505 Parnassus Ave.
San Francisco, CA 94143

Before your spinal procedure, your physician will schedule an appointment with the Prepare Clinic to review your labs and test results, manage your medications, and clear you for surgery. This appointment needs to be scheduled 7-14 days prior to surgery.

Phone: (415)353-1480

How to reach your surgeon:

• Dr. Christopher Ames: (415)353-9360
• Dr. Praveen Mummaneni: (415)353-2547
• Dr. Aaron Clark: (415)353-3191
• Dr. Lee Tan: (415)353-4915
• Dr. Nima Alan: (415)353-2365
• Dr. Tarun Arora (at Marin): (415)514-6868
• Dr. Anthony DiGiorgio and Dr. Patrick Maloney: (415)502-2231

After hours/weekends: Call (415)353-7500

UCSF Urgent Care: (415)353-9188

Millberry Union Garage
500 Parnassus Ave.
San Francisco, CA 94143
Hourly rate: $5
Daily max: $35
Disabled person daily rate: $7

Parnassus Maps and Directions

If you are traveling to San Francisco for your surgery, check out UCSF Housing's Short-Term Lodging Guide for a list of options of places to stay nearby.

Discuss with obtaining a temporary displaced person parking placard for your recovery with your Primary Care Provider.

Submit your application through the California DMV. 

1. Well-lit path to the bathroom. Ensure you have a well-lit path for trips to the bathroom at night. Consider installing a nightlight.
2. Balance and support aids. Evaluate your bathroom setup for safety. Consider placing grab bars, purchasing a shower chair, nonslip bath mat, and commode. Assess the height of your toilet to determine if you may need a raised seat after surgery.
3. Accessible place to sleep. Set up sleeping accommodations on the first floor if needed, especially if there are stairs to your bedroom.
4. Tripping hazards. Roll up loose rugs. Rearrange furniture to make clear pathways free of clutter.
5. Items within reach. Place anything you'll need in easy to reach areas. Keep everything between hip and shoulder height, so no bending is necessary.
6. Stock your fridge and pantry. Buy or prepare food that can be readily available (i.e., microwaveable food or cold foods).

• Hibiclens® (chorhexidine gluconate, CHG) antiseptic skin cleanser 
• Heat packs and/or ice packs
• Lidocaine cream, patches, or spray OR capsaicin, menthol, or other topical medicated creams for pain
• Adaptive equipment (e.g., reacher/grabber, toilet aid, elevated toilet seat, sock and shoe aid, portable bed rail) 
• Extra-long cell phone charger
• Bowel regimen (Tylenol, MiraLAX, Senna, chewing gum)

With every surgery there is always a risk of infection. We will do everything we can to prevent infection, but you can help by following these bathing instructions before surgery.

Reducing the amount of germs on your skin prior to surgery is an important step you can take to protect yourself from developing an infection at your surgical site. The most effective way to do this is bathing with a special soap called chlorhexidine gluconate (CHG), commonly found in stores as Hibiclens®. The soap comes in a liquid form and can be purchased at most stores and pharmacies.

Shower with Hibiclens® two nights before surgery, one night before surgery, and the morning of surgery.

1. Turn water off. Apply CHG soap to your entire body from the jaw down. Use a clean washcloth or your hands. Avoid getting CHG near your eyes, ears, nose or mouth.
2. After applying CHG soap to your whole body, wash thoroughly for five minutes. Pay special attention to the area where your surgery will be performed. Do not scrub your skin too hard.
3. Pat yourself dry with a fresh, clean, soft towl after each shower. Do not wash with your regular soap after using the CHG.
4. Put on clean clothes or pajamas.
5. Use freshly laundered bed linens for the first night.

Do not shave the area of your surgery. Any new cut, abrasion or rash on your surgical limb will need to be evaluated and may cause a delay in your procedure.

Do not use other hygiene products. Do not apply any lotions, hair conditioner, perfumes, deodorant or powders after using CHG soap.

