There are many steps involved in recovering after your spinal surgery. We hope you find this information helpful. Your questions are important to us and we hope this packet will make you feel more comfortable with expectations, restrictions and ways you can help yourself have the most successful surgical outcome. Please read this before your pre-operative visit so we may address any questions. Please share this information with family or friends that will be helping to care for you.
We will see you back in our office in 2-3 weeks for a scheduled post-operative visit. This visit is very important to assess how you are healing. We will look at your incision and if healed, remove steri-strips and sutures. You will have x-rays taken of your surgery to assess initial progress. We will discuss and provide appropriate guidance for your mediation use. After this visit, we generally schedule a 3 month follow-up visit.
Anesthesia can cause you to not act like yourself. It is normal to feel discouraged, tired or ‘not yourself’ for several days after surgery. These feelings may be your body’s natural reaction to the circulation of extra hormones necessary to handle the surge of stress from surgery. Although emotional changes are not uncommon, try to stay positive for a healthy recovery.
It is normal to have pain after any operation? The incision area may be very tender. This is normal and expected and does not mean that your surgery was unsuccessful or that you will have a slow recovery. Pain in the spine or in the arms or legs is not unusual. This is often caused by an inflammatory response after surgery. For our patients we are using the ERAS protocol which is a revolutionary regimen to help improve patient’s recovery after surgery by limiting their time in the hospital and need for post-operative medications. Patients often receive short and possibly long acting medications which is monitored closely by our team. Muscle relaxers can also be helpful for pain associated with spasm. You will be sent home with a plan for post-operative medications.
At home, take all of your medications as prescribed. Do not exceed any maximum restrictions. Ice will help after surgery and we recommend using ice packs over the incision or around areas of pain. Make sure you have a barrier between your skin and the ice pack to avoid frost burn and do not leave ice in place for longer than 20 minutes.
You should gradually use less pain medications while recovering. To wean medications, you can extend the time between taking pills and/or reduce the number of pills taken each time. Log when you use your medications daily to help you understand how much you are taking and when you are taking them. Discomfort and pain are expected after surgery until inflammation and nerve sensitivities have subsided. Use ice/heat, light exercise, and short periods of rest to help relieve pain. Try not to sit or lie at home all day, this is not helpful for your recovery. If you need specific instructions on tapering your medications, please contact your provider.
DO NOT TAKE anti-inflammatory medications such as Advil, Ibuprofen, Motrin, Aleve, Naprosyn, Naproxen, Voltaren, Diclofenac, Aspirin, Celebrex, etc. for 3 months after a fusion surgery unless directed by your surgeon or cardiologist. These medications delay healing and can interfere with the fusion process.
DO NOT USE NICOTINE PRODUCTS. Nicotine interferes with the healing process, increasing the perception of pain, and threatens successful wound and fusion healing.
The onset of nerve recovery will start immediately after the nerve is decompressed. However, nerves heal at a slow rate, approximately 1 mm a day or an inch per month. Although many patients notice an immediate difference in symptoms after surgery, results can vary. This does not mean that surgery was unsuccessful. Immediately after surgery, pain may improve followed by improvements in numbness and tingling. This can take weeks or months to improve or resolve.
Daily walking is your physical therapy initially when you go home. We recommend ten small walks a day. This means whatever distance you can comfortably do ten times a day. Try to increase your distance a little each day, setting a pace that avoids fatigue or severe pain. You may climb stairs more frequently as your feel comfortable (holding the rail). If you have a living situation in which you have to go upstairs, you will only want to do this a little to start but then increase as tolerated. The need for physical therapy will be discussed at your post-operative visit.
Remember your BLT restrictions (bending, lifting, twisting) following surgery. We recommend lifting no more than 5 pounds for the 2 weeks after surgery, this is less than the weight of a gallon of milk and avoiding household chores. The total length of time with the “BLT” restrictions is dependent on the type of surgery. For instance, these BLT restrictions are in place for 3 months for all fusion patients as we need this time for the bone to properly heal. If you have been told to wear a brace, follow the instructions given to you by your surgery team.
Sexual relations may be resumed during the recovery periods. Avoid positions that cause pain. Your surgeon will clarify any concerns with you.
“Listen” to your body. It is normal to have discomfort as you gradually return to normal activity. You may have increased pain temporarily as you begin moving more and work with physical therapy. Pain is a signal to stop what you are doing and proceed more slowly.
