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  • Provide Comprehensive and
    Technically Excellent
    Neurosurgical Care
    Provide Comprehensive and Technically Excellent Neurosurgical Care
  • Offer Patients
    The Most Upto Date
    Surgical Advances And
    Best Practice Medicine
    Offer Patients The Most Upto Date Surgical Advances And Best Practice Medicine
  • Compassionate and
    Timely Intervention in a
    Setting Respectful of
    Our patients needs
    Compassionate and Timely Intervention in a Setting Respectful of Our patients needs
  • Open Communication With
    Our patients Primary
    Care Providers
    Open Communication With Our patients Primary Care Providers

Post Op Instructions

Bowel Management :: Incisional Wound Care :: Carpal Tunnel Decompression :: Anterior Cervical Discectomy and Fusion :: Anterior Cervical Discectomy and Artificial Disc Replacement

 

Bowel Management Following Surgery

Bowel Management aims to reinstate normal bowel function following surgery.

Consider the following factors, which affect the bowel:

Age

The ageing process naturally decreases the bowel mobility. Therefore elderly
patients need to pay particular attention post surgery in reinstating normal bowel
function.

Diet and Fluid intake

It is recommended you increase fibre intake post surgery in conjunction with
increase in fluid consumption. Plenty of water is essential.

Mobility and Exercise

As exercise stimulates bowel movement, often the reduction in mobility and exercise
post surgery affects normal bowel function. Nursing staff and your physio will encourage
early mobility. It is important to continue regular movement and light exercise
once at home (unless instructed otherwise by your surgeon).

Medications

Many of the narcotic medications slow bowel movement and cause constipation (commonly
codeine based analgesics). It is recommended that patients purchase a stool softener
prior to surgery to have at home should they experience constipation once discharged.

Commonly used stool softener medications include Coloxyl with senna, Lactulose,
Movicol or Metamucil. Consult your pharmacist with any queries.

Pre-existing Bowel Conditions

Taking into consideration usual bowel patterns, do not leave it too long between
bowel motions (2days). As an inpatient, nursing staff should ask each day if you
have opened your bowels and commence bowel management on the ward. Advise the nursing
staff should you have any concerns or difficulty with your bowels while you are
in hospital.

Neurological Surgery

Avoid constipation or straining where possible. Regular use of aperients may
be required immediately post-operatively.

Incisional Wound Care

After your discharge it is extremely important that you monitor your wound each
day for signs of infection and to enable proper healing.

Guidelines to follow:

  • Always wash your hands before and after touching your wound, or avoid touching
    it altogether.
  • Limit showers to 5 minutes and avoid submerging wound in water completely.
    Keep wound dry.
  • Avoid extreme temperatures
  • Gentle soaps are permitted, do not scrub or be rough with the wound
  • Lotions and ointments are not recommended until the wound is completely
    healed
  • Slight itching, numbness or tightness of the wound area is normal
  • Contact your General Practitioner if you notice any of the following signs
    of infection:

    • Swelling or redness
    • Warm and or painful to touch
    • Any purulent discharge or opening of the incision
    • Fever greater than 37.5 degrees Centigrade
  • Note if your feet or ankles appear swollen, elevate when possible and do
    not cross legs. Notify surgeon if there is no improvement.
  • Regular walks and wearing TED stocking (if provided) is recommended.

 

Carpal Tunnel Decompression

What is carpal tunnel syndrome (CTS)?

CTS is a condition that often leads to pain, tingling, numbness and associated weakness in the first three digits of the hand. The median nerve passes through the carpal tunnel which is made up of the small bones of your wrist roofed in by a ligament (flexor retinaculum). CTS occurs when the median nerve is compressed and inflamed in the tunnel resulting in the symptoms. It is often caused by repetitive movements that place additional loads through the wrist. Often patients complain of pain and numbness in the hand which wakes them at night. Confirmation of the diagnosis may be obtained by nerve conduction studies performed by a neurologist.

What is carpal tunnel decompression (CTD)?

When conservative treatment has failed, Dr. Lewis performs a CTD. The procedure involves making a small incision on the wrist and incising the ligament to relieve compression on the median nerve. In most cases the symptoms significantly reduce immediately after the operation. This procedure is most commonly performed as a day stay procedure and admission to hospital overnight is usually not required.

