What to Expect

  Every patient is unique. Every spinal surgery is unique. Even so, there are many common questions and topics concerning recovery. This information is provided as a general guide. This guide does not replace any specific advice you receive from your surgeon.

The Day Before Surgery

 What To Bring To The Hospital – One of the benefits of minimally invasive surgery is a shortened stay in the hospital after your surgery. You will either go home the same day or the next day after surgery.  

Here are some suggestions on things to bring with you to the hospital:

·         Insurance card

·         Toiletries

·         Loose fitting clothes

·         List of your medications, dosage, frequency

·         List of your allergies

minimally invasive Spine Surgery

If you are to have minimally invasive spinal fusion, the surgery most often is performed through the back. The fusion is done both in the front and back region of the spine.  This technique increases the rate of fusion and also stabilizes the spine, thus decreasing the amount of pain postoperatively.  Minimally invasive fusion surgery allows you to go home either the same day or the day following surgery.  You will most likely have four small incisions on your back.  Two larger incisions (one to two inches) will be in the lower area of the spine fusion.  Two smaller incisions (about a centimeter in length) for passage of the rod will be above or below the other two incisions.  Your skin is numbed prior to surgical intervention. No muscles or other tissues are cut. At the end of surgery more numbing medication is placed around the incision and into the muscle to help with pain control. 

The Night Before Surgery

 DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT BEFORE SURGERY. If you do, your surgery may be canceled by the anesthesiologist.

In The Hospital

 Pain Control – Pain medication such as Lidocaine is given during surgery. While in the recovery room, patients are given IV medication as well as the oral medication such as Percocet and Valium to take home. 

 Eating – Patients are allowed to eat and drink small amounts of food such as ice chips and clear liquids.  Bland foods such as soda crackers will also be introduced in the recovery room to tolerance. Temporarily the anesthetic can cause nausea or vomiting which can be exacerbated by food intake.

 Walking – A physical therapist will see you in the hospital and make sure that you are stable with ambulation.  You will most likely be sent home with a front-wheeled walker to assist with your ambulation. 

  Bowel Movements – Bowel movements can be slowed by medications. Taking a stool softener while at home or a laxative is recommended. 

  Length Of Hospital Stay – Most patients either go home the same day of surgery or the following day after surgery. 

  Rehabilitation – Every patient who undergoes minimally invasive surgery is placed in an extensive rehabilitation program for approximately twelve to thirteen weeks. Physical therapy begins the day of surgery.  We will help you get your initial appointment with a physical therapist as soon as possible after discharge.  Within two to three weeks, you should be in aquatic therapy strengthening and stretching the back.  It is important that you continue your therapy for the entire duration and until we feel you have maximized the therapeutic benefits of the rehabilitation. 

The First Two Weeks After Surgery

  During the day of surgery, you will take it easy and do some mild abdominal contraction type of exercises.  The day after surgery this will continue.  We strongly recommend that you walk about ½ hour daily. The physical therapist will provide instructions so you begin and continue mild strengthening exercises and pelvic tilts.  Pain medications given to you in the hospital will be used for your postoperative pain.  You will return to see us in the office at two weeks after surgery for wound checks and a general evaluation. 

Week 2-6 After Surgery

  Physical therapy will continue with strengthening and stretching exercises as well as aquatic therapy once your wounds are well healed.  You will continue to strengthen your back and your legs throughout this entire period and increase your walking endurance.  Aerobic activity will be prescribed in this time frame.  Most patients can discard the walker two to four weeks postoperatively.  Many patients can go back to work depending on the type of work.  At the end of six weeks, you will return for another evaluation at which time x-rays of your back will be taken to assess the fusion. 

WEEK 6-12 AFTER SURGERY

  You will continue to increase activity. Some patients are back to full duty at this time. Some patients are still having some minor discomfort, which is usually alleviated with mild medications such as Tylenol and muscle relaxants. At three months postop, you will return for another evaluation including x-rays.  Most patients are progressing well towards a solid fusion at this point.  At three months, patients are usually released from physical therapy and can return to full duty regardless of the type.  Activity can continue to increase.  At three months after surgery, patients are permitted to use non-steroidal anti-inflammatory medications such as Aleve or Advil. 

3 MONTHS - 6 MONTHS AFTER SURGERY

  At three months postop, patients are released to regular activity and will follow up with us for more x-rays.  At 6-12 months, patients are back to normal activity levels and their pain is controlled with minimal medication such as non-steroidal anti-inflammatory medications only or some mild muscle relaxants. 

ONE TO TWO YEARS AFTER SURGERY

  At 1-2 years after surgery, you have no restrictions. We will obtain final x-rays at the two-year mark to assure that your fusion is completely healed. You will be released from our care at two-years from surgery. 

THE FUTURE

  Many patients will continue to have mild discomfort in their back.  In most cases, further surgical intervention is not helpful for this. Patients can use Tylenol, non-steroidal anti-inflammatory medications and occasional muscle relaxants. No narcotic medication is provided after the three-month time frame.  Some patients may experience other degenerative segments in their back within five to ten years following surgical intervention.  If this should occur, about 20% may need further surgical intervention above or below the previous fusion. If further surgical intervention is necessary, previous instrumentation will need to be removed.  Generally speaking, minimally invasive surgery can not accomplish removal of instrumentation and a subsequent fusion at the same time. 

GENERAL GUIDELINES

  Patients can eat a normal well balanced diet.  Calcium intake is within the FDA Guidelines which should be about 1500 mg a day (in split doses).  No bracing is done during the postoperative time frame.

Bathing - Showering is allowed postop but do not allow water to directly hit your incision and dry it as soon as you are out of the shower. No submerging in water is permitted until the wound is well healed and after your first two-week evaluation. Aquatic therapy begins soon thereafter. 

Back To Work - You may return to work depending on your job as soon as you start to feel that you can handle sitting or performing some activity of your job.  Most patients are able to return to some function by four to six weeks postoperatively. Some patients involved in manual or heavy duty jobs must wait full three months. 

Postoperative Symptoms/Precautions – Some patients will experience slight temperatures such as 100 or 101.  These can be decreased with Tylenol and with increased ambulation and getting up.  These slight increases in temperature are most likely a result of either pain or decreased breathing from lying down. When the lungs are fully expanded and pain is well controlled, temperatures are very rare.  However some people will have increased body temperature with healing.  We are not significantly concerned about increased temperatures unless you experience excruciating back pain and/or the wounds become red and drain purulent material.  If the temperature reaches 102.5 or greater, you should contact the office.

  Back Pain After Surgery – Patients will experience back pain after minimally invasive surgery related to muscle spasms.  Valium is given to all patients unless you have an allergy for control of muscle spasms.  Percocet is also given for pain control.  This regimen is fully capable of handling all pain that patients have after minimally invasive spinal fusion. 

 Leg Pain After Surgery – Very few patients will have some leg pain. This is due to irritation to the nerve roots during the surgical intervention and may be the most significant pain postoperatively.  It is usually controlled with medications such as steroids and or nerve medications such as Neurontin or Zonegran.  It may take several months to improve but it should improve with time.

Exercises – Patients should get used to being involved in a regular exercise program specifically aerobics and strengthening and stretching exercises to their core muscles which will be taught in physical therapy. In the long run, you will feel better and be able to do more after you are fully recovered if you learn to include exercise in your daily routine.

© Copyright 2005. Arthritis Education by Professionals, Inc.