Most people who have spinal surgery experience good to excellent results. They find significant relief of pain and the return of functional movement and strength, enabling them to walk, sit, drive a car, and cope with the activities of daily life. Patients often report improvements in the way they feel immediately after they awake from the surgery. Although many patients see and feel immediate benefits, they maximize the benefits of surgery by taking part in a comprehensive rehabilitation program. Post-surgery rehabilitation involves the care and instructions you receive after spine surgery. Nursing staff will monitor your condition from the moment your surgery is completed. When the anesthesia begins to wear off, you may be taken to a hospital room until you are ready to go home. Depending on the surgical procedure, your stay in the hospital could be from one to five days. Minimally invasive surgical procedures, such as kyphoplasty and vertebroplasty, are usually performed on a outpatient basis, which means you can usually go home the same day.
Managing at the Hospital
The type of operation you have will determine how long you will need to stay in the hospital and how much assistance you will need shortly after surgery.
The day after surgery is considered “day one.” Some spine surgeries require the use of a brace for a period of time afterward. If so, keep your brace on until your doctor specifically instructs you to remove it. Patients are often encouraged to stand and sit (with assistance if needed) within 24 hours after surgery. Supervised by a physical therapist (PT), you’ll sit on the edge of the bed and stand with support. Walking, however, is approached gradually and in a guided manner to avoid injury and complications. Try not to overdo it the first few times you get up and walk.
A nurse will check the circulation and motion of your legs and feet. You may have an incentive spirometer (blue inhalation tube) to help expand your lungs and prevent pneumonia. Surgical tape, sutures, or adhesive tape will have been used to close your incision. This dressing may be removed and changed. An ice pack or cooling pad may be used to help decrease swelling and increase your comfort. It is common to continue intravenous fluids for the first day or two.
Antibiotics may be given intravenously for 24 hours to help prevent infection. Pain medication is available to ensure your comfort. During the first 24 hours after surgery, you will probably be given pain medications that are injected either through your intravenous (IV) line or into your arm or buttock. These medications are usually much stronger and faster acting than pills taken by mouth. Alert the nurse if you are uncomfortable due to pain. It is important to have a level of comfort so you can participate in your rehabilitation program.
Your doctor will order your diet. Recovery from anesthesia varies from person to person, so your diet will be adjusted as your intestinal function gets back to normal. Usually you will be allowed to have clear liquids as soon as you are able to eat. If you are able to tolerate these, you will be given food that is more solid. Special precautions are used for patients who have had surgery from the front of the neck.
Your PT will work with you to begin moving safely in bed and up to a sitting position. You will gradually progress to standing and walking. You may require the use of a walking aid (cane or walker) for a short time. Exercises may be suggested to ease soreness in your legs. You may begin static tightening of your thigh and buttock muscles. Pumping your ankles back and forth keeps fluid from pooling in your lower limbs and prevents the formation of blood clots in your legs.
You may need to have blood drawn daily if your doctor has placed you on blood thinning medications. These tests are needed to regulate anticoagulant (blood thinning) therapy. During the first few days, your doctor will monitor your blood thinning level and determine your need for additional blood transfusions.
Your IV line may be removed. If you have a urinary catheter, that is also often removed on day two. You will probably continue using the incentive spirometer. Your wound dressing may be changed or removed.
There is naturally some pain during the first few days after surgery. This should be expected. But pain can be adequately controlled with medication, so let your nurse know if you are uncomfortable. After the first day, you’ll begin switching from medications given through injection or IV to pills that can be taken by mouth. Taking medications by mouth will make things easier when you are ready to go home.
It is important to continue with your exercises to promote motion and prevent muscle soreness and tightness. Ice packs may be applied before and after therapy treatments to reduce swelling and relieve pain. With assistance from a therapist, you will gradually increase the distance you are walking in preparation for going home.
Day Three and Beyond
Your wound dressing will be changed or removed if needed.
Your physical activity will continue to focus on safety with mobility and moving toward independence. In spite of any mild discomfort, it is important that you do the deep breathing and physical therapy exercises as instructed. Patients who breathe and move well gain improved lung capacity and circulation. And they often heal faster.
