Medically reviewed by Mousa Hamad, MD · Last reviewed: Sept 27, 2026
Once a date is on the calendar, most of the advice you’ll find is about logistics: freeze some meals, arrange a ride, pack a bag. That advice is useful, and there’s a checklist for it further down.
But the weeks before surgery also contain a handful of things that genuinely change how the operation goes, and they get much less attention. Blood sugar, nicotine, conditioning and a realistic understanding of what the surgery can and can’t fix all influence your result, and all of them are at least partly in your hands.
Key takeaways
- If you have diabetes, your HbA1c should be checked before surgery. Above 7.5%, guidelines say patients should be counseled about a higher risk of infection and reoperation.[1]
- Stopping nicotine at least 4 weeks before surgery is the single most useful thing a smoker can do.[2][3]
- A short conditioning program before surgery, sometimes called prehabilitation, has been shown to help recovery.[4]
- Ask what the operation is expected to fix, and what it isn’t. Leg or arm pain usually responds better than back or neck pain alone.
- Sort out insurance approval early. Prior authorization is often what delays a surgery date.
Before you agree: questions worth settling first
What exactly is this operation meant to fix? Nerve pain down the arm or leg tends to respond better than back or neck pain by itself. If your main complaint is back pain, ask directly what the realistic expectation is.
What happens if I wait? For some conditions, waiting is reasonable. For others, such as spinal cord compression, delay carries risk. You should understand which situation you’re in.
Have I exhausted the non-surgical options that make sense? Physical therapy, medication, activity changes and, in some cases, injections come first for most conditions.
Is there more than one surgical option? For many problems there is. Our articles on cervical fusion and its alternatives and on motion preservation versus fusion in the lower back walk through two of those decisions.
Would a second opinion help? It’s routine, and a reasonable surgeon expects it. Our article on choosing between a neurosurgeon and an orthopedic spine surgeon explains what to compare.
“The question I wish more patients asked is what this operation is not going to fix. Decompressing a nerve is very good at taking pain out of an arm or a leg. It is far less reliable for back pain that has been there for years. If we agree on that before surgery, nobody is disappointed three months later.”
— Mousa Hamad, MD, Neurosurgeon, Maxim Spine
The four to six weeks that matter most
Nicotine
Nicotine narrows blood vessels and slows bone healing. For fusion surgery it raises the chance the bone won’t knit.
Prehabilitation guidelines recommend stopping 3 to 4 weeks before elective spine surgery.[2] Across surgical specialties, patients who quit 4 weeks beforehand had roughly 41% fewer postoperative complications, including wound and lung problems.[2] Reviews of spinal infection prevention recommend at least 4 weeks of abstinence to meaningfully lower infection risk.[3]
One honest caveat: the neurosurgical guideline panel found the evidence that quitting reduces reoperation specifically is thin, while still advising patients to stop before and after fusion surgery.[1] Vapes, patches and gum all contain nicotine, so tell your surgeon what you’re using.
Blood sugar
If you have diabetes, this is the number to focus on. National neurosurgical guidelines recommend an HbA1c test before spine surgery, with counseling about increased risk of reoperation or infection above 7.5%.[1] A narrative review of infection prevention reports more than double the rate of deep infection after thoracolumbar fusion when HbA1c is above 7.0%.[3]
If your number is high, it’s worth asking whether surgery can wait a few weeks while your primary doctor or endocrinologist helps bring it down.
Weight and conditioning
Prehabilitation guidelines suggest a target BMI under 35 before elective spine surgery to reduce wound complications, and recommend an exercise program beforehand for patients with heart or lung conditions.[2] A randomized trial of prehabilitation combined with early rehabilitation in lumbar fusion patients found better recovery than standard care.[4]
You don’t need a gym membership. Walking daily, gentle core and hip work within your pain limits, and practicing getting in and out of a chair without twisting all help.
Alcohol, bone health and medications
Guidelines advise abstaining from alcohol before elective spine surgery, and patients with osteoporosis may benefit from vitamin D and calcium, and in some cases medication that strengthens bone before instrumentation is placed.[2]
Your surgeon will tell you which medications to stop and when. Blood thinners and anti-inflammatories such as ibuprofen are the usual ones, typically 10 to 14 days beforehand, and some are held for weeks afterwards while bone heals.[5]
“Nicotine, without question. Patients hear it as a lecture, but for a fusion it is the difference between bone that heals and bone that doesn’t. The other thing people underestimate is how much easier recovery is if they walk every day in the weeks beforehand. You cannot start getting fit the day after surgery.”
— Mousa Hamad, MD, Neurosurgeon, Maxim Spine
Insurance and approval in New Jersey
Most spine surgery needs prior authorization. Insurers commonly want documentation of the conservative treatment you’ve already tried, recent imaging, and notes showing how symptoms affect daily function.
Start this early. Ask the office who handles authorization, how long it usually takes with your plan, and whether the hospital, the surgeon and the anesthesiologist are all in network. Ask for an estimate of your out-of-pocket cost. If your plan denies the request, ask what the appeal process involves, because denials are sometimes overturned with additional documentation.
