Patient guide: before, during and after

Before the first consultation

Bring your original imaging on disc or USB, not only the written report. That is the most overlooked point and the one that most limits a consultation: the radiologist's report is an interpretation, and the neurosurgeon needs to see the images himself, slice by slice.

Bring as well the complete list of medications you take — supplements and herbal remedies included — recent laboratory results, summaries of previous consultations or operations, and your questions written down. In the room they get forgotten; on paper they do not. And come accompanied if you can: two people remember more than one.

During the consultation

The first part is clinical history and neurological examination. Your imaging is then reviewed on screen and you are told what is there and what it means. If there is a surgical indication, the technique, risks, alternatives and prognosis are explained.

Before signing a consent form you should be able to answer five things in your own words: what will be done, why now, what can go wrong, what the alternatives are, and what happens if you do not have surgery. If any is unclear, ask again. Nobody serious minds.

Before surgery

Laboratory tests will be requested and, in some cases, a cardiac assessment. The most delicate point is anticoagulants and antiplatelets: warfarin, acenocoumarol, apixaban, rivaroxaban, clopidogrel and aspirin are usually stopped days beforehand, and that is coordinated with the doctor who prescribed them, never on your own.

Stop smoking. This is not brochure advice: tobacco worsens wound healing, increases respiratory complications of anaesthesia and demonstrably reduces the chance a spinal fusion consolidates. Follow fasting instructions exactly, and remove nail polish, jewellery and contact lenses.

After surgery

Expect fatigue: it is the most consistent and most underestimated symptom. Walk short distances several times a day rather than one long outing. Keep the wound clean and dry as instructed, and respect loading restrictions even when you feel well; feeling well is not the same as being consolidated.

Rehabilitation is not an extra. In spine surgery, trunk work is what reduces the risk of recurrence, and in brain surgery neurological rehabilitation is what recovers function. Doing the first three sessions and stopping wastes half the result.