Postoperative Instructions After Spine Fusion Prior to spinal fusion, you have likely been treated with physical therapy, medications, braces, and/or cortisone injections or nerve blocks. These have not been successful and now it is time to consider fusion surgery. Spine fusion is the process of eliminating motion between two vertebrae. This is done in a similar fashion to building a brick wall. Think of your vertebral (spine) bones as the bricks, and bone taken from your pelvis (bone graft) as the mortar. Without the mortar, the brick wall falls down without much effort. The same is true if your spine is not fused, despite using strong metal rods, screws, and cages (spinal implants). If your spine does not heal properly and fuse, the spinal implants will eventually break. It is important that you make every effort to help this process be successful. 1) Stop smoking. Your chance for a poor result increases significantly if you continue to smoke or use tobacco products after surgery. Tobacco impairs the body s ability to heal bones together after surgery. Please do anything you can to stop smoking completely for surgery and the first 3 months after. This includes anyone living with you in your home. Second hand smoke is every bit as bad as smoking yourself. 2) Don t take anti-inflammatory medications. These medications must be stopped at least a week before surgery and should not be restarted until instructed to do so after surgery. These medications include: naprosyn, ibuprofen, aspirin, Aleve, Motrin, Celebrex, Vioxx, among others. If you are on a medication you are not sure about, please let me know so that I can advise you properly. These medications prevent bone from healing properly after surgery as well as prevent normal blood clotting, and should only be started after your fusion has a chance to begin healing. 3) Make sure all blood-thinners have been stopped. This includes baby aspirin, warfarin (Coumadin), Plavix, heparin, or any other medicine that thins the blood. Even pain or anti-anxiety medications like Paxil can create significant problems with bleeding after surgery, so it is of utmost importance that I know all of your medications prior to surgery with the dosages. Autologous Blood Donation You have the option of giving your own blood (autologous means YOUR own blood) at the blood bank for your own personal use after your surgery. I expect to need a minimum of 2 units of blood for transfusion after your surgery. The blood bank is usually safe, however, is there any blood safer than your own? It takes very little effort to give 2 units of your blood. This can be arranged by Adrienne with the blood bank prior to your surgery. It usually will require about 3-4 weeks to donate the required amount of blood prior to your surgery. During that time, you may become a bit anemic. Please take these
over-the-counter medications until your surgery to prevent your blood count from dropping too much: Iron sulfate (FeSO4) 325 mg 3 times a day with food. Iron can sometimes upset your stomach. If this happens, try Iron gluconate 300 mg 3 times a day instead. Vitamin C (ascorbic acid) 500 mg 3 times a day. Folic acid 1 mg daily. Colace 100 mg 2 times daily (prevents constipation). For those of you who don t want to give your own blood or are too anemic to start with, your family members or friends may direct their blood donations to you for use (directed donor blood). This is only useful if they share your blood type. History and Physical Exam Once your surgery has been scheduled, you will return to my office within a week of your surgery date for an examination. This is done to ensure that all your questions have been answered, and that all necessary studies have been completed (X-Rays, MRI scans, CT scans, myelograms, etc.). Also, if you have any medical conditions that require regular medications or doctor visits, you will also need a letter from your doctor for your chart saying that it is medically safe to proceed with your surgery. Do not hesitate to bring a close family member or friend with you so that they can hear the discussion of your surgery as well as ask questions. An extra set of ears often helps avoid confusion. Once this exam is completed, I will see you next the day of surgery. You will have preadmission testing (blood tests, and possibly a chest X-Ray or EKG) done at the hospital. The preadmission testing people will tell you what time to arrive at the hospital and where to go for your surgery generally, you should be at the hospital at least 2 hours prior to surgery time. Hospital Stay The anesthesiologist and nurse anesthetist will speak with you prior to entering the operating room. A spinal cord monitoring tech will place wires on your body so that I can make sure that your spinal cord and nerves function normally during your surgery. This is done to protect your nerves during surgery. Once you are in the OR, your family will remain in contact with the OR nurses if they desire. Otherwise, I will speak with your friends/family after the surgery about the procedure unless you request specifically that I not discuss your surgery with family. After surgery, you will awaken in the recovery room. From there, you will either be taken to the intensive care unit (ICU) or the nursing floor. I occasionally use the ICU for recovery after long surgeries just as a precaution. Usually, only 1-2 days are spent there depending upon how you are doing. The first day after surgery, you will use a patient controlled analgesia (PCA) device. This is a button for you to control your own IV pain medications. You may also use pain pills in addition to the PCA if you need them. You must ask the nurse for these. You will have a catheter in your bladder. Some swelling in the face is normal after long surgeries, but it will disappear in a day or two by keeping the head of your bed up. On your feet will be