You'll need a caregiver to receive care instructions from hospital staff, drive you home, and help you with recovery.

• Identify who will help you get home from the hospital before your surgery.
• Discharge from hospital typically occurs before noon, so please plan your ride accordingly.
• If you own a walker or cane, have your caregiver bring it for your ride home from the hospital.
• Plan who will pick up your prescriptions after discharge and which pharmacy will be most convenient. 

It is important to identify the type of pain you are having in order to know which pain medication will will:

Muscle spasms. Muscle relaxants such as baclofen will help with abnormal muscle tightness, soreness, or stiffness.

Neuropathic pain (tingling, burning). Gabapentin (Neurontin) will help with burning, tingling, or nerve pain.

Generalized pain. Opioid pain medications (Norco®, Percocet®, oxycodone) or acetaminophen (Tylenol®) can treat generalized pain. Opioid pain medications can be habit forming. You should only take these medications when pain is severe. Always take the lowest dose that works for you.

For spinal fusion patients, it may be as long as 3-6 months before you can take non-steroidal anti-inflammatory medications such as ibuprofen. They can impair bone healing.

Your body goes through a lot during surgery! Expect to have soreness and discomfort after surgery. At times, you may have significant muscle pain, nerve pain, or surgical site pain.

Our team will continuously reassess your pain and pain medications to ensure that you have adequate pain management for your needs. You should not expect to be pain-free.

Indications that you are ready to go home:

• Your pain is managed on pain pills (not through intravenous pain medications)
• You are getting out of bed independently or with a family member safely assisting you
• You are walking more than 50ft (with a walker, if needed)
• You can climb the stairs, if there are stairs at home
• You can remove your brace (with help, if needed)
• You have had your discharge X-ray (if applicable)

The typical length of stay may vary from person to person. Once you have met certain milestones for discharge, your surgeon and care team will discharge you from the hospital.

As soon as your surgical team deems you medically ready for discharge, the expectation is you will be able to call your designated family or friend to pick you up. While we try to give advance notice, sometimes these decisions are made the morning of discharge.

If you are being discharged to a rehabilitation facility, the case manager wil work with you at arrange medical transport to that facility.

Care for staples and sutures

• Cover staples and sutures with Mepilex (silicone foam dressing). Change bandage every 5-7 days.
• Keep the incision dry while the staples/sutures ae in place and 24 hours after they are taken out.
• You may shower as usual 24 hours after the staples/sutures are removed.
• Staples/sutures may be removed between 14-21 days after surgery depending no your physician's recommendation. Your local primary care provider can remove staples or sutures to save you from having to travel to UCSF. It is recommended that you send a photo to your surgeon via MyChart prior to having the local provider remove the staples/sutures.
• Do NOT take baths, soak the incision, or apply ointments to the incision for 4 weeks.

Care for steristrips, skin glue, and prineo

• At the time of discharge, you will be instructed whether to keep your incision open to air (without a bandage) or keep it covered with a bandage for the first week after surgery.
• Keep the incision dry for 7-10 days after surgery.
• For teh first week after surgery, use plastic wrap and tape to cover your dressing when you take a shower to ensure the dressing does not get wet.
• If you notice that it is slightly wet following your shower, pat your incision dry with a clean, dry towel.
• Do NOT take baths, soak the incision, or apply ointments to the incision for 4 weeks.
• Dermabond Prineo (liquid adhesive and mesh) forms a protective covering over your incision.
  • Keep Prineo in place. It will fall off on its own over the next few weeks (It may take 3-6 weeks).
  • Most types of dressings or bandages will stick to Prineo. Therefore, use caution when removing them so as not to remove Prineo inadvertently. A dressing or bandage is not needed after you leave the hospital.
  • It is best to keep Prineo dry 3-7 days after surgery. You may then get it wet in the shower, but do not soak in water for at least 4 weeks after surgery (including swimming pools, jacuzzis, or bathtubs).
  • Avoid soaps, lotions, or ointments in the area as they can dissolve the adhesive that keeps Prineo in place.