Once home, we recommend you not drive until you are fully recovered. In general, you may resume driving only when you feel safe, your reaction times are fully recovered, and you are not taking narcotic medications when you need to drive. In some states, including Virginia, if you are pulled over and known to be on narcotics or muscle relaxers that impair your ability to drive you may be charged with a DUI.
You should not drive if you are wearing a neck collar. You need to be able to see other cars safely by rotating your neck or trunk or using mirrors, and be completely in control of the car. If you need to travel for over an hour, take frequent breaks to stand, walk and stretch to eliminate any pain from sitting for a prolonged period. Please contact your provider with any specific questions about driving.
Constipation: Constipation is a common side effect from narcotic pain medications and is often a challenge for patients after surgery. This can be more severe in large surgeries or in those with an abdominal approach. Once at home, we recommend using stool softeners or laxatives such as Colase, Dulcolax, Milk of Magnesia, Senokot, or Magnesium Citrate. If these are not successful, you may need to use a Dulcolax suppository or a Fleets enema to stimulate a bowel movement. It is important to have regular, soft bowel movements. These medications are all available over the counter at your local pharmacy – you do not need a prescription. It may be helpful to consult your pharmacist while you are shopping if you have any questions. A diet of whole grain cereal, fruits and fruit juices (especially prune juice) will also help. Call our office if you need guidance.
Nausea: It is common in the post-operative course to experience nausea. This is typically due to anesthesia or pain medications. Anesthesia will wear off with time, however this may take many days. If nausea is severe, medications may be prescribed for a limited period of time post-operatively.
Urinary Retention:Urinary retention is an inability to void completely. This can happen after surgery when a urinary catheter is used. You will feel as if you need to urinate but are unable to do so. Retention can be very painful and needs to be evaluated at an urgent care or ER location. If this should occur, please call our office to let us know. Often, this may happen during your hospitalization in which case we have you follow-up with urology outpatient.
After surgery use a clean, dry dressing on your incision daily. You may shower on the THIRD day after surgery. When you shower remove any dressings beforehand but remember you may have thin steri-strips on your incision – DO NOT take these off. We will do so at your post-operative appointment. Let warm, soapy water run over the incision. Do not scrub the area. Pat the incision dry and make sure the area is completely dry before placing another protective bandage if needed. Do not apply antibiotic gels, ointments (Neosporin or Bacitracin) lotions, peroxide, or iodine solutions on or around the incision. You are not allowed to soak your incision in a bath tub, hot tub, or swimming pool until the incision has completely healed. We evaluate your incision and take off any necessary sutures or steri-strips if they are ready to be removed at your post-operative visit. If you underwent an anterior cervical fusion (neck incision), you do not need to keep the incision covered once home unless clothes or a collar irritate the area.
If you notice increased redness, swelling or any drainage around the incision at home, please let us know immediately. If you notice fever, chills, sweats or temperatures greater than 100.4F, this could be a sign of infection and you should call the office to inform your doctor.
Immediately after surgery, you will likely not be hungry. Depending on your surgery, we may slowly advance your diet from water to food as your appetite and gastrointestinal functions return. A well balanced diet with high protein intake is necessary for proper healing. It is important to understand that your body needs roughly double the number of calories it did before surgery in order to heal. Be sure to eat more than usual, but only of good nutritious foods. We encourage eating small, balanced meals at least four times a day. Protein or nutritional shakes are a good way to get more calories with protein. For patients having larger surgeries, we recommend Ensure or Boost shakes 2-3 times a day during the first 4-6 weeks after surgery. We offer nutritional counseling at the Virginia Spine Institute, please contact us if you would like to set up a consultation before surgery.
Your doctor will help determine when you can return to work and with what limitations. If a work release is required, we will provide this at the appropriate time. In general, work release is dependent on what your position is and how well you are feeling. You may return to work part time or on light duty and increase your hours and lifting over time.
Healing is a natural process of restoring damaged tissues and does take time. It requires a gradual and persistent effort to increase your physical strengths; it is expected to still have good and bad days but over time the good days should become more and more present. Try to concentrate on what is improving over time rather than what symptoms remain. We see you at intervals after surgery to make sure that you are continuing to heal and progress, these visits are very important to make sure surgery is as successful as possible.
Enhanced Recovery After Surgery or ERAS is a multimodal set of protocols used by your surgical team to help ensure best possible outcomes from your surgery. Important components of ERAS occur before, during and after your surgery.