The practical checklist
Two to four weeks before
- Complete pre-operative testing and medical clearance
- Confirm who will drive you home and stay with you
- Arrange time off work; ask for a letter if your employer needs one
- Fill prescriptions you’ll need afterwards
- Ask whether you’ll need a brace or collar, and get it fitted beforehand
One week before
- Prepare meals and freeze them
- Move everyday items to waist height so you don’t bend or reach
- Remove loose rugs and cords, and set up a firm chair with arms[5]
- Do laundry and cleaning in advance
- Confirm your arrival time; hospitals usually call the day before[5]
The night before and the morning of
- Follow fasting instructions exactly
- Wash with the antiseptic soap you were given, if you were given one[5]
- Skip lotions, perfume and jewelry
- Bring your ID, insurance card, medication list, and a case for glasses or dentures
- Bring your brace or collar if you have one
What recovery generally looks like
This varies more by procedure than anything else, so ask about yours specifically. A few patterns hold across most spine surgery:
- Walking starts early, often the same day.
- Bending, lifting and twisting are limited at first, commonly to about five pounds.
- Driving resumes once you’re off strong pain medication and can turn comfortably.
- Desk work usually returns before physical work.
- If a fusion is involved, the bone takes months to heal even when you feel fine.
Ask for the specific milestones for your operation in writing, along with who to call after hours and what warning signs matter.
Getting evaluated in New Jersey
Maxim Spine is a neurosurgical spine practice with board-certified, fellowship-trained surgeons who perform both fusion and motion-preserving procedures. If you’re weighing a recommendation you’ve already received, we also see patients for second opinions. You can read about our surgeons and where they trained.
We see patients at four New Jersey offices:
- Morristown: 310 Madison Avenue, Suite 300, Morristown, NJ 07960
- Cedar Knolls: 197 Ridgedale Avenue, Suite 225, Cedar Knolls, NJ 07927
- Bridgewater: 745 US-202, Suite 205, Bridgewater, NJ 08807
- Verona: 799 Bloomfield Avenue, Suite 112, Verona, NJ 07044
Offices are open Monday through Friday, 9 a.m. to 5 p.m. See directions and contact details for each location.
Frequently asked questions
How long before surgery should I stop smoking?
At least 4 weeks, and longer is better. Guidelines for spine surgery recommend 3 to 4 weeks minimum, and infection-prevention reviews recommend at least 4.[2][3]
Do I need to lose weight before spine surgery?
Not always, and it depends on your procedure and starting point. Prehabilitation guidance suggests aiming for a BMI under 35 before elective spine surgery to lower wound complication risk.[2]
Should I be exercising before surgery?
Usually yes, within your pain limits. A randomized trial found that a program combining prehabilitation with early rehabilitation improved recovery after lumbar fusion.[4]
Can my surgery be delayed because of my blood sugar?
It can be, and sometimes that’s the right call. Guidelines recommend HbA1c testing beforehand and counseling about higher infection and reoperation risk above 7.5%.[1]
How long does insurance approval take?
It varies by plan, from days to several weeks. Ask the office to start the authorization as soon as surgery is decided, and ask what documentation your insurer requires.
What should I ask at my pre-op visit?
What the operation should fix and what it won’t, how long the restrictions last, when you can drive and work, what warning signs to watch for, and who to call after hours.
Next steps
If surgery has been recommended and you want a clear explanation of the options, or a second opinion before deciding, an evaluation is a reasonable next step. Request an appointment at any of our four New Jersey offices.
Medically reviewed by: Mousa Hamad, MD
Specialty: Neurosurgery · Minimally invasive and complex spine surgery
About the reviewer: Dr. Hamad is a neurosurgeon at Maxim Spine specializing in minimally invasive and complex spine surgery. He earned his medical degree at Rutgers New Jersey Medical School, completed his neurosurgery residency at Montefiore Medical Center in New York, and completed a fellowship at NewYork-Presbyterian Hospital, Weill Cornell Medicine. He sees patients at the Cedar Knolls office and is affiliated with Morristown, Overlook and Chilton Medical Centers.
This article is for general education and is not a substitute for medical advice. Follow the instructions your own surgical team gives you, since they may differ from the general guidance here.
References
- Congress of Neurological Surgeons systematic review and evidence-based guidelines for perioperative spine: preoperative surgical risk assessment. Neurosurgery. 2021. doi:10.1093/neuros/nyab316. https://pubmed.ncbi.nlm.nih.gov/34490901/
- Comprehensive guidelines for prehabilitation in spine surgery. J Craniovertebr Junction Spine. PMID 40292172. https://pubmed.ncbi.nlm.nih.gov/40292172/
- Strategies to prevent post-operative surgical site infection in spinal surgery: a narrative review. Eur Spine J. 2026. https://link.springer.com/article/10.1007/s00586-026-09911-3
- Nielsen PR, Jørgensen LD, Dahl B, Pedersen T, Tønnesen H. Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clin Rehabil. 2010. https://pubmed.ncbi.nlm.nih.gov/20530650/
- RWJBarnabas Health. Planning and preparing for spine surgery. https://www.rwjbh.org/treatment-care/spine-care-and-back-pain-treatment/spine-surgery/patient-education/planning-preparing-for-spine-surgery/
