General Post-operative Guidelines for Spinal Surgery
Post-operative instructions vary widely due to the many different types of spinal surgeries performed. In addition, age and health status may influence specific instructions and activities. The following instructions are appropriate for most surgeries. Your doctor or their assistants may modify these instructions, if necessary, for your specific circumstance. If you have any questions, please do not hesitate to ask the hospital or office clinic staff.
All patients undergoing spinal surgery will need to limit their activities for a period of time during their recovery. The specific limitations vary greatly depending upon the type of surgery. Your doctor will discuss these limitations with you and your physical therapist, prior to your discharge.
In general, avoid strenuous activities until told otherwise.
- LIFTING - It is usually safe to lift up to ten pounds initially (about the weight of a half-gallon of milk). Gradually, you will be allowed to lift more as muscle strength returns. Always remember to use proper lifting technique.
- SITTING – Sitting for brief periods is usually tolerated. Prolonged sitting should be avoided.
- DRIVING – You should not drive if you are taking narcotic pain medications and your driving ability is impaired. Muscle weakness or numbness in your arms or legs will also impair your driving ability. A neck brace restricts your ability to turn and may make such activities as changing lanes, turning in traffic, or parking unsafe. Prolonged driving also places stress on the lower back and may results in increased pain or prevent normal healing. In general, you should avoid driving for 4 – 6 weeks unless you have specifically discussed this with your physician.
- WALKING – Walking is an excellent exercise and may be started immediately after most spinal surgeries. If your balance is unsteady, you should use a support such as a cane or walker initially. Begin by walking short distances and gradually build up your endurance. Start on flat, level ground, and as your recovery progresses, you may tackle more challenging terrain. Always be careful on slippery surfaces, especially during winter when ice or snow may make walking unsafe. If you live close to a shopping mall, supermarket, or public building, these may provide locations in which you can walk during poor weather. Many patients find pushing a shopping cart excellent early exercise.
- STAIRS — After most spinal surgeries, you may use stairs if your balance is satisfactory. If you have any questions, please discuss this with your physical therapist. Sturdy handrails are important on your staircase at home.
- BENDING, TWISTING, AND TURNING – These activities should be avoided early after all spinal fusions, these activities are usually avoided several months following surgery.
- SEX – You may resume sexual activity in most cases as soon as you feel comfortable. You should avoid activities or positions that place stress on the operated area. You may need to consider new methods of obtaining and giving pleasure during the early post-operative period. Don’t be frustrated if it takes some time before your sexual desire returns. Post-operative pain, general anesthesia, and medications you are taking can all cause temporary impairments in sexual functions.
- BATHING — You may shower four days after your surgery. You should not soak in the tub for two weeks.
BRACE / NECK COLLAR
Depending upon the type of procedure you undergo, you may need a brace following surgery. In general, patients undergoing discectomy or laminectomy do not need a brace following surgery. Patients undergoing a cervical or lumbar fusion will usually use a neck collar or a lumbar spine brace following surgery. Usually these are worn when out of bed and may be removed when resting in bed. In certain cases, such as spinal fractures, you may need to use your brace at all times until instructed otherwise.
EXTERNAL BONE GROWTH STIMULATOR
Depending on the type of fusion you undergo, your doctor might order an external bone growth stimulator. This unit helps the bones fuse after the surgery. Start wearing the unit approximately 3 weeks after surgery. The unit is to be worn as instructed.
Gradually resume your normal diet after surgery. You do not need to take specific supplements as long as you follow a balanced diet. If you have undergone an abdominal approach for anterior surgery on the lumbar spine, it may take several days for your normal intestinal function to return, and you may need to return to your regular diet at a slower rate. If you develop abdominal pain or distention, you should contact your healthcare provider.
Constipation may develop following surgery due to medications. Increase your fluid intake, especially water. If necessary, varieties of food or over-the-counter medications are available and should be considered. These include:
- Prune juice, Multigrain cereal, High fiber foods (raw fruits)
HOME SUPPLIES / EQUIPMENT
- BED – In most cases, a normal bed is all that is required. If your surgery has been extensive or your mobility is markedly impaired, a hospital bed may facilitate positioning and assist in moving in and out of bed. You should discuss this with your therapist.
- WALKER – A walker may be helpful after surgery to improve balance and decrease stress on your lower back.
- CANE / CRUTCHES – Used for balance.
- BEDSIDE COMMODE – A bedside commode may be helpful following surgery if your bathroom is far from your bedroom or your mobility is impaired.
- GRASPER – For picking up objects from the floor if you are unable to bend. Discuss this with your therapist.
Routine dental appointment should be avoided for six weeks following spine surgery. If an emergency procedure is required within that time, it is recommended that you receive antibiotic coverage for that procedure. After six weeks, antibiotics are not necessary unless prescribed by your dentist.
