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After Lumbar Spine Surgery

What can I expect after the surgery is finished?


After surgery, you may spend one night in the Surgical Intensive Care Unit (SICU), however you
will most likely go directly to the Spine unit. Here we have nurses specially trained to take care
of post-op surgery patients, so you will be in good hands!

Spine surgery is a fairly long procedure, usually 2-5 hours. By the time surgery is over and you
have spent an hour or so in the Recovery Room, it is usually the afternoon before you are in your
room on the Patient Tower. For this reason, the remainder of the day is devoted to rest. You
will be allowed to eat once you are in a room.

Pain Control
After surgery, you will probably wake up with a back brace on. You will have pain
medication ordered for your post-op pain. This is administered by mouth, IV or both. You may
also have fluids and medications for nausea, as needed.

Normally after surgery, you will receive a PCA (Patient Controlled Analgesia) Pump filled
with pain medication. The pump allows you to control the timing of the medication, based on
your individual pain. In most cases, the PCA Pump will be used for 1-2 days. You will then be
switched to oral pain medicine as needed. You will also have an IV Pump which is used to give
you fluids and medicine for post-operative nausea.

Nursing Care
You will also have an SCD (Sequential Compression Device) Pump connected to cuffs that
fasten around your lower legs. As they inflate and deflate, they stimulate circulation in your legs
to help prevent blood clots from forming. You may also have compression stockings for the
same purpose.

A small drainage tube may be placed in your incision during surgery to allow the incision site
to drain small amounts of fluid and blood that may form after surgery. Depending on how much
drainage is forming, the drainage tube is usually removed 2-4 days after surgery. You also may
have a urinary catheter called a “foley” which was placed in your bladder during surgery. The
foley catheter is usually removed 1-3 days after surgery.

The Day after Surgery


The next morning after your surgery day, you will receive a visit from a physical therapist who
will assess your condition and help you get out of bed and into a chair. The therapist will show
you the proper way to transfer from bed to chair and back, so that you are comfortable doing so
in the hospital and when you get home. It is important to keep your back straight. No bending or
twisting! The therapist will help you stand and walk using a walker if needed.

You will be given an Incentive Spirometer to help you deep breathe and cough after surgery.
This is important to keep your lungs clear after anesthesia so that you do not develop pneumonia.
You will use the Spirometer several times each day.

It is important to move around as much as possible. You will be encouraged to get out of the bed
and into a chair often, and to have your meals in the chair. Staying mobile will help you recover
fast and avoid complications that may result from staying in bed.

You may be fitted with a Bone Growth Stimulator. This device uses a small amount of
electrical current to help stimulate bone growth around the area of the spine which was operated
on. You will wear the Bone Growth Stimulator for up to six months after surgery, for about four
hours each day.

Leaving the Hospital


Normally, Lumbar Spine patients spend 3-4 days in the hospital after surgery. On Day 2 or 3,
you will receive a visit from someone in Social Services. At that time, we will help you make
plans to either go home with visits from a Home Health Nurse, or transfer you to a Rehabilitation
Center for a few days. The Social Services staff will help you make arrangements for things like
a walker, shower chair, or bedside commode, depending on your needs.
In most cases, you will be ready to leave the hospital once your drain has been removed, you
have switched to oral pain medication, and you are able to walk with the aid of a walker.
Caring for Yourself at Home after
Lumbar Spine Surgery
Everyone heals at a different rate. However, after Cervical Fusion Surgery, it usually takes 1-2
days in the hospital and several weeks of healing to fully recover. While healing at home, you
should gain a little more strength and energy each day. Take things slowly at first, and
remember to stop and rest in between activities.
The following is intended to provide you with general guidelines to assist you in your healing
process. If you have more specific questions, please ask your doctor.

Incision Care – Preventing Infection


It usually takes 4-6 weeks or longer after surgery for the incisions to heal. For the first few
weeks after surgery, you may notice that your incisions may be numb, sore, itchy or bruised. Be
careful not to scratch because this can interfere with healing. It is important to watch for and to
recognize any signs of infections after surgery.

To reduce the possibility of infection in your incision:


 Look at your incisions every day and become familiar with their “normal” appearance.
 Check for increased swelling, redness, warmth, pain or tenderness to touch, or discolored
or foul smelling drainage. Drainage should be clear amber or clear pink-tinged.
 Take your temperature every day, the same time each afternoon the first week to check
for fever over 101 degrees. If your temperate is 101.5 or greater, notify your surgeon.
 Keep your incision dry. Your surgeon will tell you when it is OK to shower.
 Do not apply lotion, powder, salves or ointments to incisions, unless instructed to do so
by your doctor.
 Do not soak or swim in any water.
 Remember to keep your hands away from your incisions.
 Your physician will give you specific orders regarding your dressing changes and wound
care.

