Recovery from Lumbar Spinal Fusion Surgery

​Many of our patients come to us after trying many things for their lower back pain.  This usually includes physical therapy, chiropractic care, modification of physical activity, and various medications. If this is unsuccessful then spine surgery may be an option, but then what? In some cases a fusion is even needed, and this is the largest spine surgery one can have. Therefore there are often lots of questions surrounding this. In this blog we would like to address some of the most common but more obscure questions patients have after surgery.
 
The purpose of a fusion is to take an unstable joint and fuse two or more vertebrae together to increase stability and decrease degeneration.  This can include rods, screws, and a spacer to maintain vertebral height called an interbody cage that often takes the place of a damaged disc. .
 
Here are a few most common questions I receive from patients or their family members following spine surgery: These answers are most applicable to patients undergoing lower lumbar surgery with hardware being placed.  

How active can I be after surgery?
For the first week you should minimize activities which require you to bend at the waist, twist the torso, or lift anything heavier than a gallon of milk, which is about 8 pounds.  This means most household chores, such as laundry or loading a dishwasher will be off limits for the first week or two.  These activities are going to be best done by someone else during this important recovery period. 
 
This time period of reduced movement is to allow the muscles surrounding the spine to heal and avoid injury.  However, most importantly this time period of reduced movement at the location of your surgery will improve better bone formation and increase potential for faster and stronger fusion. 
 
After a week or two when the pain subsides you can increase your activity slowly. We recommend limiting your lifting to less than 30 pounds for the first 4-6 weeks to minimize the risk of pain or implant failure. You will have a brace which supports your back for this period also. If you experience pain with increased activity then slow down and return to your prior level of activity. Then try again in a day or two.
 
After the first month you will be slowly increasing your activity.  I often rely on the old saying ‘If it hurts don’t do it’. This means that it will often take more and more activity before the patient feels discomfort.  This will continue to improve over time but the patient needs to rest when that limit has been reached. 

How often should I be walking?  Each patient is different in the level of activity that they are able to perform prior to surgery so the same goes for after.  Studies have shown the best recovery in patients following spine surgery are those that take multiple walks throughout the day and continue to increase this amount each day throughout their recovery.   Walking is key for recovery from any surgery!
 
It is best to walk at least every 2 hours, during waking hours, even if it is just to take a bathroom break.  This helps to increase blood flow, drain inflammation, prevent pneumonia, and prevent blood clots.  

I don’t want to take narcotics for pain, are there alternatives? Narcotic pain medication was developed for post-operative pain.  The best way to take this medication is as prescribed by your provider.  Once you begin to have decreased pain then you can slowly decrease the amount of pain medication.  Stopping this medication at one time can cause increased side effects.  Any NSAIDs or non-steroidal anti-inflammatories such as Ibuprofen, Naproxyn, Celebrex, Advil or Aleve should be avoided for at least 4 to 6 months ideally after surgery due to the negative effect these medications have on bone growth and your fusion.
 
Narcotic pain medication was developed for post-surgical pain. There has been a great deal of concern of this in the news lately.  The words addicted or dependent are often used.  These medications will be utilized after surgery to help decrease pain.  The best plan is to take the medication as prescribed by your healthcare provider and if there are any questions to call your provider. 
 
I am often told by the patients that their pain improved so they stopped taking the medication “cold turkey”.  Unfortunately, this behavior can increase the side effects if the medication was taken for more than 2 weeks.   I often suggest to slowly decrease the amount of medication as dictated by your pain.  This will minimize both the side effects of the medication and decrease the side effects of stopping the medication.  

Will I set off airport detectors?  This is often a question if there is hardware placed in the neck or lower back: The new airport screening method uses millimeter wave technology, which does not penetrate the skin.  So no you will not set off any alarms if you have hardware placed during your spine surgery.  In the past you received a card showing that hardware had been placed, however these are no longer accepted by security and therefore are no longer needed.
 
What is the best diet to improve healing? I am often asked if there is a supplement or vitamin that will speed healing.  Unfortunately there is not, it is important that you eat healthy to provide the body with proper nutrients to heal. 
 
When will I be able to drive myself? No driving for two weeks after a lumbar fusion. No driving while taking narcotic pain medication. You must be able to act fast for your safety and for the safety of others.

When will I be fully healed?  It takes 12-18 months for bone to grow and form a solid fusion following surgery. If you are not undergoing a fusion, it can still take about 12 months for the nerves that were compressed or irritated to heal.  During this time period the nerves are hyper-excitable or easily irritated. Often the pain following surgery is improved but not completely gone.  We will often refer to the pain following surgery as different and continuing to change.  It is possible for some leg pain to remain due to permanent nerve damage, however this is less common. 
 
In addition, there may be lower back pain present intermittently. This pain is often due to arthritis throughout the lumbar spine at locations other than your fusion.  This is due to age and wear and tear over time. 

How do I know if I am “fused”?  A “fusion” is designed to take a joint that causes pain and reduce its movement.  This is done by placing hardware and overtime bone growth solidifies this.  How do we know when this has occurred? It takes 12-18 months for bone to grow to form a solid fusion following surgery. If your pain remains improved then no further imaging is needed to visualize that the fusion has completed. If the pain was better and then worsens around 12-18 months, then new imaging /CT scan may be needed to determine if there is full bone growth.
 
When can I travel?  Now that travel season and summer is upon us I get asked this a lot.  Anywhere from international travel, family camping trips, to weekend trips to the coast.  This question goes along with with physical activity question, recovery will vary with each patient and depend on the specific surgery.  However, I would recommend not traveling for a minimum of 2 weeks and ideally 4 weeks following major spine surgery. 


Hope you found this month's blog helpful.  Have a great summer!

Shaylan Zanecki PA-C
Director of Patient Safety & Clinical Research  

References:
http://www.pnl.gov/nationalsecurity/millimeterwave/learn_more.stm
http://www.spine-health.com/