Spine Surgery
Spine SurgeryWhat to Expect and How to Prepare
Table of ContentsThe Spine and Spinal Surgery.4Common Spine and Disc Problems.5WelcomeThank you for choosing Mount Carmel to meet your healthcare needs. Our team ofspecialized health care professionals are dedicated to providing you with the highestquality care. This guide contains information to help you better understand thedifferent aspects of your care and will be a helpful resource throughout your surgeryand recovery.Recovery from spinal surgery continues after you are discharged from the hospital.Because each patient responds differently, your care and exercise plan will betailored to meet your needs. Please share your questions and concerns with yourhealthcare team.Please review this book for information about: How to prepare for surgery What to expect during your hospital stay How to prepare for your recovery and dischargeDegenerative Disc Disease.5Bulging and Ruptured Discs.5Arthritis and Bone Spurs.5Spinal Instability.5Spondylolisthesis.6Spinal Stenosis.6Understanding Your Surgery.7Surgical Consent.8Anesthesia.8Before Your Surgery.8Preparing for Surgery. 10Planning for Care After Surgery. 10Packing for Your Hospital Stay. 11Getting Ready for Surgery. 11Your Surgery and Hospital Stay. 14The Patient Care Team. 14Your Surgery Day. 14Plan of Care. 15Managing Your Pain. 17Activity After Your Surgery. 18 Activity after surgeryGoing Home. 22Discharge Process. 22Your Care at Home. 22Getting Back to Your Daily Activities. 23Getting In and Out of a Car. 25Notes. 2623
The Spine and Spinal SurgeryCommon Spine and Disc ProblemsYour spine supports your upper body andprotects your spinal cord, which is the nervecenter of the body. The spine is made of smallbones (vertebrae) that are stacked on top ofeach other to create the spinal column.DegenerativeDisc DiseaseArthritis andBone SpursDegenerative disc disease is a condition inwhich the discs in your spine have beendamaged or worn down due to aging or wearand tear.Arthritic bone surfaces begin to rub againsteach other. When this occurs, inflammationand bone spurs can form, causing pain. Asbone spurs continue to grow, increasednarrowing of the area through which nervespass causes even more pain.Cervical(neck) curveC1–C7A healthy spine forms an S-shape from theneck to the lower back. This curve helps todistribute the body's weight and helps thespine withstand stress.Thoracic(middle back) curveT1–T12The spine is made up of 3 sections: The cervical spine (or neck) has7 vertebrae — C1–C7. The thoracic spine (or chest) has12 vertebrae — T1–T12.Lumbar(lower back) curveL1–L5 The lumbar spine (or lower back)has 5 vertebrae — L1–L5.The lumbar spine is the hardest-workingpart of your spine because it carries the mostweight and moves the most.SacrumCoccyxBone spurWorn discBulging andRuptured DiscsWith a bulging disc, bone surfaces beginto rub against each other. This causesinflammation and pain. Bone spurs (calciumdeposits) can also form, causing pain.The vertebrae are separated by soft, gel-likecushions, called discs. Discs act as a "shockabsorber" for the spine by helping to absorbpressure and keep the bones from rubbingagainst each other.The spine andits natural curvesThe discs between the vertebrae can weardown over time due to injury or aging.Without these “shock absorbers,” pressureon the nerves of the spine can cause pain inthe lower back and/or legs. Bone spurs mayform and narrow the space through whichthe nerves pass. This may also lead to nerveirritation and pain.Your doctor has recommended that you havespinal surgery to relieve the pressure on yourspinal nerves. Surgery is needed when rest,medication, physical therapy, and/or exercisehave not relieved your pain or improved yourability to carry out daily functions.Each disc has a spongy center surrounded bytough outer rings. When a disc weakens, theouter rings may not be able to contain thematerial in the center of the disc. When thismaterial bulges against, or squeezes through,a weak spot or a tear in the outer rings, itcreates pressure against the nerve, causingpain in your back and/or legs.Spinal InstabilityAs the discs wear out and flatten, thevertebrae can slip back and forth. Thisslipping can cause the outer rings of thedisc to stretch, causing pain, but also, moreimportant, decreasing the protection for thespinal cord. Instability may also result fromtrauma or muscle paralysis.When a disc is ruptured (herniated), thespongy center squeezes through the toughouter rings, putting pressure on the nerves.Bulging and ruptured discs can cause severepain.Ruptured (herniated) disc45