What should I feel after I leave hospital?

In most cases the preoperative pain and numbness in the affected hand is immediately improved. There will be some wound discomfort from post operative swelling but this will settle down over the first week. It is important to rest with the arm elevated so as to help prevent excessive swelling of the surgical wound. Commonly only simple analgesia is required in the immediate post-operative period. Dr Lewis will discuss your requirements prior to discharge from hospital.

How do I manage the surgical wound?

Upon discharge from hospital your wound will be covered with a dressing. This should be removed Day 3 following the operation. The surgical wound is held together by nylon sutures. Once the dressing has been removed we recommend gently washing the wound under the shower taking care not to vigorously scrub it. It should be carefully dried and if necessary a simple dressing to protect the suture line may be applied. This should be changed daily. It is normal for slight itching, numbness or tightness around the wound area. The sutures should remain in place for 10 to 14 days. Make an appointment with your GP to have these removed. If this is not possible then contact the Perth Neurosurgery office.

Although unlikely, potential wound problems during the healing phase include:

  • Wound infection – should the wound become painful, reddened, swollen or warm to touch, it may be infected. Infection is often accompanied by fever.
  • Wound drainage – fluid should not leak from a surgical wound in this region. Coloured fluid or a “pus like” discharge may indicate infection.

Should you have any concerns about your wound, contact your GP. Dr Lewis is usually available at all times and can be contacted by any Emergency Department or your GP if they have any concerns.

Other potential post-operative problems

  • Increasing pain in the wound/wrist: It is common to have some pain and discomfort at the site of surgery. As you use your hand and wrist more there may also be some stiffness. This is to be expected. However should you develop steadily increasing pain this may indicate a problem and it is important to seek advice.
  • Increasing or new onset weakness or numbness in the hand or fingers: It may take some time for the preoperative numbness and weakness to resolve This will depend on several factors including the severity and duration of nerve compression. Hwever your symptoms should not worsen nor should you develop new onset numbness or weakness. This may indicate a problem and it is important to seek advice.
  • Deep vein thrombosis/pulmonary embolus: Some patients who undergo surgery develop blood clots in the veins of the legs. These clots can cause pain or swelling in the legs or may cause no obvious problems. Sometimes the blood clots can break free from the legs and travel to the lungs, causing shortness of breath and/or chest pain. If you develop pain or swelling in your legs after surgery, contact your GP. If you develop breathing problems or chest pain after surgery then it would be advisable to seek urgent assessment at your local Emergency Department. Dr Lewis is usually available at all times and can be contacted by any Emergency Department or your GP if they have any concerns.

Following discharge from hospital – what to do?

  • Pain Medication: At discharge from hospital you will be given pain medications. Please take this medication as prescribed. Some patients are reluctant to take pain medication however it is perfectly normal to take pain medication for up to several weeks after surgery. It is important that your pain is controlled so that you can move freely and do not become stiff. As bruising around the wound site resolves, affected nerves recover and wound healing occurs, the need for pain medication will reduce. It is important to remember that pain medications can cause nausea or constipation. Nausea may be minimized by taking the medication with food. Constipation can be relieved by taking stool softeners and/or laxatives as needed. Sometimes patients develop an allergy to a medication started during the hospital stay. Most frequently this will be an itchy rash. Call your GP if you think you might be having an allergic reaction.
  • Wrist management: For the first 24 to 48 hours rest the arm and keep it elevated to ensure the inflammation is minimised. Use an ice pack on the region for the first 48 hours several times a day for 20 minutes per occasion to assist with decreasing the inflammation.
  • Exercise: Commence the post-operative exercise schedule as outlined below. Most patients do not require specific physiotherapy but if you have been working with a physiotherapist preoperatively then at day 7 to 14 book an appointment to see your physiotherapist for review and progression of exercises. Plan your recovery by trying not to overdo it. Start with tasks you are comfortable with and then gradually increase the level of activity as tolerated.
  • Return to work: As a general rule, most patients return to work between 2 to 4 weeks post surgery. This will vary depending on resolution of preoperative symptoms, pain medication requirements, neck mobility and type of work you are returning to. Return to work certificates may be obtained by calling the Perth Neurosurgery Office or your GP.
  • Follow up appointment: You will receive a follow up appointment with Dr Lewis at 4 to 6 weeks post surgery.

