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 - Whether your stay is just overnight, or a few days, there are some things you will like to have with you in the hospital. Here are some suggestions:

• Insurance card
• Toiletries
• Loose fitting clothes
• List of your medications
• Robe and slippers
• T-shirts (if brace is used)
• List of your allergies
• Reading material

Anterior Spine Surgery

  If you are scheduled to have your spine fused from the front through the abdomen or side, we recommend you give yourself an enema the night before surgery. This will help your bowels get moving quicker after surgery, and makes surgery technically easier for the surgeon doing the exposure of the spine.

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 - Most patients are placed on a PCA pump (patient controlled analgesia). When pain is present, push your pump button to get immediate delivery of medication. The pump prevents overdosing, even if you push the button more than you should. If pain is still present, additional pain medication is available. At the appropriate time, pain pills will replace the PCA pump. There will always be more pain medicine available if you have pain.

  Eating - For most surgeries involving the back part of the spine, patients begin drinking clear liquids the night of surgery. Over the next few days, a regular diet is resumed when we are sure you are tolerating liquids first. For patients requiring surgery from the front of the spine (through the side or through the abdomen), it often takes 1 - 3 days to regain bowel function and be ready to eat. Eating too soon can cause nausea and vomiting since the stomach and the intestines have not fully awakened from surgery. If you are able to eat regular food, friends and family may bring in food from outside the hospital

  Walking - Unless specifically instructed, you should plan on getting up and walking the day after surgery. Physical therapists and the nursing staff will help you. You may require a walker at first to keep your balance safely. As soon as you don't need the walker, you can walk on your own. Plan on walking three times a day, increasing the distance as you are able.

  Bowel Movements - Since the bowels are slowed by surgery and some of the pain medicine, it takes time to get them going again. You will be placed on a daily stool softener pill, and you may be given a suppository to help get things going. In some cases, an enema may be required. Things which you can do to help your bowels awaken quicker include sitting up in a chair several times during the day, and going for at least two walks a day. The more you are up, the faster you will get back to a normal bowel schedule. Be aware however that it may take up to 2 weeks to get back to a normal bowel routine.

  Length Of Hospital Stay - Most patients are ready to go home from 2-4 days after surgery, depending on what was done in surgery and your general health. The more motivated patients are, the faster the recovery tends to be.

  Going Home or to a Rehabilitation Center? - When you are ready for discharge from the hospital, a decision will be made as to your immediate needs. If the hospital's physical therapist considers you independent, or if you have help at home, you will be released to go home. A visiting nurse or therapist may be requested by your physician to visit you at home on a daily basis for a few weeks, if it is covered by your insurance plan. For patients who still require additional therapy before they are independent, or for those without any help at home, discharge to a rehabilitation center or skilled nursing unit may be appropriate. At the care center, the focus will be on physical therapy and becoming independent.

The First Two Weeks After Surgery

  Help at Home - For patients going home, it is very reassuring to have someone there who can physically help and provide positive emotional encouragement for the first few to several days. Help is most often needed with making meals, getting in and out of bed or a chair, and with bathroom and bathing activities. Some patients do not need the help, while others require assistance with bathroom and bathing activities for a few weeks. Plan accordingly.

  Pain control - Strong narcotic pain medication is used immediately after surgery for the first two weeks. After that, you will slowly be weaned to a lesser strength pain medication. Often, additional medication will be prescribed along with the pain pills to "boost" the effect and pain relief. Patients who follow our pain medication recommendations will not become addicted. We will make certain.

  Eating - It is common to have a decreased or absent appetite after major surgery. However, it is very important to begin eating a normal diet as soon as possible after surgery. A large number of calories are needed to heal a large surgery such as spinal fusion, and to prevent infection. This is not the time to go on a diet! Try several small meals and snacks until a healthy appetite returns.

  Bowel Regularity - For the first few weeks after surgery, it is very common to have some constipation. This is usually caused by the narcotic pain medicine used to control your pain, and from the general anesthetic used to put you asleep for surgery. If you continue to sit up several times a day and walk at least three times a day, thing will get back to normal. You may have to continue an over-the-counter stool softener such as Colace for a few weeks, and you may require an occasional enema. Ask your family doctor or call our office if you have any questions or concerns.