SpondylolisthesisSpinal StenosisSpondylolisthesis is a slippage of one vertebra,causing the spine to be out of alignment. Thismisalignment can pinch the nerves and causepain.Spinal stenosis is the narrowing of thecanal where the spinal cord and nerves passthrough. This may be caused by bony growthand/or bulging of the disc. This often occursas we age. The narrowing creates pressureon the spinal cord and nerves, which maycause swelling, pain, numbness, tingling, orweakness.AffectednerveVertebralUnderstanding Your SurgeryYou and your doctor have decided thatsurgery is the best option to relieve your backand/or leg pain. You may have one or more ofthese procedures done during your operation. Discectomy: Removal of part, or all, of adisc.Lamina is a bony arch that is part of thevertebrae. It protects the spinal cord. Cervical Corpectomy: Removal of partof the vertebral body and the disc on bothsides of the vertebral bone in the neck. Laminotomy: Removal of part of thelamina. Fusion: Stabilization of two or morevertebrae by joining them with bone grafts. Laminectomy: Removal of the entirelamina. Fixation: Metal plates, rods, and screwsplaced to improve the likelihood of bonefusion. Foraminotomy: Enlargement of theforamen where spinal nerves exit.slippage Facetectomy: Removal of all or part offacet joint.Spinal cordVertebraDiscBodyNerveVertebral foramenPedicleTransverseprocessLaminaSuperior articularprocessSpinal process67
Surgical ConsentRegional AnesthesiaAs with any major surgery, there are riskswith spinal surgery. You will be asked to signa surgical consent form before your surgery.This form gives consent to the surgeon toperform your surgery.Regional anesthesia involves the use ofanesthetics and/or pain medication to blockthe feeling in a certain region of the body.Before Your SurgeryBefore signing the consent form, make sureto ask any questions you may have so thatyou understand your surgery and its risksand benefits. It is important that you fullyunderstand the information and are an activepartner in your care.Pre-admission TestingAll patients are required to have preadmission testing before surgery. This isto assess your body’s ability to tolerate thesurgical procedure. It will include a reviewof your medical history, a physical exam,and blood tests. Please arrange to have thistesting at the hospital pre-admission testingdepartment or with your primary care doctor.Please check with your surgeon about theirpreference for pre-admission testing.AnesthesiaAnesthesia is medication that is used tocontrol pain and make you comfortableduring surgery. An anesthesiologist is adoctor specially trained to give anesthesiaand monitor you during the procedure. Youranesthesiologist will meet with you beforesurgery to discuss your anesthesia options.Testing must be completed two to four weeksprior to surgery (two weeks prior to surgeryis preferred). This allows time for follow uptesting to be completed as needed, such asa chest X-ray, EKG, or other testing. Testscannot be used if they are completed morethat 30 days prior to surgery and would needto be redone.The type of anesthesia you receive will dependon the kind of surgery you are having andother factors, including your medical history.There are various types of anesthesia that maybe used alone or together. They include:MedicationGeneral AnesthesiaYour pre-admission testing appointmentis the time to discuss the medications youare taking for your medical conditions (forexample: diabetes, high blood pressure,acid reflux, chronic pain, asthma or otherbreathing problems). Bring a list of all of yourmedications, including prescription, over-thecounter, herbal products, and supplements.General anesthesia is medicine that putspatients in a sleep-like state so they donot feel pain or remember the surgery. Abreathing tube may be placed to supportyour breathing during general anesthesia.During the surgery, your heart rate, bloodpressure, breathing and other vital signs willbe carefully monitored.8You may be instructed to temporarily stoptaking certain medications because theycould complicate surgery or interfere withother medications you might need. This mayinclude non-steroidal anti-inflammatorydrugs (NSAIDs) such as aspirin or ibuprofen.If you are taking blood-thinning medicationsfor any reason — such as heart stents, atrialfibrillation, or previous blood clots — contactthe doctor who prescribes them. You willneed to discuss your upcoming surgery andwhether the medication can be stoppedbefore surgery.Dental CareIf you are in need of dental work, makecertain to have it done well before yoursurgery. Bacteria from your gums can enteryour blood stream and cause an infection.Do not schedule any dental work, includingroutine cleanings, for several weeks after yoursurgery.If you have any questions about which ofyour medications to take before surgery,contact the doctor who prescribes them.DietAdvance DirectivesEat a well-balanced diet in the weeks beforesurgery. Be sure to include protein such asbeef, chicken, fish, legumes, and eggs.Mount Carmel supports and complies withour patients’ advance directives for medicalcare. In order to comply with your wishes,we will ask you about a Living Will or HealthCare Power of Attorney. If you have one orboth of these documents, please bring a copyto the hospital. If you do not have an advancedirective and would like information aboutwriting one, talk with your nurse.Skin CareAny cuts, open sores, or rashes need to betreated and healed before surgery. If you haveany of these skin problems, report them toyour surgeon.SmokingFlu and PneumoniaVaccinationsMount Carmel is tobacco- and smoke-free.The use of tobacco products — includingcigarettes, electronic cigarettes, cigars,chewing tobacco, and pipes —is not allowed inside or outside any MountCarmel buildings, properties, or parkingstructures.To keep you well and provide you withthe fastest recovery, we recommendthat you receive a flu and/or pneumonia(pneumococcal) vaccine before you have yoursurgery. You should