Other Risks for Infection


It is important that you notify your healthcare providers about your surgery before undergoing
ANY procedure that might break the skin, even dental procedures! During the first two years
after back or neck surgery, you are more susceptible to infection because your immune system is
not as strong as normal. This is why it is vital that you notify your dentist or any other physician
about your surgery before making an appointment. They may wish to start you on antibiotics
prior to your procedure.
Preventing Blood Clots
Support Stockings
After spine surgery, you may be asked to wear compression stockings for 2-3 weeks. These
stockings, sometimes called T.E.D. hose, are used to compress veins in your legs and help
prevent blood clots from forming.
 Wear your support stockings continuously during the day. You may remove them twice
each day for one or two hours. Notify your surgeon immediately if you notice any pain
or swelling.

Blood Clots
A Pulmonary Embolus is a blood clot that has broken away and travels into the lungs. This
can occur after surgery. This is extremely dangerous and can be life-threatening. If you
have sudden chest pain, shortness of breath, sweating or confusion or difficulty breathing, call
911 IMMEDIATELY. DO NOT take the time to call your surgeon.

Staying active after surgery – walking and avoiding becoming sedentary – can help prevent
blood clots forming in the lower extremities. After spine surgery, you should not take
Coumadin, BC powders, Aleve, Ibuprofen or other anti-inflammatories. Ask your surgeon when
it is OK to resume any other-the-county medicines or any prescribed anticoagulant.

Home Care and Safety


Pain Management
At home, it is important that you stay comfortable and to keep your pain under control, just like
when you were in the hospital. Inactivity can prolong your recovery time, so it is important to
stay as active as possible. Change positions every 30-40 minutes so you do not stiffen. Ice can
help you control your stiffness and discomfort. An ice bag or even a bag of frozen peas wrapped
in a towel can be applied to the surgical site to help control discomfort. Remember to remove
the ice after 20 minutes to avoid causing any tissue damage to the site.
After leaving the hospital. Your need for narcotic pain medication should be steadily decreasing.
When you are able, substitute 1-2 Extra Strength Tylenol capsules for one dose of the narcotic
medication.

DO NOT take more than 8 Extra Strength Tylenol capsules per day, however. Discuss pain
medications with your doctor, especially if you are taking anti-coagulants or blood thinners.
Unfortunately, sometimes the lack of physical activity and use of narcotics for pain can cause
constipation. Eating lots of fiber-rich foods like fruit, grain, and vegetables will help. Drinking
plenty of water is also very important. You should avoid caffeine in coffee and soft drinks. You
may need stool softeners or laxatives if the problem persists.
Just as in the hospital, it is important that you take every precaution to prevent a fall. Some
things you should do to reduce the fall risk at home include:
 Rise slowly from a bed or chair to avoid any sudden drop in blood pressure.
 Know the side effect of any medications you are taking.
 Watch for slippery or uneven surfaces.
 Wear appropriate footwear such as non-skid rubber soled shoes with low heels.
 Reduce hazards in your home environment:
 Watch out for pets
 Remove rugs
 Watch for loose cords
 Have appropriate lighting
 Keep area clean and free of clutter

Durable Medical Equipment


You will likely need some special equipment to help you adjust to returning to activities at home.
Your surgeon may prescribe the following items which will help you better function around the
house:
 A cane or walker to help you get around.
 An elevated commode which may also function as a shower chair.
 A reacher which can help pick up things on the floor without bending and which can help
putting on shoes and socks.
 A back brace may be prescribed to help protect your back during recovery.

Bathing
When your doctor says it is OK to get your incision wet, you will be able to take a shower Walk-
in showers are recommended over baths because they are easier to get in and out of. It is a good
idea to place a shower chair in the shower for safety. If possible, have someone help you during
your first attempts in and out of the shower. Hand-held shower hoses and long-handles bath
sponges are helpful. Keep everything within easy reach in a shower caddy so you do not have to
bend or reach for things. Always have a rubber slip-free mat in the shower to reduce the risk of
slipping.

Toilet
In most homes, regular toilet seats are quite low. This could cause you to develop back pain and
may make it difficult for you to sit down and get back up without trouble. You could try facing
backwards so you will have support to help you stand.
Your doctor may prescribe a 3-in-1 commode. This portable, raised toilet seat functions as a
toilet, a shower seat and a chair. It provides a steady and safe way for you to st up and down
because it is raised and has sturdy arms.
Driving
You will not be allowed to drive a car until your surgeon gives you permission. You should be
very careful getting in and out of car seats because they tend to be very low. Add a firm pillow
or cushion to the seat and recline the seat to give you more room to get in and out. Just like at
home – sit down first and then swing your legs into the car.

Other Activities
With anything you do at home while recovering from neck or back surgery, TAKE YOUR
TIME. Carefully assess what you are doing and don’t hesitate to ask for help. Allow your
family and friends to help in your recovery process.
While standing, always maintain the three natural curves of your back. It helps to place one foot
on a stool or lower shelf when possible. Keep your head, shoulders and hips aligned as much as
possible. Do not work in a stooped position for long without standing upright.

