Avenue.
Parking is located on the right, past the employee and physician parking areas. Parking is permitted
on the street if the lot is full.
Why should I consider a lumbar fusion? LANDMARK HOSPITAL
A fusion should only be considered in two situations. One, if progressive 115 Cass Avenue. Woonsocket, RI
muscle weakness is occurring in the lower extremities, or two, if all From Warwick and Points South
conservative options have failed, and the impact of the conditions has a Take I-295 North to Exit 9B (Route 146 North). Move to center land and follow signs to Route 99
North. Proceed to the intersection of Route 99 and Route 122. Turn left onto Route 122 and then
significant effect on one’s lifestyle. follow directions as highlighted in ‘From Route 22.’
Will I lose a significant amount of mobility with a lumbar fusion? From Boston and Points North
Those patients who require spinal fusions are suffering from a significant Take I-95 South to I-295 South (Exit 4 in Attleboro area of I95) to Route 146 North (Exit 9B off
I-295). Follow signs to Route 99 North. Proceed to the intersection of Route 99 and Route 22.
amount of discomfort. Ultimately, with a successful surgery, the amount Turn left onto Route 122 and then follow directions as highlighted in ‘From Route 22.’
of pain-free mobility that a patient experiences is more than compared to From Route 22
before surgery. Therefore, patients generally are moving much better and Proceed straight through the four sets of lights. At the fifth light (Dunkin’ Donuts will be on your
with greater freedom and range of motion compared to prior to surgery. right), bear right onto Cass Avenue. Landmark Medical Center is on the right.

3. Post-operative Instructions Frequently Asked Questions
Wounds How long will my surgery last? Between 4
 Keep the wound clean and dry. and 6 hours, depending on the number of
 Leave the original dressing on for 2 days. levels of the fusion.
 Change the dressing every other day.
How long will I be in the hospital? 1 to 2
 Allow steristrips to fall off on their own.
days.
 Do not tamper with any stitches or staples.
 Do not use lotions, powders, or ointments on or around the wound When can I drive?* Short drives are fine after
site, i.e. Vaseline, Neosporin, Bacitracin, etc. 5 days; longer drives are acceptable after 2
 Please call our office if you experience any excessive drainage from the weeks, provided you feel comfortable while
wound. sitting.
Activity When can I go back to work? This will depend on the individual and the
 NO strenuous activity, i.e. jogging or lifting. type of work being performed.
 Walking is acceptable and recommended. Light/sedentary work (lifting <25 lbs.) 4 weeks
 Riding in the car is acceptable. Medium work (lifting up to 50 lbs.) 2-4 months
 Driving is dependent on your level of discomfort and/or your use of Strenuous work (lifting >50 lbs.) 4-6 months maximum
pain medications.
How active can I be? Activity is encouraged, especially walking. You
 Wear any brace as prescribed.
may begin to exercise as early as one to two weeks in the post-operative
Medications period. Avoid activities with twisting and/or bending.
 Use your pain medication as prescribed. Anti-inflammatories are
What if I want to get pregnant after a fusion? There are certain
NOT permitted within the first 6 months after surgery.
precautions associated with pregnancy after a fusion. Please discuss this
 Pain medications may cause constipation; increase your fluid intake
with one of our physicians.
and use of stool softeners and/or laxatives to help alleviate these
effects. When do I wear my brace? The brace is worn at all times when active
 Nausea is also common; taking food with your medication may help out of bed (not required when sitting or lying down).
alleviate these effects.
How long do I wear my brace? Typically 6-8 weeks after surgery.
 If you develop a rash or itching, stop taking the medication
immediately and call our office. How long do I wear my bone stimulator?* 6 months.
 Please let the office know ahead of time if you think you will need a
refill. Can I get an MRI after a PLIF? Yes, the instrumentation used for a
PLIF is MRI-compatible.
NO REFILLS WILL BE GIVEN ON WEEKENDS, HOLIDAYS,
OR OFF-HOURS. *Narcotic usage is not recommended while driving.
*Dependent upon condition; not all patients are required to have a bone
stimulator.