receive the vaccine(s) atleast 2 weeks before your surgery. You cancontact your primary care doctor, pharmacy,or the local health department to get thevaccines. We will need to know the dates youreceived these vaccines.If you are a smoker or tobacco user, it isimportant to quit at least a few weeks beforesurgery. Smoking greatly increases yourrisk of having complications after surgeryincluding respiratory issues, pneumonia,delayed wound healing, and infections.Call your doctor if you have a fever, cold orflu symptoms, or any other changes to yourhealth during the week before your surgery.9Talk with your doctor about quitting smokingand alternatives to smoking or tobaccoproducts. Quitting smoking has a majorimpact on improving your health, andMount Carmel supports your efforts tosucceed. Ask a staff member for moreinformation, call the Ohio Tobacco Quit Lineat 800-QUIT NOW, or visitwww.smokefree.gov.
Preparing for Your SurgeryPacking forYour Hospital StayGetting Readyfor SurgeryPlanning for CareAfter SurgeryWhat to BringA Few Days Before Surgery A list of your medications and yourpreferred pharmacy informationYou will receive multiple phone calls inthe days leading up to your surgery. Thesecalls are critical in helping to prepare foryour surgery. A hospital staff member willcontact you to verify information, includinginstructions on which medications you shouldtake the morning of surgery.Home PreparationsFor your safety, you or your family should: Make certain you have secure handrailsalong stairways and in the bathroom.Consider installing grab bars.The best place for you to recover from surgeryis in your own home. Plan to have someonehelp you until you are safe with your dailyroutine. Place a non-skid bath mat in your tub. Remove anything in your walking paththat may cause you to trip or fall such asthrow rugs, cords, and furniture.There are times when other arrangementsneed to be made. If you live alone, yourcaregiver is unable to care for you, or you arehaving difficulty meeting physical therapygoals, your multidisciplinary health care teammay make other recommendations. It maybe necessary for you to have home healthcare or be discharged to a skilled nursing orrehabilitation facility. The case manager willwork with you in the selection of a facility.They will also work with your insurancecompany to determine eligibility. Have a straight-back chair with arms to sitin. Have a telephone within easy reach. Make sure that you have good lighting andthat the light switch is within easy reach. Run errands and grocery shop beforesurgery. Stock up on food that is easy to prepare,and store it at waist to shoulder level toavoid bending and reaching.Driving Arrange to have someone drive youhome or to the skilled nursing facilityupon discharge from the hospital.Transportation costs will be yourresponsibility. Make sure your pets can be out of yourway when you return home.Durable MedicalEquipment (DME) A higher vehicle is easier to get into thanone that is low to the ground. Check with your surgeon about specialequipment you may need after surgery,such as a wheeled walker, crutches, or acane. Do not drive after surgery until you aregiven permission from your surgeon. Thismay be several weeks. Do not drive whileyou are taking narcotic medications. Check with your insurance plan to findout which items will be covered. Someequipment may need your doctor’sauthorization, and not all equipment iscovered by insurance. You will also need someone to drive you toand from your follow-up appointments.10 If you already have a brace or wheeledwalker, plan to bring this to the hospitalwith you. Your driver’s license and insurance card Copy of Living Will and/or Health CarePower of Attorney Credit card or money for insuranceco-payment Follow all instructions given by yourdoctor. Glasses, contacts, hearing aids, dentures,and cases Call your doctor right away if there are anychanges to your health before your surgery,including a cold or other infections. CPAP or BiPAP Brace or walkerThe Day Before Surgery Pair of non-skid shoes that are not tight —you may have swelling.Many details are involved in determiningyour final surgery time. Depending uponwhere your surgery will be performed, youwill be notified of your arrival and surgerytimes either at your pre-admission testingappointment or by phone. You may receivea call with additional information or timechanges up to the evening before surgery. One set of clothes — loose-fitting shirt andpants or shorts. If you wish to wear a robe,bring one that opens along the entire frontand is no longer than calf length.What Not to BringPlease leave all valuables such as jewelry,keys, and electronic devices at home. Afterregistering for your surgery, plan to giveyour purse/wallet, checkbook, credit cards,cell phone, and any other valuables to yoursupport person to be responsible for theseitems. It is recommended that these items aretaken home.Leave your medications at home unless youhave been instructed to bring them to thehospital.11 Do not smoke, eat, drink, chew gum, oreat mints or candy starting after midnightthe night before surgery until you areallowed to have fluids after surgery. Shower using a CHG solution the nightbefore surgery. Follow the directions onthe next page unless your surgeon givesyou other instructions.