Following discharge from hospital – what not to do?

  • Smoking: Do not smoke after the operation as this can be associated with significant delays in bone healing and general recovery.
  • Driving: It is not advisable to drive for at least 1 week following surgery. The reasons for this include allowing time for the effects of recent surgery and anaesthesia to completely wear off, being able to grip your hand and move freely without discomfort and to ensure that you are not taking any medication that will impair your judgement (i.e. narcotics).
  • Lifting etc.: Avoid any repetitive actions that may inflame the area i.e. typing, manual labour, holding tools until the sutures are removed and the swelling has settled. Do not lift anything that weighs more than 5kg for the first 4 weeks. After this slowly increase the weight limit over time..

Carpal Tunnel Decompression Mobility and Exercise Timeline

Day 1 – 7

Keep the hand elevated and rested as able to assist with swelling management.

Commence the following exercises to improve wrist mobility:

  • Sitting or standing. With the arm supported move the wrist upwards until you feel a tightness (not pain). Stop and hold for 3 seconds. Gently reverse direction, moving the wrist downward Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10, Perform exercise three times daily as tolerated. You may feel some stiffness but do not push it to cause pain.
  • Move and use your fingers as often as you can. This will prevent long term stiffness from developing.
Day 7 – 14

Continue with the exercises as above. Book in to see your GP fpr removal of sutures around day 10 to 14. Make an appointment to visit your physiotherapist for review and progression of exercises as necessary.

Week 2 – 4

Plan for return to work, conditional on clearance from Dr Lewis or your GP.

Week 4 – 6

Post operative review appointment with Dr Lewis.

Week 6 -12

Based on your rehabilitation progression, some sports can be introduced.

 

Anterior Cervical Discectomy and Fusion (ACDF)

What is an ACDF?

Dr Lewis performs an ACDF to remove herniated or degenerative discs causing neck and/or arm pain by relieving the pressure placed on the nerve. There is a small surgical incision made in the front of the neck region to access the vertebrae and disc. After the disc of interest is removed and nerve roots decompressed, the vertebrae above and below are fused together.

What should I feel after I leave hospital?

In most cases the severe pain in the neck and/or arm goes immediately after surgery once the nerve has been decompressed. There are some patients in whom the pain can take up to 4 weeks before it starts to reduce. Similarly, some patients report an ‘ache’ in the neck region that is different to the original pain prior to undergoing the surgery; this also often dissipates with time. Some patients also report throat irritation, hoarseness or difficulty with swallowing which resolves with time and normally requires no further medical management. Commonly only simple analgesia is required in the immediate post-operative period. Dr Lewis will discuss your requirements prior to discharge from hospital.

How do I manage the surgical wound?

Upon discharge from hospital your wound will be covered with a dressing. This should be removed Day 3 following the operation. The surgical wound is held together by an absorbable suture beneath the skin. This will dissolve over time. Once the dressing has been removed we recommend gently washing the wound under the shower taking care not to vigorously scrub it. The wound may be left uncovered but if clothing is rubbing against it, then a simple dressing changed daily is sufficient. Remember that surgical wounds are very sun sensitive during the first 12 months. Lotions and ointments should not be used on the wound until it has completely healed. It is normal for slight itching, numbness or tightness around the wound area.

Although unlikely, potential wound problems during the healing phase include:

  • Wound infection – should the wound become painful, reddened, swollen or warm to touch, it may be infected. Infection is often accompanied by fever.
  • Wound drainage – fluid should not leak from a surgical wound in this region. Coloured fluid or a “pus like” discharge may indicate infection.

Should you have any concerns about your wound, contact your GP. Dr Lewis is usually available at all times and can be contacted by any Emergency Department or your GP if they have any concerns.