  If you have been asked to wear a brace, you need to learn to use the bathroom with the brace on. Wiping your bottom is a challenge but can often be managed by slightly loosening the brace. You may require help with keeping your bottom clean, if you have to wear a brace.

  The Incision - This is easier than you may think. Your incision was closed with self- dissolving suture. There are no staples or stitches to remove. You will notice that under the dressing are "steri-strip" tapes on the incision edges. Do not remove the "steri-strip" tapes that hold the skin edges together. They will begin to peel off all by themselves after a week or two. If they are still there after 3 weeks, you can peel them off if you want.

  Change the outside bandage or dressing once a day and replace it with a light dressing held in place by minimal tape. Keep your incision clean, dry, and covered. Please do not put any salves, Vaseline, Neosporin ointment, vitamin E, aloe vera, or anything else on it during the first 3 weeks. Keep it covered with a clean light bandage for the first week.

  After 7-10 days, you may stop putting a dressing on your incision if you want, or you can continue with a daily light dressing for an additional week if it feels better covered.

  It is not uncommon to have a small amount of clear yellow fluid drainage from the incision. This should decrease in amount daily and should be completely dry by one week. If you notice any drainage beyond a week, any increase in drainage, or drainage which becomes cloudy (pus), or if the edges of the incision become red, please call us immediately. If you have any concerns about your incision, it is better to call.

  Showering - If you want to shower during the first week, tape plastic over the incision to keep it dry. After the first week, you do not need to put anything on the incision. An alternative to showering is to sponge bath for the first week.

  Avoid bending in the shower. Make sure the soap, shampoo, etc is within reach while standing. Have someone else wash your legs, dry your legs, and shave your legs (if you are so inclined). Some people are more comfortable with an elevated bar stool to sit on in the shower.

  No baths yet. It is too much stress on the fusion to get in and out of the tub. You can take a bath after 3-5 months, depending on your surgery.

  Walking - Plan to take at least 3 slow walks each day. The distance you walk should slowly increase. No matter how good you feel, do not walk more than ½ mile at a time. This is the time to let your spine heal, not to exercise.

  Activity Level - Avoid bending, stooping, kneeling, crawling, and lifting more than 5-8 pounds. Try not to spend the entire day lying down. The more you are up, the better your appetite, digestion, circulation, lung function, and mental attitude will be. Sitting is permitted and encouraged. Lie down to rest when you need to.

  It is too soon to exercise. The fusion must have a chance to heal without stress. For this reason, walking is the only form of physical activity permitted. It is too soon for swimming.

  You can go for short trips in the car as a passenger. It is too soon to be driving though.

Week 2-6 After Surgery

  Help at Home - The need for assistance with the activities of daily living becomes much less between weeks 2 and 6. Patients become more independent with personal care, food preparation, getting the brace on and off, and moving around the house. Assistance in the bathroom is sometimes still needed, however. Most patients do not need constant assistance at home after 6 weeks. Family, neighbors, or friends who stop by or call once or twice a day is usually sufficient.

  Pain control - Pain medication is safely used as needed during this time. Post-operative pain from the surgical procedure is much less by 4-6 weeks and the need for narcotic pain medications decreases. Often by 6 weeks, people are taking only a rare pain pill, and managing their pain primarily with extra-strength Tylenol or something similar. In some cases, pain pills are needed up to 3 months. After 3 months, we want our patients off narcotic pain pills and taking over-the-counter medications such as Tylenol for pain.

  The incision - The incision should be completely dry. Dressings are no longer required. If the steri-strips are still present, peel them off. You do not need to cover the incision when you shower. After 4-6 weeks, if you really want to put lotion, salve, or vitamin E on the incision, it is safe to do so. We do not know of any value from such topical treatments, however. The size and thickness of your scar is related to your body's scar forming tendencies, not which lotion you apply.

The incision will be a pink to light red line. The color of the scar will fade to normal skin tone after several months.

  Walking - Start increasing your slow and casual walking. You can now walk up to a mile at a time, so long as you do it slowly. This is NOT power-walking. It is meant to maintain baseline muscle tone and circulation, and help your mental attitude. It is not meant to be exercise.

  Activity level - Continue to avoid bending, lifting >10 lbs, stooping, crawling, and kneeling. Short rides in the car are permitted. If you are still using a walker and feel stable, consider switching to a cane.