The Day of SurgeryPreparing Your Skinwith ChlorhexidineGluconate (CHG) SolutionBefore you come to the hospital: Shower again using CHG solution.Infection is a risk with any surgery. Our careteam takes every measure to protect you andto prevent infection while you are in our care.You play an important part in this. Remove all jewelry, including weddingbands and body piercings. You may replacebody piercings with temporary plasticposts before coming to the hospital. If youhave rings that will not come off, please tella staff member.To help reduce the risk of infection, beforeyour surgery: Use a special soap to clean your body.The soap contains an antiseptic calledchlorhexidine gluconate (CHG). Cleaningyour body with CHG soap before surgeryhelps prevent infection. Do not wear makeup, perfume, powders,lotions, or creams. You may brush your teeth, but do notswallow the water. Wear glasses instead of contacts or bringa container to remove your contact lensesbefore surgery. Do not shave near the surgical area as thiscan make it easier to get an infection. Thoroughly rinse your entire body withwarm water from the neck down. Turnoff the water or step out from under theshower stream to avoid rinsing the CHGsoap off too soon. Allow the product to soak on your skin for2 to 3 minutes. Turn on the water or step back under theshower stream to rinse well. Do not useregular soap after applying and rinsing theproduct. Apply the CHG product directly to yourskin from the neck down and wash gently.Do not use above your neck, in yourgenital area, or on wounds that are deeperthan a scratch. DO NOT touch your eyes,ears, or mouth while scrubbing. Pat your skin dry with a clean softtowel. Do not use any makeup, perfume,deodorant, powder, lotion or cream afteryou have showered. Put on clean nightwear or clothes. Pay special attention to washing the areaof your surgical procedure very well. Use aback and forth motion to gently scrub thearea.*Repeat these steps the morning of yoursurgery.It is a good idea to read the label for fullproduct information and precautions. Donot use this product if you are allergic to it. Ifyour skin becomes red or irritated, stop usingthe solution and contact your surgeon forfurther instructions.If you cannot reach your back, have someonewash it for you. Put clean sheets on the bed you will besleeping in the night before surgery. If you have been told to take certainmedications the morning of surgery, takethem with a small sip of water.The Night Before andMorning of Surgery Do not smoke or use tobacco productsbefore your surgery.Your surgeon has directed that you use aChlorhexidine product such as Hibiclens ,Dyna-Hex , and others. Use half the bottlethe night before and the other half themorning of your surgery.Your doctor may instruct you to begin usingCHG wash earlier. Follow your doctor'sinstructions.Follow these steps as you shower: Shower or bathe as usual with soap andwater. This will help remove dirt andoil that can prevent chlorhexidine fromworking correctly. Wash off the soapcompletely. If you plan to wash your hair,use regular shampoo on your hair andrinse well.1213
Your Surgery and Hospital StayThe Patient Care TeamYour Surgery DayYou are the most important member of thehealthcare team. Your health and wellbeingis our highest priority. In our efforts to makeyour hospital stay as comfortable as possible,you will be asked your preferences duringyour time with us. Please let the healthcareteam know if you have any questions orconcerns.RegistrationWhen you arrive at the hospital, go to PatientRegistration. You will need to have yourdriver’s license and insurance cards. You willreceive a “find code” to ensure your privacyand confidentiality. This is a four-digitnumber that only you can give out to familyor friends. It is important for you to knowthat anyone calling or asking how you aredoing cannot be told any information unlesshe or she has this find code.There are many other members of thehealthcare team who will be working withyou. They will provide care, evaluate yourprogress, and communicate with each otherand with you and your family.Pre-opYour surgeon, anesthesia provider, andprimary care physician or hospitalist willmanage your medical care. Your healthcareteam will also include a team of speciallytrained nurses, patient care technicians,physical therapists, and occupationaltherapists