Other potential post-operative problems

  • Deep vein thrombosis/pulmonary embolus: Some patients who undergo surgery develop blood clots in the veins of the legs. These clots can cause pain or swelling in the legs or may cause no obvious problems. Sometimes the blood clots can break free from the legs and travel to the lungs, causing shortness of breath and/or chest pain. If you develop pain or swelling in your legs after surgery, contact your GP. If you develop breathing problems or chest pain after surgery then it would be advisable to seek urgent assessment at your local Emergency Department. Dr Lewis is usually available at all times and can be contacted by any Emergency Department or your GP if they have any concerns.

Following discharge from hospital – what to do?

  • Pain Medication: At discharge from hospital you will be given pain medications. Please take this medication as prescribed. Some patients are reluctant to take pain medication however it is perfectly normal to take pain medication for up to several weeks after surgery. It is important that your pain is controlled so that you can move freely and do not become stiff. As bruising around the wound site resolves, affected nerves recover and wound healing occurs, the need for pain medication will reduce. It is important to remember that pain medications can cause nausea or constipation. Nausea may be minimized by taking the medication with food. Constipation can be relieved by taking stool softeners and/or laxatives as needed. Sometimes patients develop an allergy to a medication started during the hospital stay. Most frequently this will be an itchy rash. Call your GP if you think you might be having an allergic reaction.
  • Exercise: Commence the post-operative exercise schedule as outlined below. At day 7 to 14 book an appointment to see your physiotherapist for review and progression of exercises. Plan your recovery by trying not to overdo it. Start with tasks you are comfortable with and then gradually increase the level of activity as tolerated.
  • Return to work: As a general rule, most patients return to work between 2 to 4 weeks post surgery. This will vary depending on resolution of preoperative symptoms, pain medication requirements, neck mobility and type of work you are returning to. Maintain good sitting/standing posture at all times to prevent additional stress load on the surgical site. Depending on the degree of physical effort required at your place of work, a graduated return to work program may be required. Arrange a workplace ergonomic assessment if necessary. Return to work certificates may be obtained by calling the Perth Neurosurgery Office or your GP.
  • Follow up appointment: You will receive a follow up appointment with Dr Lewis at 4 to 6 weeks post surgery. You will also receive an X-ray request form for a post-operative X-ray of your neck. This will be reviewed with you at your appointment.

Following discharge from hospital – what not to do?

  • Smoking: Do not smoke after the operation as this can be associated with significant delays in bone healing and general recovery.
  • Driving: It is not advisable to drive for at least 2 weeks following surgery. The reasons for this include allowing time for the effects of recent surgery and anaesthesia to completely wear off, being able to rotate your head freely to see oncoming traffic and ensuring you are not taking any medication that will impair your judgement (i.e. narcotics).
  • Lifting etc.: Do not lift anything that weighs more than 5kg for the first 6 weeks. After this slowly increase the weight limit over time. Avoid bending your head upward or downwards for prolonged periods and avoid repetitive tasks until advised otherwise.

ACDF Mobility and Exercise Timeline

Day 0

Surgery

Day 1

Mobilize out of bed, walking the hospital

Commence the following exercises:

  • Lying on your back with a pillow under your neck, gently retract your neck by bringing your chin downwards. Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10. Perform exercise twice daily. You may feel some stiffness but do not push it to cause pain.
  • In standing, move shoulder blades backwards and downwards to assist in improving posture. Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10. Perform exercise twice daily. You may feel some stiffness but do not push it to cause pain.
Day 2 – 3

Discharge home, continue with the exercises as above. Ensure you have a good pillow to maintain adequate neck posture. Walking is an excellent low impact exercise to begin after surgery.

Day 3 – 7

Continue with the exercises as above.

Commence the following exercises to improve neck mobility:

  • Sitting or standing. Gentle extend the neck by looking upward until you feel a tightness (not pain). Stop and hold for 3 seconds. Gently reverse direction, flexing the neck by looking downward until you feel a tightness (not pain). Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10. Perform exercise twice daily as tolerated. You may feel some stiffness but do not push it to cause pain.
  • Sitting or standing. Gentle rotate the neck by turning your head to the left until you feel a tightness (not pain). Stop and hold for 3 seconds. Gently reverse direction, turning your head to the right until you feel a tightness (not pain). Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10, Perform exercise twice daily as tolerated. You may feel some stiffness but do not push it to cause pain.
Day 7 – 14

Continue with the exercises as above. Book in to see your physiotherapist for review and progression of exercises.