In general, you should resume any medications prescribed by your primary care physician upon returning home unless instructed otherwise. In addition, you may also receive a number of other medications to help with post-operative pain and muscle spasm. These include pain medications, muscle relaxants and anti-inflammatory medications.
REHABILITATION CENTER AFTER SURGERY
After discharge from the hospital, most patients will be able to return home. On occasion, if your medical condition requires additional treatment or if there is insufficient support at home, a stay in a rehabilitation center can be considered. This can allow additional time for you to regain strength, improve mobility, and prepare for a safe return home. If you believe this is needed, discuss this with your doctor or with the case management nurse assigned to you while in the hospital.
Some patients are able to go immediately home from the hospital but will benefit from additional support until they feel stronger and are more independent. These support services can include, nursing visits, physical therapy, and home assistance with activities such as shopping and meal preparation. If you believe this is needed, discuss this with your doctor or with the case management nurse assigned to you while in the hospital.
- Visiting Nurse Association
- Home Physical Therapy
- Home Health Aide
- Meals on Wheels
Your surgical incision, in most cases, is closed with either metal staples or dissolvable sutures.
- METAL STAPLES – Do not need to be covered after four days. Typically, they are removed approximately 10 – 14 days after the surgery. This can be arranged through Dr. Papazoglou’s or Dr. Mick’s office. If you live a long distance from either office, in some cases your primary care physician may be willing to remove the sutures.
- DISSOLVABLE SUTURES – The incision is also covered with pieces of tape called Steri-Strips. They’re giving the healing wound more strength and improve the cosmetic appearance. Leave them in place until they fall off (usually between two and three weeks).
Following surgery, your incision will either be left open or covered with a dressing. The dressing is usually left in place for 3 – 4 days. If there is drainage on the dressing, it will be changed before you leave the hospital. After four days, the dressing can be removed and the wound does not need to be covered. If there is drainage, the wound should be covered with a piece of sterile gauze. If the drainage persists, contact your physician.
Infection is unusual and may take several weeks after surgery to develop. If you notice increasing redness of the wound, drainage, and fever, consult your physician’s office.
Almost all patients can travel home in a normal automobile. For lower back surgery, initially you should travel lying down in either the back seat or the front seat with the back fully reclined. It may help to bring along several pillows to cushion sensitive areas or an ice pack. As long as you are comfortable, there is no limit to how long you can ride in the car, but you will probably need to stop periodically to move and stretch.
In rare circumstances, ambulance transportation home may be required. Public transportation should be avoided. If you need to travel by airline, discuss this with your physician. Some of the metal implants used in spinal surgery may set off metal detectors. Relax! This is a common occurrence for the millions of people who have had metal screws, plates, rods, or artificial joints implanted. The security guards are very familiar with this occurrence. You do not need a special card or doctor’s note. Simply follow the guard’s instructions.
Some types of spinal surgery require periodic x-rays to assess healing. The first x-ray is usually obtained during surgery. Repeat x-rays may be obtained 4-6 weeks following surgery and then again, every few months as needed.
If you have sutures in place that need to be removed, your initial follow-up appointment is usually 10-14 days following surgery. If dissolvable sutures have been placed, your initial follow-up appointment is usually 4-6 weeks following surgery.
A return-to-work date is quite variable following spinal surgery. If you have had a discectomy or laminectomy, in some cases, many patients return to work within 6-12 weeks. This is dependent upon your overall physical condition and the requirements of your job.
More complex surgeries such as spinal fusions will have greater limitations and typically require months of healing and therapy before you are able to return to work.
In most cases, you will see a physical therapist during your hospital stay. They will review basic self-care activities with you as well as an initial exercise program. Formal physical therapy may be instituted following surgery when sufficient healing has occurred.
In general, if you have had a discectomy or laminectomy, therapy will begin within 1-2 months after surgery.
If you have had a spinal fusion, upon returning home, you should begin exercising by walking each day. Gradually increase your walking as you feel stronger. For most people, by six weeks after surgery the goal is to walk one mile each day. In several months, when the fusion strengthens, a formal physical therapy and exercise program will be prescribed. Your physician will discuss the specifics of your exercise program.
Questions can be answered in the hospital by the nursing staff, physical therapists, your physicians, or their assistants. After discharge, you may contact the clinical staff:
Britten (Dr. Papazoglou’s office) (413) 734-2540
Donna Egan (Dr. Mick’s office) – (413) 582- 0330
If there is any change in your overall health that develops after spinal surgery, you may also need to discuss this with your primary care practitioner. Should any life-threatening emergency develop, such as chest pain or difficulty breathing, contact your local hospital emergency room immediately.
- Electrodiagnostic Medicine
- Electromyography/Nerve Conductions Studies
- Cervical Epidural Cortisone Injections
- Lumbar Epidural Cortisone Injections
- Facet Joint or Nerve Injections
- Radiofrequency Neurotomy
- General Post-operative Guidelines for Spinal Surgery
- Spinal Fusion
- Spinal Cord Stimulation