to care for you as you recover fromsurgery.Once your paperwork is completed, you willbe directed to the pre-operative area. You willchange into a hospital gown. A nurse will startan IV line and take your blood pressure andtemperature. One family member can be withyou during this time.The anesthesiologist will meet with youand review your health history. He or shewill discuss the types of anesthesia that canbe used. Once a decision is made, you willbe asked to sign a surgery and anesthesiaconsent form. Please ask your surgeon oranesthesiologist any questions you havebefore your surgery.A number of other clinicians will work withyou to meet your healthcare needs. Thesemay include respiratory therapists, dietitians,social workers, discharge planners, and nursecase managers.14Plan of CareSurgeryYour surgeon will tell you how long itshould take to complete the surgery.Family members should not be alarmed ifyour surgery takes longer. Surgery timesare sometimes delayed or changed due toemergencies or cancellations. Every attemptwill be made to notify your family if yoursurgery is delayed.Members of the care team will be checking onyou to ensure your safety as you recover andprogress.ActivityYour first step in getting active again will besitting on the side of the bed, followed bystanding. Depending upon when you returnto your room from surgery, you may be seenby the therapist that day. With the help ofthe therapist or another staff member, youwill start to increase your activity. Walkingsoon after spinal surgery is one of the mostimportant things that you can do to speedyour recovery process. Early activity afterspinal surgery also helps prevent manysurgical complications, including:Your family should wait in the surgerywaiting room so they can receive updatesthroughout your surgery and recovery.Post-Anesthesia CareAfter surgery, you will go to the recoveryroom, also called the post-anesthesia careunit (PACU). This is where you will wakefrom anesthesia. You may have a dry mouth,nausea, itching, chills, or feel confused. Tellyour nurse if you experience any of thesesymptoms. Also tell your nurse if you awakenwith pain. Infections Pneumonia Blood clots Urinary tract infectionsYou may be given medication for pain andnausea. Most patients stay in the recoveryroom for 1 to 2 hours, although some patientsrequire a longer stay. Urinary retentionThe therapist will work with you on exercises,getting in and out of bed, walking and usingstairs safely, and caring for yourself.Nursing UnitAfter you have recovered from anesthesiayou will be moved to the nursing unit, whereyour family will be able to visit. You will beginyour therapy and make progress toward yourdischarge. Please make sure to let us knowwhat we can do to make your stay morecomfortable.15
Call, Don’t FallTreatmentsAlways call for help before getting out of bed.A staff member should always help you whileyou are in the hospital. Preventing a fall is akey part of your safety and recovery. Hand HygienePreventing infection is important aftersurgery. One of the best ways to preventinfection is by washing your hands often —after using the bathroom, before meals, andbefore and after you touch your incision orchange your dressing. Follow these five stepsevery time:Wet your hands with clean, running water(warm or cold), turn off the tap, and applysoap.Lather your hands by rubbing them togetherwith the soap. Lather the backs of your hands,between your fingers, and under your nails.Scrub your hands for at least 20 seconds.Rinse your hands well under clean, runningwater.Dry your hands using a clean towel or air drythem.Soap and water are best, but an alcohol-basedhand sanitizer that contains at least 60%alcohol can be used as long as your hands arenot visibly soiled. Ask all visitors to wash theirhands when they enter and leave your room.Don’t be afraid to remind the staff about handhygiene. You will wear compression hose and mayhave compression pumps, also calledsequential compression devices (SCDs),throughout your stay. The compressionpumps are worn while you are in bed.Both help to prevent blood clots fromforming in the legs.You may have a Foley catheter in yourbladder to drain urine when you wakeup from surgery. This will be removed assoon as possible. You may have a dressing (bandage) overyour incision. The nursing staff will carefor your incision, change