OrthoNeuroSpine & Pain Institute
Not surprisingly, different patients heal at different rates. Younger, healthier people might heal more quickly than older individuals with medical problems.
Activity, especially walking, seems to help the healing process more rapidly and with better strength. Unless specifically directed by your surgeon, bed rest after surgery is not recommended. Get up and around, using pain as your guide.
How much pain should you expect?
You will most certainly have some pain after surgery, but you should be reasonably comfortable by using your pain medications and good body mechanics. Pain medications will not eliminate your pain. Occasionally, pain can be very upsetting but does not mean there is a problem with the surgery. In general, as you heal the pain will improve. As you become more physically active, however, your pain may increase. Increase your activities in small increments, and the increased pain should subside with rest and recovery.
Talk with your physician about what to expect in your specific case.
Limitations and Restrictions
Sit in a straight chair 4-6 times per day for short periods of time – 5-15 minutes. Always maintaining a neutral spine, increase your tolerance gradually.
Once home, short walks for ten minutes in your house every few hours is advised. As you tolerate these short walks, take longer walks outside. You should recover from any increased pain overnight.
Continue the process in small increasing increments.
Do not resume your exercise regimen (other than walking) until you have had your follow-up visit with your surgeon for further instruction.
Pain medications are the leading cause of constipation after surgery, so treat constipation aggressively, and reduce your pain medications as quickly as possible.
Avoid car travel for 2-4 weeks after surgery unless it is essential (travel from the hospital or to a doctor’s appointment).
What about sleeping?
Use the log-rolling technique to turn in and get out of bed. This technique will be taught preoperatively. The goal is to avoid twisting the spine – move your body as one unit.
Most people have a preferred position in which they spend most of the night. Set up your bed to provide maximum support for this position.
If you sleep primarily on your back, place a cylinder roll or pillow under your neck and a flat pillow under your head so the overall alignment of the neck and spine is neutral.
If you sleep on your side, place a larger pillow under your neck and a smaller pillow under your head so the overall neck alignment is straight rather than curved.
A water pillow usually provides the best spine alignment.
When is it time to call your physician?
If you have marked increase in your pain for more than two days
If you are experiencing a new pain or new weakness
If you have a fever
If you experience severe headache
If you lose control of your bowel or bladder function
If you experience new or increase redness, swelling, or draining from your incision.
When can you return to work?
Depending on the individual, some patients return to light work in about two weeks with a gradual increase as tolerated. Those with more strenuous jobs (including prolonged sitting) may require more time.
How long will it take to heal from surgery involving removal of a herniated disc?
The incision and muscles heal quickly, with the incision usually closed by 2 weeks and healed by 4 weeks. The muscles may be swollen, stiff and painful for 6-8 weeks. The disc will be gradually strengthened over 2-6 months.
How long will it take for a fusion to heal?
Lumbar (low back) fusions take an average of 6-12 months to become solid. Cervical (neck) fusions are usually healed by 3-6 months.
After the operation, you will be brought to the recovery room or intensive care unit (ICU) for observation. When you wake up from the anesthesia, you may be slightly disoriented, and not know where you are. The nurses and doctors around you will tell you where you are, and remind you that you have undergone surgery. As the effects of the anesthesia wear off, you will feel very tired, and, at this point, will be encouraged to rest.
Members of your surgical team may ask you to respond to some simple commands, such as “Wiggle your fingers and toes” and “Take deep breaths.” When you awaken, you will be lying on your back, which may seem surprising, if you have had surgery through an incision in the back; however, lying on your back is not harmful to the surgical area.
Prior to the surgery, an intravenous (IV) tube will be inserted into your arm to provide your body with fluids during your hospital stay. The administration of these fluids will make you feel swollen for the first few days after the operation.
When you awake from the anesthesia, you may feel the urge to urinate. So, in addition to the IV, a catheter tube (also commonly called a Foley Catheter) may be placed into your bladder to drain urine from your system. The catheter serves two purposes: (1) it permits the doctors and nurses to monitor how much urine your body is producing, and (2) it eliminates the need for you to get up and go to the bathroom. Once you are able to get up and move around, the catheter will be removed, and you can then use the bathroom normally.
During your hospital stay, you will get additional instructions from your nurses and other members of your surgical teams regarding your diet and activity.
Proper nutrition is an important factor in your recovery. Your surgeon may restrict what you drink and eat, or place you on a special diet, depending on the surgical approach that was used during the operation. Calories and food intake are an important part of recovery. Some patients find that their physician orders are less restrictive than the diet they follow at home. After the surgery, you will continue to receive intravenous fluids until you are able to tolerate regular liquids, which typically involves gradually transitioning you from sips of clear fluids to full liquids (including JELL-O® gelatin). From there, you will be given small amounts of solid food until you are ready to return to a regular diet.
With respect to physical activity, in most cases, your surgeon will want for you to get out of bed on the first or second day after your surgery. Nurses and physical therapists will assist you with this activity until you feel comfortable enough to get up and move around on your own.
Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home – a list of “dos and don’ts,” which you will be asked to follow for the first 6 to 8 weeks of your home recovery. So, if you are unsure of any of these instructions, ask for clarification. Following these instructions is crucial to your recovery.
Nowadays, surgery involves one or more incisions depending on the surgical approach used to perform the operation. Therefore, when you are discharged home you may still have a surgical dressing on your incision(s). Either a nurse will visit your home to change the dressing or a caregiver, such as one of your family members, will be taught to do it for you. It is important that the dressing be changed daily and kept dry.
If any signs of infection are observed while changing the dressing, call your doctor. These signs include:
- Fever – a body temperature greater than 101°F (38°C)
- Drainage from the incision(s)
- Opening of the incision(s), and
- Redness or warmth around the incision(s).
- In addition, call your doctor if you experience chills, nausea/vomiting, or suffer any type of trauma (e.g., a fall, automobile accident).
- During this recovery period, you will also be instructed to keep your incision(s) clean, making sure only to use soap and water to cleanse the area. In general, you should not shower until your doctor has permitted you to do so.
- In addition to caring for your incision(s), you will also be encouraged to:
- Drink plenty of fluids
- Maintain a healthy diet (high in protein)
- Walk or do deep-breathing exercises, and
- Gradually increase your physical activity.
- Activities to avoid include any heavy lifting, climbing (including stairs), bending, or twisting. You should also avoid the use of skin lotion in the area of the incision(s); you need to keep this area dry until it has had the opportunity to heal well.
Follow up with your doctor on a regular basis during this post-operative period, and make sure to call your doctor if you have any concerns or questions.