  Back to School - For children and teen-agers of school age, plan to be back in school in 3 weeks. No carrying more than one book at a time, and no back packs.

Week 6-12 After Surgery

  Activity Levels - Now is the time to start doing a bit more than you have been doing. Walking can be increased to up to 2 miles a day. You can begin to walk at a faster pace to where you become slightly "winded".

  Bending, stooping, crawling, kneeling, and lifting are still avoided, though may be done on rare occasions if needed. Limit your lifting to 10-15 pounds. If you are wearing a brace, you still must wear it when ever you are up.

  You may travel for long distances if you want. This includes air travel.

  Driving - You may begin driving for short trips.

  Work - Some patients want to get back to work as soon as possible. It is safe for you to return to work on a part-time or full-time basis if you feel up to it. This must be sedentary or light duty work. You must still adhere to the activity guidelines (no lifting, etc.) and wear your brace as directed.

  Sex - After 6 weeks, sexual activity can be resumed. It is advised that you assume the role of being a passive partner on the bottom. This will decrease the stress across the healing spine fusion, and will avoid back pain. If sex is painful, tell your hopefully understanding partner that you need to stop. After 3 months, your fusion should be solid enough to allow you to become more active. After 3 months, there are no restrictions.

3 Months

  Pain Control - By 3 months from surgery, you should be off all of your narcotic pain pills. Ninety percent of people are successful at achieving this goal without much difficulty. We will help you accomplish this while keeping you as comfortable as possible. Use over-the-counter pain relievers first. If the pain does not go away, an occasional pain pill can be helpful.

  Home Exercises - After 1-2 months of therapy, patients are ready to continue the program learned in physical therapy at home. It is very important to perform the daily exercise program learned in therapy in order to avoid injuring a vulnerable and deconditioned spine. All of the progress made in therapy will be lost if the home program is not followed. After a few months of exercised, the spine is stronger and less likely to hurt. Make your home exercise program a part of your daily routine.

For overall fitness, an exercise bike is excellent. Swimming is great. Jogging can be started. Try to walk or run 2 miles each day.

  Work - With the help of physical therapy, by 3-5 months, most patients are ready to return to a light duty status at work. Lifting can be increased to 25 - 45 pounds, and patients can do some occasional bending, stooping, crawling, and kneeling. There are no restrictions on driving.

  Physical Therapy - Patients are usually ready to begin a supervised gentle strengthening and flexibility program by 3 months. This is usually done through a physical therapist. Therapy is usually 2-3 times per week for a month or two. During that time, spinal flexibility is reestablished with stretching exercises. Endurance is increases with a cardiovascular workout. The trunk muscles (abdominal and back) are strengthened to take stress off from the spine. Pain decreases as fitness, flexibility, and endurance increase.

6 Months

  Activity Levels and Sports - Time to get back to sports and other more physical types of exercise. This includes golf, tennis, basketball, and other non-collision type sports. Weight lifting restrictions are dependent on the person. Fifty pounds is usually the limit. The main limiting factor is the rehabilitation of the back muscles and their ability to perform at demanding levels. Even if the spine is fused, function will be limited if the trunk muscles are not strong.

  Work - Most patients can return to full duty by 5-7 months from surgery. When the job demands very heavy lifting, it may be 6-9 months until the patient is ready to return. We do not view spine surgery as a disabling event. To say it another way, just because you have had spine surgery doesn't mean you should be disabled. The whole purpose of surgery is to get patients back to a higher level of function. Most people get back to work. This is our goal and we want it to be yours. It is extraordinarily rare that a patient is unable to do some type of work.

One Year

  Activity Levels - There are no restrictions after one year if your fusion is solid (based on x-rays and clinical evaluation). No limitations. Patients are free to bend, lift, stoop, crawl, or anything else. If the back is fully rehabilitated, patients can play football, weight lift, snow ski, and participate in rodeos. Remember though, just because you are not restricted from an activity doesn't mean you should do it. Use good judgment.

  Common Sense - Having invested a year of your life solving your spine problem, you should be cautious about causing new problems. Use good back posture and lifting mechanics. Do your exercises faithfully. Keep your abdominal muscles strong and your weight under control.