Week 2 – 4

Once your surgical wound has healed, commence swimming in the pool with a mask and snorkel as tolerated. Return to driving as able assuming that neck movement is adequate and arm strength has improved. Plan for return to work, conditional on clearance from Dr Lewis or your GP.

Week 4 – 12

Continue with mobility pool exercises outlined above. Post operative neck X-ray and clinical review appointment with Dr Lewis.

Week 12

Based on your physiotherapy/rehabilitation progression, functional exercises and some sports can be introduced.

 

Anterior Cervical Discectomy and Artificial Disc Replacement (ACD and ADR)

What is an artificial disc replacement?

An Artifical Disc replacement is a prosthetic implant that replaces the cervical disc. This innovative surgical technique preserves neck range of motion and maximises function with minimal restrictions. It is an alternative to the commonly performed anterior cervical discectomy and fusion (ACDF). An artificial disc replacement is is typically performed for a patient with a cervical disc herniation that is causing significant neck and/or arm pain that has not responded to nonsurgical treatment options and is significantly affecting the individual’s quality of life and ability to function.

What should I feel after I leave hospital?

In most cases the severe pain in the neck and/or arm goes immediately after surgery once the nerve has been decompressed. There are some patients in whom the pain can take up to 4 weeks before it starts to reduce. Similarly, some patients report an ‘ache’ in the neck region that is different to the original pain prior to undergoing the surgery; this also often dissipates with time. Some patients also report throat irritation, hoarseness or difficulty with swallowing which resolves with time and normally requires no further medical management. Commonly only simple analgesia is required in the immediate post-operative period. Dr Lewis will discuss your requirements prior to discharge from hospital.

How do I manage the surgical wound?

Upon discharge from hospital your wound will be covered with a dressing. This should be removed Day 3 following the operation. The surgical wound is held together by an absorbable suture beneath the skin. This will dissolve over time. Once the dressing has been removed we recommend gently washing the wound under the shower taking care not to vigorously scrub it. The wound may be left uncovered but if clothing is rubbing against it, then a simple dressing changed daily is sufficient. Remember that surgical wounds are very sun sensitive during the first 12 months. Lotions and ointments should not be used on the wound until it has completely healed. It is normal for slight itching, numbness or tightness around the wound area.

Although unlikely, potential wound problems during the healing phase include:

  • Wound infection – should the wound become painful, reddened, swollen or warm to touch, it may be infected. Infection is often accompanied by fever.
  • Wound drainage – fluid should not leak from a surgical wound in this region. Coloured fluid or a “pus like” discharge may indicate infection.

Should you have any concerns about your wound, contact your GP. Dr Lewis is usually available at all times and can be contacted by any Emergency Department or your GP if they have any concerns.

Other potential post-operative problems

  • Deep vein thrombosis/pulmonary embolus: Some patients who undergo surgery develop blood clots in the veins of the legs. These clots can cause pain or swelling in the legs or may cause no obvious problems. Sometimes the blood clots can break free from the legs and travel to the lungs, causing shortness of breath and/or chest pain. If you develop pain or swelling in your legs after surgery, contact your GP. If you develop breathing problems or chest pain after surgery then it would be advisable to seek urgent assessment at your local Emergency Department. Dr Lewis is usually available at all times and can be contacted by any Emergency Department or your GP if they have any concerns.

Following discharge from hospital – what to do?