little pumping devices which help to prevent blood clots from forming in your leg veins. Please keep these on as much as possible until you are able to walk normally after surgery. Aches, pains, tingles or numbness, blisters on the skin or bruises are normal after long surgeries. Let me know if something bothers you and I will reassure you if I feel it is not serious. Day 1 Your physical therapist will be in the first day after surgery. You will sit at the side of the bed and, if you feel up to it, you will take a few steps in the room with assistance. Everyday, you will improve with your efforts. Use your PCA for pain and take it easy. You will not have much of an appetite for several days. Position yourself in bed so that you are most comfortable. Rules: 1) do not raise the head of your bed unless your head is at the top of the bed and your back is completely flat in the bed; 2) if you want to lie on your side, you may do so only if the bed is flat. These instructions keep you from bending your back right where I just did your surgery. Help the nurses keep your back straight and from bending abnormally by using the hospital bed correctly. Day 2 Sit up in a chair at least 2 times. More physical therapy. You will continue with the PCA, and the bladder catheter may be removed. Day 3 Up in the chair at least 3 times daily. Progressive physical therapy. The PCA is stopped and you will take only pills. The bladder catheter will be removed if it has not been already. Any drainage tubes left in your back will also be removed by this time. You may or may not need a transfusion during the first several days after your surgery and blood has been drawn until your blood count is no longer dropping. Expect to be ready to leave the hospital when these goals are met: you are able to get up and move about by yourself including steps; you are eating and keeping down fluids; you are able to take pain pills to control your pain; you have no signs of infection or fevers or other complications after surgery. After Discharge When you return home, take it easy. I encourage you to walk as much as you can, but avoid any bending, lifting, or twisting until I see you in the office in 6 weeks. Your stitches do not need to be removed since they are the absorbable kind. If you feel you need or want to see me sooner than 6 weeks after surgery, please call Adrienne (901) 767-9500 and set up an earlier appointment. If you find that you are having drainage from your incision, fevers, sweats, chills, or increased pain after you get home, let me know this ASAP. Infections, when present, need to be treated early in order to avoid a big problem later. You may begin to shower once you get home. I request that you do not take a bath for at least 2 weeks. First, you will have difficulty getting into and out of the bathtub. Second, the incision has not healed well enough to be completely watertight this
early and could cause an infection. My rule of thumb: if there is bleeding from your incision, you should not shower until this stops. Don t forget to take your usual prescription medications prescribed by your family physician or internist. The only exception is to avoid the anti-inflammatory medications as I mentioned before. I will tell you when you can safely restart these medications. I will send you home with several narcotic prescriptions. Percocet (acetaminophen and oxycodone) is used for your most severe pain. This medicine is useful the first several days or week after you get home. After that medication is gone, or if you feel you need something less strong, Lortab or Vicodin (acetaminophen and hydrocodone) is used. Again, about 1 week s supply of this will be prescribed for your use for moderate pain. Finally, Darvocet N100 (acetaminophen and propoxyphene) is used once these medications are gone or for mild to moderate pain that Tylenol (acetaminophen) alone won t control. Please use no more than 8 pain pills per day. I don t mind if you combine these medications, but if you take more than 8 per day the Tylenol content could cause serious liver problems. If your pain medications are not working, please call and I will try to help you with this. Pain medications cause nausea and constipation in most people. Use a stool softener like Colace 100 mg 2 times daily until you are no longer taking these medications. Once you are no longer constipated, you should begin some medications to help restore your blood count after surgery. About 2 weeks after you are home, please start these over the counter medications until I see you in the office: Iron sulfate (FeSO4) 325 mg 3 times a day with food. Iron can sometimes upset your stomach. If this happens, try Iron gluconate 300 mg 3 times a day instead. Vitamin C (ascorbic acid) 500 mg 3 times a day. Folic acid 1 mg daily. You should not drive until you are no longer taking narcotic medications. If you use these medications only at night, then I feel you will be safe to drive during the day as soon as you feel able. If you are concerned, have a friend or family member ride with you the first time or two to make sure that they agree you are safe. Aches and pains are the norm. As you get more active, you will strain the sore and painful muscles where the surgery was done. Use your pain medications as you must to stay active, but don t overdo it. Some common sense here goes a long way. Remember, also, that an ice pack will help better and more quickly for muscle spasms than most medications. Expect to return to light activities and work between 6 weeks and 3 months after surgery. Some people who do minimal lifting will go back sooner, but give yourself the benefit of the doubt and don t get in trouble by trying to get back before you are ready. If you are no longer taking pain medications,that is a good indicator that light activities are allowed.
Sexual activities should be sidelying the first 3 months after surgery to avoid stress on your lower back. After 3 months, light impact aerobic activities can be restarted: biking, swimming, walking, etc. Lifting should be kept below about 20 pounds and then only if there is no strain felt in your lower back. Between 6 months and 1 year after surgery, there are usually very few limitations regarding your activity. Each person is different and the final decision depends on your pain level and how the healing is progressing on your X-Rays. Summary I hope this has been informative and answered your questions. Please, if you have any questions before or after your surgery, please contact my office. I will make sure your questions are answered to your satisfaction. We are available Monday through Friday 8:00 AM to 4:00 PM. Call (901) 767-9500 to speak with Adrienne. If she is on the telephone, please be patient and leave a voice mail. Your call will be returned ASAP.