  The more repetitive stress the spine endures, the more likely it will show signs of wear (degenerative arthritis of joints and discs). Consider just how important it is to you to continue such activities as working a heavy construction job, golfing every day, continuing to driving a cross-country truck, or other similar activities.

  The Future - Plan on obtaining x-rays every few years to follow the status of your fusion and the joints adjacent to the fusion. For some patients, there is a 20% chance that another joint in the spine will wear out and require fusion to alleviate pain. For this reason, it is important to use good common sense about your back and to keep in touch with us through the years.

General Guidelines

  What to Eat - Spine surgery can be stressful on your body's nutritional requirements. A large number of calories are required to heal the surgical incision and promote healthy fusion of the bones. Because of the high calorie requirements for healing, it is very important to eat, even if your appetite is low. If you don't eat enough, your body will take the calories from your muscles and other tissues and you will lose weight. This is not the time to go on a diet! A well balanced diet is best for meeting your nutritional needs. If you have a hard time eating enough, we recommend a can of Ensure drink with each meal (Ensure may be purchased at grocery stores and pharmacies without a prescription).

  Calcium - If you already eat a well balanced diet including dairy products, you will not need to take extra calcium. If you have any doubts, you can take 500-1500 mg of extra calcium per day. Women after the age of menopause should be taking 1000-1500 mg per day.

  For Those Who Are Asked To Wear A Brace - Unless otherwise directed, you need to wear your brace 24 hours a day whenever you are out of bed. Do not get up without it on. You may take it off after you are in bed and it can remain off as long as you are lying down. The brace goes on before you get up.

  Showering is permitted out of the brace. Take the brace off and step into the shower. Pretend the brace is on while showering, which means no bending over to pick up the shampoo. Someone else will have to wash your legs for you. You may sit on a stool or shower chair while in the shower. Everything in the shower should be reachable without bending. When finished, step out of the shower and towel off. Someone else will have to dry your legs. While standing, put on your underwear, a soft cotton T-shirt, and then the brace. Then you are ready to finish getting dressed.

When prescribed, the brace is usually worn for 2-4 months.

  Back To Work Or School - You may return to work or school as soon as you feel up to it. This will likely be between a few weeks and a few months, depending on your surgery, your motivation, and other factors. Follow the activity guidelines listed above. If you need a note for your boss or you teacher, let us know.

  Fever - It is common for a low-grade fever to occur during the first few days after surgery. This is most often due to the lungs needing to be fully expanded to their normal size. Deep breathing exercises help this to happen. If a fever occurs after the first few days or is greater than 100.5(please call your family physician or call us.

Back Pain After Surgery - During the first few months after surgery, it is very common to have some back pain. The trunk muscles become weak due to healing from the surgery and the sedentary level of activity that is required. It is common for this type of back pain to improve with physical therapy as the trunk regains its strength and endurance. After 6 months from surgery, back pain should be mild and occasional.

  Leg Pain After Surgery - If your leg hurt before surgery, your spinal nerves were likely compressed and irritated. The longer your leg hurt before surgery, the more likely it is that the nerve may be somewhat irritated after surgery and hurt for some time (days to weeks). The leg pain after surgery should be much better than before surgery. With time, leg pain usually gets better. When leg pain starts or worsens weeks or months after surgery, it may be the result of scar tissue around the nerve that can cause irritation when you are especially active. If the leg pain becomes intense at any time, please call us.

  Leg Swelling - The more you sit or stand after surgery, the more your legs are likely to swell. Put your feet up when you sit or lay down. This will help the swelling. If you notice swelling in only one leg, please call us since that can be a sign of a blood clot in the deep veins of the leg.

  Dental Work - Although it is not well documented, our experience convinces us that taking antibiotics before and just after having dental work is a good idea for those who have had spinal fusion with instrumentation. Ask your dentist for a prescription.

  Exercises - Plan to establish a daily habit of exercise to keep your trunk muscles strong and flexible. This is the single most important thing you can do for the long-term health of your spine. It is the most reliable way to avoid episodes of back pain in the future. Just do it.

  Chest Pain, Abdominal Pain, Or Shortness Of Breath - If you experience any of these symptoms, please call us or your family physician immediately. If you have a hard time getting through, go to an emergency room to be evaluated.

© Copyright 2005. Arthritis Education by Professionals, Inc.