Watch this video to learn how to change a bandage.

Showering

Incisions should be kept dry for a specific duration of time. If you have staples or sutures, keep them dry while they are in place (2-3 weeks). If you have any other skin closure such as prineo, glue, or steristrips, keep dry for 7 days.

• Securely cover the dressing with plastic food wrap or a freezer bag with edges secured tightly using medical tape to prevent water entry. You can also purchase plastic shields meant for showering. Some names for this are aquaguard or shower guard.
• After showering, remove the plastic wrap. If the dressing has become damp, change it to a new dressing.
• If your incision gets wet, be sure to PAT DRY, or use a blow dryer on COOL setting to air dry, but DO NOT RUB.
• If you are not able to securely cover the dressing, do not shower. Try sponge or towel bathing instead. 
• Do not submerge the incision site in water for 4-6 weeks (i.e. pool, jacuzzi, bathtub, ocean, lake).

How long should a brace be worn?

Wear the brace as ordered until your follow-up appointment 6-8 weeks after surgery.

More on how to put on a cervical brace >

More on how to put on a thoracic lumbar sacral orthosis (TLSO) >

How to put on a lumbar-sacral orthosis (LSO) >

Within 1 week after surgery, you should be able to decrease your dose of pain medicines by AT LEAST 30-50% of the amount you were taking right after surgery. For instance, if you were taking 12 tablets per day, you should have reduced that to 6-8 tablets per day, or fewer. After 2-3 weeks, you should reduce your total intake to 50-100% OR LESS of the amount after surgery, i.e., 0-6 tablets per day or less. You should taper your pain medicine to OFF (or back to your pre-surgery dose) as soon as you can tolerate it.

You may have to decrease by 1/2 to 1 tablet every 1-2 days. For example, decrease from 6 tablets maximum per day to 5 tablets for a day or two, then 4 tablets maximum for 1-2 days, then 3 tablets, etc. until you are no longer taking the opioids that were prescribed for your surgical pain. It is expected that you should no longer require the additional opioids within 3 weeks of your surgery. You should taper off of the opioids before you stop doses of other medications for pain (e.g., acetaminophen, gabapentin, baclofen, tizanidine, etc.)

It is strongly recommended that you take the lowest effective dose of medicine that treats your pain symptoms. To prevent excess sedation from your pain medicines, it is also recommended that you take them at different times than other drugs that make you drowsy, such as muscle relaxants. You should separate these medicines by at least 1-2 hours, if possible. 

If you have any trouble reducing your dosage, you should contact the Spine Clinic.

• Call pharmacy or spine clinic coordinator at least 3 days in advance for medication refills.
• No refills are done on the weekend.
• Remember your surgeon will only prescribe medications to you for up to 6 weeks total after surgery (1-2 weeks at discharge, and up to another 4 weeks by spine clinic, if needed). You will then have to go to your primary care provider for pain medications.

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil/Motrin), naproxen (Aleve), celecoxib (Celebrex)
• More than 81 mg per day of aspirin (until your surgeon approves)
• Nicotine, including cigarettes, vaping and chewing tobacco
• Acetaminophen (Tylenol) is okay for mild/minor pain

Acetaminophen (tylenol) can be found in over the counter (OTC) and prescription medications. Some patients exceed the recommended daily amount by accidentally taking multiple acetaminophen-containing products without realizing it or by not following dosing instructions. The liver warning on the OTC label states that severe liver damage can occur if more than 4,000 mg of acetaminophen is taken in a 24-hour period. Plan to limit your total dose to no more than 3,000 mg or 3 grams of acetaminophen per day.

Narcotics such as percocet, vicodin, and norco have acetaminophen in them (either 325 mg or 500 mg) per tablet. It is important that you are aware of the dosage and do not combine it with other products containing acetaminophen.

