Patient Information: Post Operative Spinal Information
I give all my patients a leaflet following spinal surgery. It explains what they should expect during the initial post operative period and what they can and can’t do. The content of the leaflet is reproduced below.
You have just undergone the following spinal operation: [insert procedure].
It is important that you follow the post-operative instructions explained to you by the hospital staff. Here is some additional information.
Your Follow Up Appointment
A follow up appointment to see a member of the surgical team will be made for you on discharge. This should be in approximately [insert timeframe].
It is normal to experience some pain around your wound over the coming weeks. This should gradually settle and is different to any underlying back and neck pain. Your wound will be checked and redressed on the ward before you are discharged. Provided there are no problems, it should then be checked by a healthcare professional in [insert timeframe] and any clips or stitches should be removed.
Wounds usually take between 3 and 4 weeks to heal (but sometimes longer). The staff on the ward will give you instructions about washing. In short, after you are discharged, a brief shower with the wound covered by a waterproof dressing should be fine. You should avoid soaking in a bath.
Spinal wound infections can be serious and you should not start any antibiotics until your surgeon is made aware of the situation. If you experience any bleeding, oozing, discharge, worsening of wound pain, swelling, generally feeling unwell, sweating, fevers or headaches then please seek help from a healthcare professional or contact the ward or your surgeon's secretary.
Back and Neck Pain
When spinal surgery is performed for back and neck pain it can take several months before any benefit is noticed (if at all). Indeed, the pain can be worse in the initial post-operative period simply because you have had an invasive procedure on an already painful part of your body. If however you are experiencing worsening or new pain, or, worsening or new symptoms of numbness, weakness, balance, walking problems, bladder or bowel problems then please seek help from a healthcare professional or contact the ward or your surgeon's secretary.
Arm and Leg Pain
Spinal operations are frequently performed to improve pain in the arms or legs due to nerve compression. The time it takes for any benefits to be noticed can vary. Occasionally, due to your bodies normal healing process a flare of pain can occur in the post-operative period. If however you are experiencing worsening or new pain, or, worsening or new symptoms of numbness, weakness, balance, walking problems, bladder or bowel problems then please seek help from a healthcare professional or contact the ward or your surgeon's secretary.
Deep Venous Thrombosis
Clots in the legs (and rarely the arms) can occur in patients undergoing spinal surgery. Your surgeon will have assessed you as to your risk of clots and a preventative treatment plan initiated. For the majority of patients this consists of a period wearing TED stockings until you are back to your normal mobility. If you have any questions please discuss them with a member of the healthcare team prior to discharge.
Collars and Braces
Some patients require a neck collar or lumbar brace following surgery. The staff on the ward will show you how to fit it and give you instructions on how to go about changing it and washing yourself. You should not discard it until reviewed at your follow up appointment.
Physiotherapy Following Spinal Fusion Surgery
A fusion procedure is carried out to stiffen a segment of the spine and to stop it moving thereby helping the underling problem. Physiotherapy is used to keep stiff things moving (the opposite). The bones in your spine can take up to a year to fuse and sometimes longer. During the first 3 months following a fusion procedure you should take things easy and not excessively move the fused / operated part of your spine. This does not mean you should remain inactive but that you should avoid certain activities.
Smoking and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
These should be avoided following fusion surgery as they delay and prevent bony healing.
Activities / Employment / Driving / Sports / Things to Avoid
Following lumbar surgery (in particular a discectomy) it is important to avoid bending, lifting and twisting all at the same time especially in the initial post-operative period of six weeks. For example, turning to pick something up off the floor. Please remember to use your knees when bending. The following is a guide for the majority of cases but please note that it varies depending on the individual patient and the surgery that they have had.
Office / desk jobs - you should be able to return to work once the wound has healed and you feel comfortable. This can vary but is usually between 4 and 6 weeks but can be longer.
Manual labouring jobs - this can vary considerably and is usually discussed at your follow up appointment. You should be able to perform administrative tasks as above.
Return to driving - this is usually around the 6 week mark when your are comfortable getting into and out of a car, can turn your body to look out of the back window and can safely performed an emergency stop.
Walking - is an excellent form of gentle exercise to aid your recovery. It is important to slowly pace yourself and build up distances gradually.
Housework - once you are comfortable gentle housework should be fine. Remember to avoid bending at the back and use your knees. Avoid twisting when hoovering and when ironing make sure the board is set at an appropriate level or, you can sit down to iron. When shopping, avoid carrying heavy loads for long periods.
Babies and Children - when lifting babies and toddlers keep them close to your body keep your back straight and use your knees. When putting your child into a fixed car seat, put one foot into the foot well and slide the child on and off your thigh into the seat. Ask your partner for as much help as possible during the first 6 weeks after your operation.
Swimming - this can vary but will usually be after your follow up appointment. Your wound must have healed fully before you can swim. In line strokes are best following lumbar spine surgery (front crawl and back stoke).
Gardening, cycling, gentle aerobic activity in the gym, yoga, Pilates, tai chi etc. - this can vary and should be avoided until discussed at your follow up appointment.
Weightlifting and Contact sports – this is usually avoided for at least 3 months following simple procedures and 6 to 9 months following fusions (sometimes longer). Occasionally return to certain activities will not be advised.
The Vale Hospital Post Operative Information Leaflets
Gaynor Paull, Senior Staff Nurse at the Vale Hospital wrote the following discharge advice PDFs
- Cervical Discectomy Decompression Fusion Discharge Advice
- Lumbar Spine Discectomy Decompression Fusion Discharge Advice
- Spinal Injections Discharge Advice