your dressing,and teach you how to do this at home. You will have ice packs to help relieveswelling and pain.Be sure to ask the staff any questions you havethroughout your stay.You will resume your regular medicationsonce you are able to take them. Your doctormay also order other medications such asantibiotics, stool softeners, blood-thinners,pain medication or medicine for nausea. Askyour nurse for more information.Talk to your healthcare team about otherways to relieve pain. Rest is not alwaysthe best solution, especially after surgery.Changing your position in bed and gettingout of bed can make you more comfortable.Taking your mind off the pain by listening tomusic, watching TV, reading, or visiting withfamily and friends can also be helpful.Exercise improves blood flow (circulation)and reduces the risk of blood clots. Exercisingwill also help you gain strength and mobility,and decrease your recovery time. Aftersurgery, you will be instructed to do anklepumps, quadriceps sets, and gluteal sets. Doeach exercise 10 times every hour when youare awake (see page 21).After surgery, some pain is to be expectedwhile your back is healing. You and yourhealthcare team will work together to manageyour pain for a smoother recovery. Althoughwe want your pain controlled, we do not wantyou too groggy or sedated so you are able todo your therapy. Breathe in as deeply as you can. The meterwill rise.Your pain medication may cause side effectssuch as nausea, itching, confusion, andconstipation. Ask your nurse any questionsyou may have about side effects.Circulation ExercisesYou will begin with ice chips. If you are ableto tolerate these w
The Spine and Spinal Surgery Your spine supports your upper body and protects your spinal cord, which is the nerve center of the body. The spine is made of small bones (vertebrae) that are stacked on top of each other to create the spinal column. A healthy spine forms an S-s
Procedure Code Service/Category 15824 Neurology 15826 Neurology 19316 Select Outpatient Procedures 19318 Select Outpatient Procedures 20930 Joint, Spine Surgery 20931 Joint, Spine Surgery 20936 Joint, Spine Surgery 20937 Joint, Spine Surgery 20938 Joint, Spine Surgery 20974 Joint, Spine Surgery 20975 Joint, Spine Surgery
Procedure Code Service/Category 15824 Neurology 15826 Neurology 19316 Select Outpatient Procedures 19318 Select Outpatient Procedures 20930 Joint, Spine Surgery 20931 Joint, Spine Surgery 20936 Joint, Spine Surgery 20937 Joint, Spine Surgery 20938 Joint, Spine Surgery 20974 Joint, Spine Surgery 20975 Joint, Spine Surgery
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Spine and Pain Management Worksheet 13 Primary CPT DESC 2014 2015 Spine Discectomy 63020 N eck spine disk surgery 0 0 63030 Low back disk surgery 0 0 63075 Neck spine disk surgery 0 0 Laminectomy 63045 Removal of spinal lamina 0 0 63047 Removal of spinal lamina 0 0 63048 Removal of spinal lamina 0 0 Laminotomy 63040 Laminotomy single cervical 0 0 63042 Laminotomy, single lumbar 0 0
15 Dr. Frank Cammisa: 8 Top Challenges for Spine Surgeons This Year 16 Dr. Stephen Hochschuler: 8 Changes to Ensure a Brighter Future for Spine Surgery 18 7 Best Practices for Increasing Spine Center Profitability 31 10th Annual Orthopedic, Spine and Pain Management-Drive ASC Conference Sports Medicine 40 Dr. Brian Cole: 3 Exciting Trends in .
Center for Comprehensive Spine areC YOUR GUIDE TO SPINE SURGERY The Weill Cornell Medicine Center for Comprehensive Spine Care 888-922-2257 Please talk with your care team about how Covid-19 may have temporarily changed the details within this booklet. spine surgery booklet 2022-05 FINAL.indd 1 5/17/2022 2:57:06 PM
Spine Surgery Education Class If you or someone you know is considering spine surgery, you are encouraged to attend Shore Medical Center's free Spine Surgery Education Class. The class provides information on what you can expect before, during and after surgery. Classes last approximately 90 minutes.
2.1 Anatomi Telinga 2.1.1 Telinga Luar Telinga luar terdiri dari daun telinga dan kanalis auditorius eksternus. Daun telinga tersusun dari kulit dan tulang rawan elastin. Kanalis auditorius externus berbentuk huruf s, dengan tulang rawan pada sepertiga bagian luar dan tulang pada dua pertiga bagian dalam. Pada sepertiga bagian luar kanalis auditorius terdapat folikel rambut, kelenjar sebasea .