4. The Collaborative Advantage MEDICATIONS LIST
Coordinating spinal care through multiple physicians’ offices can The following medications contain aspirin or anti-inflammatory agents,
often be a frustrating experience for both the patient and provider. which increase the risk of bleeding during surgery or injections.
At Brain & Spine Neurosurgical Institute and Spinal Therapeutics,
our patients have access to an entire team of eight specialists all These medications and supplements should NOT be taken up to 14 days
conveniently within one practice. prior to an injection or to surgery
The collaboration of orthopedics, neurosurgery, and pain
management not only promotes seamless communication between our Should you need pain relief medication, Tylenol is acceptable. You may
physicians, but ensures that our patients get answer - and get them faster. discuss other medication options with your physician or nurse if necessary.
From epidural steroid injections to minimally invasive surgical
procedures, we’re your comprehensive solution for spinal care in Rhode Please note that this is not an inclusive list. If you have any concerns about
Island and southeastern Massachusetts. your current medications, please consult your doctor, nurse, or pharmacist.
Dr. Sumit Das Advil Duradyne Nabumeton
AGGRASTAT Ecotrin Naprosyn
Dr. Sumit Das received his Bachelor of
AGGRENOX EFFIENT Naproxen
Science from the University of Michigan in
Aleve Enbrel NSAIDS
biomedical sciences and continued at
Alka-seltzer Equagesic Norgesic
Michigan for his degree in medicine. He Anacin Etodolac Oxaprozin
received various awards at Michigan, Anaprox Excedrin Piroxicam
including the prestigious Edgar A. Kahn Ansaid Feldene PLAVIX
Award in Neurosurgery. After completing his ASPIRIN Fiorinal PLETAL
residency at Mount Sinai Medical Center Bufferin 4 Way Cold Tabs PRADAXA
under the direction of Dr. Kalmon D. Post, Cataflex Garlic Tablets Relafen
Dr. Das served as an integral part of practices Celebrex Ginko Bilboa Reopro
in Washington and Rhode Island. In 2003, Cephalgesics Ginseng Robaxisal
Dr. Das founded the Brain & Spine Neurosurgical Institute, which has Clinoril Ibuprofen Ticlid
become one of the few multidisciplinary practices in the area. CLOPIDOGREL- Indomethacin Trental
In the field of neurosurgery Dr. Das' interests include minimally BISULFATE Indocin Vanquish
invasive spine surgery with the utilization of sophisticated radiographic Coricidin Integrilin Vitamin E
and microscopic techniques. He has performed over 3000 spinal COUMADIN Ketoprofen Voltaren
procedures to date and makes it a priority to pursue cutting edge research Daypro Lodine WARFARIN
in safety and supplementary surgical techniques. Diclofenac Meloxicam
Dr. Das is also an active member of the neurosurgical community Diflunisal Midol Any herbal supplements or
through his participation in the American Association of Neurosurgery. Doan’s Mobic non-FDA approved drugs
When Dr. Das is not in the office or the operating room, you can Dristan Motrin
find him on the tennis court playing with or teaching tennis to his two
young children, Nikhil and Aunjoli. *If you are taking any of the medication HIGHLIGHTED, you MUST
consult your physician prior to discontinuing your prescription*

5. What to Expect After Surgery Mohini Yalanis, RNP
Pain at incision site: You may experience incisional pain for Mohini Yalanis, RNP has been with BSNI
approximately 5-7 days. Icing the incision and narcotic medications can since July 2010. Originally from Connecticut, she
also be helpful. Anti-inflammatory medications CANNOT be taken at received her Bachelor of Science in Nursing from
this time. the University of Connecticut in 1994. A registered
nurse for 15 years, her experience was primarily in
Increased leg pain: This is due to inflammation/swelling of the nerve
critical care. In 2009, she completed her Master’s
roots 2-3 days following surgery. It will gradually improve and slowly
in Nursing at University of Rhode Island and is
subside over the following week. In severe cases, oral steroids are used.
now a certified Nurse Practitioner.
Hoarse throat/throat discomfort: This is due to the breathing tube Mohini’s extensive background in nursing has taught her the
placement during the surgery. This will gradually improve with time. importance of providing care that takes the unique needs of her patients
into consideration. She performs pre- and post-operative patient
evaluations, interprets diagnostic imaging, and works hard to educate her
You should call the office if you develop any neurologic patients about surgery. Mohini assists Dr. Das during surgery and is
findings that were not present at the time of your hospital involved in all steps of her patient’s treatment process.
discharge. Examples include: In her personal life, Mohini enjoys spending time with her family.
She has three children, ages 10, 8 and 5 and loves driving them around to
 Sudden or slow onset of weakness in the lower extremities their many activities. When she is not busy being a mom or a nurse
 Loss of control over your bowel/bladder practitioner, you can find her jogging all over Aquidneck Island.
 Elevated temperature (greater than 101 degrees)
 Excessive redness/swelling of the incision
 Drainage/oozing from the incision site Christine Boyer, PA-C
Christine Boyer, PA-C has been with BSNI
How do I get refills of my prescription? Call our prescription hotline since November of 2010. After receiving her B.S.
during business hours (9am–4pm) at (401) 404-2975 x152. from Bridgewater State College and completing her
Post baccalaureate work at Harvard University in
When will my staples/sutures be removed? Staples are removed at 7-10
2004, she began her work as a Certified Athletic
days. Sutures under the skin will dissolve on their own. Surface/drain
Trainer. Following her appointments as a trainer at
tubes will be removed after 1-2 days.
USC and UCLA, Christine went back to school
When will I start physical therapy? This will be discussed at your first and received her Master’s of Physician Assistant Practice from USC
post-operative appointment. Keck School of Medicine in 2010. Eventually making the move back
east, Christine brings her experience in orthopedic surgery as well as her
When can I shower? We do not encourage showering within the first 2 training in neurosurgical and trauma surgery to BSNI. She cares for her
days after surgery. Showering is permitted provided that the wound patients through every step of their treatment process, conducting patient
remains completely dry. You must replace the dressing after every shower evaluations, acting as first assist in the operating room, and visiting
with a clean, dry dressing. patients after their procedures.
What about taking anti-inflammatory medications after surgery? Anti- Outside of work, Christine played soccer in college and continued
inflammatory medications should NOT be taken until 6 months afterward as a member of a national team. She also competes in
AFTER your surgical procedure. triathlons and long distance running events.

6. The Procedure
An incision is made in the lower back
with the patient lying on their The addition of screws and rods
stomach. Once the spine is accessed, help to support and stabilize the
the surgeon removes the lamina (the spine until the graft hardens, or
bone covering the spinal cord) so as to fuses (e.g. similar to the purpose
visualize the nerve roots that are of a cast for a broken leg).
being compressed.
The compressed nerve roots are then
moved to one side and the disc material The incision is then
is completely removed and is replaced closed using dissolvable
with bone that is packed in a cage. suture material. A brace
should be worn for 6-8
weeks after this surgery
so as to help support the
spine as it heals.