Using Your Brace
You may require the use of a back or neck brace after surgery, and you may have been fitted for your brace before surgery. Follow the directions of your doctor or PT with regard to wearing your brace, including whether you should wear your brace when bathing or showering.
Care of Your Incision
As your incision heals it will be inspected for signs and symptoms of infection. After you are released from the hospital, you can have a family member or friend check your incision. Or you can use a hand-held mirror to inspect your incision yourself.
Do not use lotions, powders, or oils on your incision while it is in the healing process. If you are wearing a brace and skin irritation occurs, try wearing a silk scarf under your brace. This can be very soothing and help decrease irritation.
Your doctor or PT may issue self-care aids such as chair cushions, a raised toilet seat, or bathing aids to reduce strain while you heal.
You will be able to return home when your medical condition is stable. You may be instructed to limit your activities for a period of time to give your body a chance to heal. As you prepare to leave the hospital, be sure to follow the instructions given by your health care team.
Managing at Home
Before leaving the hospital, your PT may outline ways for you to help control symptoms once you get home. Here are some ideas that may help.
Ice and Heat
You may be instructed in “first aid” pain control measures using ice or heat. Cold treatments are usually chosen in the first few days after surgery. Ice makes blood vessels vasoconstrict (get smaller), decreasing the blood flow. This helps control inflammation, muscle spasm, and pain. Heat makes blood vessels vasodilate (get larger), increasing the blood flow. This action helps flush away chemicals that cause pain. It also helps bring in healing nutrients and oxygen.
RelaxingPain after surgery can be physically and emotionally draining. Relaxation exercises can help you control pain and its accompanying stress. You may be given a set of breathing exercises to help air reach even the lower lobes of your lungs. Combining deep breathing to a slow relaxing count can help muscles relax while bringing much needed oxygen to sore tissues.RestingGiving your body a chance to rest can help ease soreness after surgery, giving your spine time to heal. Follow your doctor’s instructions for using any prescribed supports or braces.PositioningYour PT may give you ideas of ways to position your spine for the greatest comfort. These positions help take pressure off the surgical area by supporting your spine and limbs with pillows or towels.Moving
Careful movements suggested by your PT can safely ease pain by providing nutrition and lubrication in the areas close to the surgical area. Movement of joints and muscles also signals your nervous system to block incoming pain.
Using safe body movements can help you avoid extra strain on your spine in the weeks after your spine surgery.
Lying In Bed
Avoid lying in positions that twist or angle your spine. Don’t curl up in the “fetal” position. Choose a firm mattress to lie down on rather that a soft bed or sofa. Keep enough pillows nearby to support your head, shoulders, trunk, and legs.
Moving in Bed
When getting in or out of bed, use the “log roll” technique. This is a way to roll to your side and sit up while keeping your spine steady and secure. Instead of twisting your upper body when you roll to one side, try to roll your whole body as a unit, like the rolling of a log. Then let your legs ease off the edge of the bed toward the floor as you push yourself up into a sitting position. This reduces strain from twisting your spine, giving the surgical area time to heal.
Keep your spine upright and supported when sitting. A safe, upright posture reduces strain on your spine. Choose a chair that supports your spine. Avoid soft couches or chairs. Place a cushion or pillow behind your back while driving or riding in a car. When standing up, keep your spine aligned by leaning forward at your hips.
You may be restricted from bending for a few weeks after spine surgery. Follow your doctor’s instructions. If you are given the okay to bend, do so safely. Try to keep your back straight and secure as you bend forward keeping your spine straight. Consider using a “grabber” to avoid bending over at the waist to put on socks, shoes, or pick up items from the floor.
Your doctor may restrict you from lifting or carrying for a period of time after surgery. Don’t test your back by trying to see if you can lift or carry. If you must pick up or carry lighter items, squat down by bending your knees. Do not lean forward by bending your spine forward. Hold the item close to your body even if it is light. Holding the weight out in front of you puts extra strain on your spine. Check with your doctor or PT if you have any questions about the safety of lifting or carrying.
Your doctor may prescribe a series of outpatient rehabilitation visits once your condition has begun to stabilize. Your recovery from spine surgery can be improved by learning new ways to strengthen your spine and prevent future problems. Your PT therapist can teach you ways to help reduce your pain now and form new habits to keep your spine healthy.