Store your medications in a secure cool, dry place out of the reach of children or pets. Dispose of them properly when you no longer need them; avoid flushing or placing whole tablets in the trash. Contact your local pharmacy or refer to the U.S. Environmental Protection Agency for additional information about drug disposal.

If you have any trouble reducing your dosage, you should contact the Spine Clinic Care Team for advice and instructions.

For any person taking opioids, it is recommended that you keep a prescription for naloxone (Narcan, Evzio) at home to administer either as a nasal spray or an injection, depending on the product. If a prescription has not been offered for this rescue (reversal) medication, please ask your provider for one. It is best that you and your family members or care assistant(s) familiarize themselves with use of the device before it may be needed for breathing problems or excessive sleepiness or unresponsiveness due to pain medication.

• Increased redness, swelling, pain, discharge or warmth around the incision
• Incision opens
• Fluid drains from pin sites or incision
• Foul-smelling discharge from the incision
• Burning or pain on urination
• Temperature higher than 101F (38.3 C)
• Shaking, chills

• Depending on your individual surgery, you may resume driving 2-6 weeks after surgery.
• Pain medications may impair your ability to drive safely.
• It is okay to ride in a car as a passenger.
• If you have a long ride, ask your driver to stop every 45-50 minutes. Get out of the car for 5 minutes to stand or walk, and then continue the ride.

Anesthesia, narcotic pain medications, dehydration and inactivity can all increase constipation. Stay well hydrated and plan to take several short walks a day. Over the counter stool softeners (I.e. COLACE) and laxatives (I.e. SENNA, MIRALAX) are helpful to relieve constipation. Take as directed on box instructions.

Bending, lifting, and twisting

• Minimize bending and twisting your back after surgery and avoid lifting anything weighing more than 10 pounds as tolerated for the first 6 weeks after surgery.
• Gradually increase amount of time for sitting, standing and walking.
• Prevent setbacks. Increased pain for two or more hours after an activity usually means you have done too much too soon. Don't just reach for the pain pills; take pain as a warning sign to slow down and pay attention to your posture and movement. Make sure you are bracing your abdominal muscles and keeping your ears, shoulders, and hips in line.

Protecting your spine

• Bend your knees and stoop if you need to pick something up (preferably not for the first 6 weeks after surgery).
• When you lift something, keep it close to your body so that your leg and arm muscles do the work.
• Avoid pushing, pulling and twisting. Avoid lifting anything heavier than 10 pounds.
• Bedrest is not good for your recovery, and limit the time you spend sitting in a straight back chair to 30-60 minutes at a time. If you need to sit in a chair for more than 30-60 minutes at a time, use a towel roll or other lumbar support behind your low back for support.

Walking

Walking is the best exercise after spine surgery. It strengthens your back and leg muscles and increased your endurance. It also relieves stress, which can cause your muscles to tighten. You should take several walks a day that are at least 5 minutes long. Brace your abdominal muscles and take medium strides. Walking also helps to prevent blood clots from forming and it increases your muscle strength and endurance. Try not to overexert yourself (i.e. If you are sweating or out of breath, your are doing too much activity).

No other athletic activities are allowed until after you are evaluated at your 6-week check-up.

Physical therapy

Most patients will be assessed at the 6–8-week postoperative mark after surgery and then released to start outpatient physical therapy as appropriate. If interested, please ask for a physical therapy referral at your postoperative appointment.

With UCSF MyChart, you can obtain online access to your lab tests, view many of your medical records, stay in touch with your provider, request appointments, view recent and upcoming appointments, as well as request medication refills. Unlike regular email, the information is safe – password-protected via an encrypted connection. It is easy to get started – just ask us and we will provide you with an activation code. To get signed up for UCSF MyChart, please email [email protected].

Also, please note that only non-urgent patient-related electronic communication should be directed to UCSF MyChart. UCSF MyChart is checked at least every 24-48 hours during regular business days. If you have an urgent or after-hours issue that cannot wait until the next business day to be addressed, please call the office at (415)353-7500. Thank you for your cooperation.

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