  • Pain Medication: At discharge from hospital you will be given pain medications. Please take this medication as prescribed. Some patients are reluctant to take pain medication however it is perfectly normal to take pain medication for up to several weeks after surgery. It is important that your pain is controlled so that you can move freely and do not become stiff. As bruising around the wound site resolves, affected nerves recover and wound healing occurs, the need for pain medication will reduce. It is important to remember that pain medications can cause nausea or constipation. Nausea may be minimized by taking the medication with food. Constipation can be relieved by taking stool softeners and/or laxatives as needed. Sometimes patients develop an allergy to a medication started during the hospital stay. Most frequently this will be an itchy rash. Call your GP if you think you might be having an allergic reaction.
  • Exercise: Commence the post-operative exercise schedule as outlined below. At day 7 to 14 book an appointment to see your physiotherapist for review and progression of exercises. Plan your recovery by trying not to overdo it. Start with tasks you are comfortable with and then gradually increase the level of activity as tolerated.
  • Return to work: As a general rule, most patients return to work between 2 to 4 weeks post surgery. This will vary depending on resolution of preoperative symptoms, pain medication requirements, neck mobility and type of work you are returning to. Maintain good sitting/standing posture at all times to prevent additional stress load on the surgical site. Depending on the degree of physical effort required at your place of work, a graduated return to work program may be required. Arrange a workplace ergonomic assessment if necessary. Return to work certificates may be obtained by calling the Perth Neurosurgery Office or your GP.
  • Follow up appointment: You will receive a follow up appointment with Dr Lewis at 4 to 6 weeks post surgery. You will also receive an X-ray request form for a post-operative X-ray of your neck. This will be reviewed with you at your appointment

Following discharge from hospital – what not to do?

  • Smoking: Do not smoke after the operation as this can be associated with significant delays in bone healing and general recovery.
  • Driving: It is not advisable to drive for at least 2 weeks following surgery. The reasons for this include allowing time for the effects of recent surgery and anaesthesia to completely wear off, being able to rotate your head freely to see oncoming traffic and ensuring you are not taking any medication that will impair your judgement (i.e. narcotics).

Lifting etc.: Do not lift anything that weighs more than 5kg for the first 6 weeks. After this slowly increase the weight limit over time. Avoid bending your head upward or downwards for prolonged periods and avoid repetitive tasks until advised otherwise.

ADR Mobility and Exercise Timeline

Day 0

Surgery

Day 1

Mobilize out of bed, walking the hospital

Commence the following exercises:

  • Lying on your back with a pillow under your neck, gently retract your neck by bringing your chin downwards. Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10. Perform exercise twice daily. You may feel some stiffness but do not push it to cause pain.
  • In standing, move shoulder blades backwards and downwards to assist in improving posture. Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10. Perform exercise twice daily. You may feel some stiffness but do not push it to cause pain.
Day 2 – 3

Discharge home, continue with the exercises as above. Ensure you have a good pillow to maintain adequate neck posture. Walking is an excellent low impact exercise to begin after surgery.

Day 3 – 7

Continue with the exercises as above.

Commence the following exercises to improve neck mobility:

  • Sitting or standing. Gentle extend the neck by looking upward until you feel a tightness (not pain). Stop and hold for 3 seconds. Gently reverse direction, flexing the neck by looking downward until you feel a tightness (not pain). Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10, Perform exercise twice daily as tolerated. You may feel some stiffness but do not push it to cause pain.
  • Sitting or standing. Gentle rotate the neck by turning your head to the left until you feel a tightness (not pain). Stop and hold for 3 seconds. Gently reverse direction, turning your head to the right until you feel a tightness (not pain). Stop and hold for 3 seconds. Start with 3 lots of 6 repetitions then gradually build up as tolerated to 3 x 8 and then 3 x 10, Perform exercise twice daily as tolerated. You may feel some stiffness but do not push it to cause pain.
Day 7 – 14

Continue with the exercises as above. Book in to see your physiotherapist for review and progression of exercises.

Week 2 – 4 Once your surgical wound has healed, commence swimming in the pool with a mask and snorkel as tolerated. Return to driving as able assuming that neck movement is adequate and arm strength has improved. Plan for return to work, conditional on clearance from Dr Lewis or your GP.
Week 4 – 12

Continue with mobility pool exercises outlined above. Post operative neck X-ray and clinical review appointment with Dr Lewis.

Week 12

Based on your physiotherapy/rehabilitation progression, functional exercises and some sports can be introduced.

credibilty

  • University of Florida
  • The University of Western Australia
  • The University of Adelaide
  • Neurosurgical Society of Australasia
  • Royal Australasian College of Surgeons: RACS