Post Op Instructions for Lumbar Fusion Surgery
Lumbar Fusion Including Anterior and Posterior Instrumented Fusion
The average hospital stay for lumbar fusion is usually 1-2 days depending on the type of surgery. Someone from my office, or occasionally a doctor covering for me, will see you each day you are in the hospital.
The brace should be worn snugly. The brace is to be worn at all times, until the surgeon tells you it is ok to discontinue its use. It is OK to sleep without the brace.
SITTING AND LYING
The hospital therapist will teach you how to get in and out of lying and sitting positions. Any lying down position is okay, if it is comfortable for you. When going from lying to sitting or standing, roll to your side and bend your hips and knees. Have your feet just dangling barely over the side of the bed. Then use your arms to push yourself upright from this side lying position. Try to use minimal twisting force. Now you are in a sitting position. To get into a standing position, scoot or slide yourself to the edge of the bed, and push yourself up using your arms and legs trying to lean forward and trying not to use your stomach or back muscles. Again, minimize your bending or twisting.
Reverse the above steps when changing from a standing position to a sitting position and for getting from a sitting position to a lying position.
Whenever you do sit in a chair, you are best off getting into a sitting position by lowering yourself with the assistance of another person and by using your leg muscles more than your stomach and back muscles. If the chair has arm rests, use your arms and hands to support the weight of your upper trunk as you lower yourself into the seat. If possible, sit on the edge of the seat first and then slide backward into the full sitting position. Your back should always be supported when sitting and the best support includes a brace, a small pillow, a rolled up towel, placed into the small of your back to maintain a normal arch.
Make sure to get a recliner out of its reclined position prior to getting out of it. If you plan to use a recliner, please have someone nearby to help push the recliner into an upright position
THINGS TO AVOID AFTER SURGERY
In the postoperative period of the first 6 weeks, you will want to avoid the following:
- Removing the brace for any reason, except as outlined above.
- Lifting or carrying anything more than five pounds.
- Any activities that put undue stress on the low back.
- Twisting or bending at the waist.
- Sitting for more than 30 minutes at a time, as this may make you stiff.
- Smoking or any other tobacco use.
***Tobacco use will delay and even prevent the fusion from healing, and in addition has been shown to cause degenerative changes in the discs, and therefore is prohibited.***
For the first three weeks after surgery, you are not to drive. This is because you will have decreased driving reflexes (such as in accident type situations) secondary to pain that you may incur with sudden movements of your legs or back. In addition, many of you will be on narcotic medications and these can also significantly dull your driving reflexes. For this same initial three weeks after surgery, you should minimize your time in a car as a passenger.
After your initial post-operative visit, you may be released to drive by your physician. After this visit, you may ride in a car as long as you are in your collar, comfortable, and in the car for only short periods of time. If the car ride lasts greater than one hour, you should pull over periodically so you can get out of the car and stretch.
Showering is acceptable starting four days after surgery. Prior to that time we suggest “sponge baths” or washcloth- type baths, taking care not to get the brace, dressing, or wound wet. When you begin showering, the brace may be taken off after you are in the shower. When you do take a shower, please have somebody around to assist you. Hair washing is permissible while in the shower. Do not scrub the incisions. If the dressing gets wet, place a dry, sterile dressing after the shower. NO bubble baths, tub baths, hot tubs, swimming pool or whirlpools for 6 weeks. NO ointments, hydrogen peroxide or Neosporin on the wound.
DRESSING AND WOUND CARE:
It is important to keep the wound and dressing dry underneath the brace. Most of the time dissolvable sutures are used so there are no stitches to be removed. Occasionally the ends or “tails” of the stitches are outside of the skin. At your follow up visit, we will check your wound and change or remove the steri-strips and dressing if necessary. If your dressing does get wet for some reason, please replace the dressing with a sterile piece of dressing gauze and medical tape as soon as possible. Please have supplies available so that someone can be prepared to change your dressing. When changing the dressing, replace the existing dressing with a sterile piece of dressing gauze, usually 2×2 inch or 4×4 inch type size, using medical tape to hold it in place: these supplies can be obtained at most drug stores. Typically, you need enough supplies to change you dressing about ten times after surgery, usually after showers.
If any of the below should occur, please call the office.
- Drainage (continued or increased) from incision Opening up of the incision
- Fevers greater than 101 degrees Flu-like symptoms
- Increased redness and/or tenderness around your incision
You may sleep in any position that makes you comfortable. Many patients find comfort sleeping in a recliner chair. It is normal to have difficulty sleeping for the first several weeks following your surgery. We recommended trying Benadryl (over the counter drugs at Walgreen’s or CVS).
Although it is important to minimize your lifting, carrying, and overhead activity, it is important to try to walk in increasing amounts every day. Please make a determined effort to walk at least three times per day. Your initial walking time may only be five to ten minutes at a time, but this should increase so that by three weeks after surgery, you are walking up to one mile per day.
You will be provided medications prior to your discharge from the hospital. This will include pain medications (usually Percocet or Lortab), muscle relaxants (usually Soma or Valium), and some general medications to help with recovery from surgery (Dulcolax, aspirin, and Colace).
DO NOT take any anti-inflammatory type medications such as ibuprofen, Motrin, or naproxen, as their use may inhibit fusion progress and/or healing. Only take Aspirin and Tylenol if instructed by physician. If you were taking any other medications prior to surgery, you will be informed which ones you can resume when you are discharged from the hospital.
STOCKINGS AND BLOOD CLOTS
You will have TED hose stockings when you leave the hospital. These help prevent blood clots in your legs. Please wear them 23 hours a day for one week after surgery. They may be removed for brief periods of time for personal hygiene purposes or to wash and dry them. If you get significant swelling of either leg, especially if accompanied by pain in the calf, it is important to call our office.
Be sure to take your incentive spirometer home. This is the “breathing” machine that you used at your bedside. Use this at home on a regular basis for your first three weeks after surgery. This helps oxygen get to your lungs, and thus to your surgery site, and also helps to prevent pneumonia.
FOLLOW UP APPOINTMENT, POST OPERATIVE PHYSICAL THERAPY, RETURN TO WORK
Please arrange a post-operative appointment approximately 2-3 weeks after discharge from the hospital. The first visit will include a postoperative wound check, dressing changes, physical exam.
The next follow-up appointment will usually be 6-8 weeks after surgery. On the second office visit, you will have x-rays taken and will start physical therapy. The physical therapist will teach you exercises you can do at home. Please perform these exercises on at least an every other day basis.
• If you have chest pain, trouble breathing, car accident, or prolonged nausea/vomiting, then go to the Emergency Room.