Keep frequently-used items in the kitchen and bathroom on the counter so you don’t have to
bend or reach for them. If you have to stoop down, lower yourself on one knee. If you have to
reach high for something, it is best to use a low stool when possible. You should not carry or lift
anything heavy, but you may carry lightweight bags close to your body.

Do not lift awkward or heavy objects until your doctor says it is OK to do so. You should not lift
anything that weighs more than five pounds at first. A gallon of milk weighs about seven
pounds. If you must lift something, keep your back straight. Bend your knees and keep the
object close to your body.

Allow extra time for dressing. Loose fitting clothes work best. Sweatpants or shorts and slip-on
shoes work great. Ladies, avoid the high heels. It is best to start getting dressed while lying
down, flat on your back. Pull on your underwear, slacks and socks as much as possible, then
finish after you carefully stand up. A long-handled shoe horn and the Reacher are helpful.

At first, sitting is more stressful on your back than standing. Your surgeon will give you specific
instruction on how long you may sit in a chair at first. Always use a chair with a straight
backrest and with arms, if possible. Using a pillow or cushion as a backrest helps.

Sleep on a firm mattress or couch. Pillows can help provide support for your neck and under
your knees while lying on your back, but don’t use pillows that cause your neck to misalign with
your back. Always keep the neck and back straight and properly aligned. To get into bed,
always sit down first o the side of the bed. Use your arm closest to the pillow for support, lower
your upper body and gently swing your legs and feet onto the bed. You should now be lying on
your side. To get out of bed, reverse the procedure.
Water Therapy
Water therapy or other pool exercise may be helpful in your recovery after Lumbar Surgery. Be
sure to discuss this with your surgeon if you have access to a pool. Your surgeon will decide if
water therapy may be a good activity for you once your incision has completely healed.

Walking
We encourage you to stay active when you go home. If you are able to walk, we recommend
this form of activity because of the heart healthy benefits. I can help to reduce blood pressure and
resting heart rate, which decreases the workload on the heart. It also assists with weight loss,
helps alleviate stress and anxiety and can help reduce blood cholesterol and triglycerides. If you
are not able to walk de to other physical conditions, please discuss alternative forms of activity
with your healthcare provider before you leave the hospital. Here are a few reminders:
 Wear comfortable, loose-fitting clothing and supportive shoes.
 Walk at your own pace. Everyone progresses at their own pace, but generally a good
place to start is with a short, timed distance. We recommend five minutes 2-3 times a
day. When you are able to tolerate this without difficulty, gradually increase walk time
as tolerated. Again, increase the time only when you complete the previous activity
without difficulty or fatigue.
 Begin and end your walk more slowly. This allows your heart rate and blood pressure to
make gradual adjustments to your activity level.
 Walk in the cooler part of the day during the warm months and in the warmer part of the
day during cool months. The general rule of thumb is to avoid walking in temperatures
greater than 80 degrees and less than 40 degrees. Walk in the indoor mall or large stores
on hot/cold days. Avoid uneven terrain to prevent falls.
 Stop and rest if you get tired. DO NOT PUSH YOURSELF.
 Stair climbing is not discouraged, but avoid pulling yourself up with the handrail.
 Be safe when walking. Avoid walking areas where there are stray dogs, uneven
pavement and traffic. Have other people around you when you walk.

Do not begin your walk if you experience:


1. Chest discomfort
2. Unusual shortness of breath
3. Pounding of your heart or in your chest or an irregular heart beat
4. Dizziness or nausea
5. Weakness or fainting
6. Muscle or joint discomfort or leg pains or cramps

Reduce the time or speed next time if you experience:


1. Excessive fatigue that lasts longer than one hour after your walk
2. Sore muscles or joints
3. Walking that feels “hard”

Diet
Because you will be somewhat immobile after back surgery, it is not uncommon to gain weight.
However, this can be a problem, since weight gain can slower your recovery and lead to less
mobility, back pain and even depression. It is very important to watch what you eat during this
recovery period. Some suggestions to help you prevent unwanted weight gain:
 Drink lots of water each day – ate least two quarts. This will help you feel full and
prevent overeating.
 Fill your pantry with healthy foods. Stay away from junk food and snacks.
 Select foods that require lots of chewing. These foods help convince your brain that you
are full and will keep you satisfied with smaller portions. Examples:
 Popcorn
 Pretzels
 Apples
 Carrots and Celery
 Bagels
 Chewing gum
Stay busy with other activities to keep your mind off the refrigerator. Focusing on TV for long
periods of time is not good for your back and can also tempt you to eat. Try to enjoy crossword
puzzles, board games, a good book, card games or other activities that will keep you occupied
with family and friends.