Post-surgery Care and Rehabilitation
The type of spine surgery you have will determine how long you will need to stay in the hospital and how much help you will need in and out of the hospital after surgery. Many procedures for the spine only require one to three nights in the hospital.
What Can I Expect While in the Hospital?
From the moment your spine surgery is completed, the nursing staff will begin monitoring your condition. When the anesthesia begins to wear off, you will be taken to a hospital room until you are ready to go home.
The day after surgery is considered "Day 1." Some spine surgeries require that you wear a brace for a period of time afterward. If so, keep your brace on until your surgeon specifically instructs you to remove it. You may be encouraged to stand and sit (with assistance if needed) within the first 24 hours after surgery. If so, with the supervision of a physical therapist (PT), you will sit on the edge of the bed and stand with support. Walking, however, will be approached gradually and carefully to avoid injury and complications. Try not to over do it the first few times you get up and walk.
- Treatments — a nurse will check the circulation and motion of your legs and feet. You may be given a spirometer (sper-ah-ma-ter) (a tube you breathe into) to help expand your lungs and prevent pneumonia. Surgical tape, sutures, or adhesive tape will have been used to close your incision. This dressing may be removed and changed. An ice pack or cooling pad may be used to help decrease swelling and increase your comfort. It is common to continue intravenous (IV) fluids for the first day or two.
- Medications — you may be given antibiotics through your IV for the first 24 hours to help prevent infection. Pain medication will be made available to help relieve any pain or discomfort you may be having. During the first 24 hours after surgery, you will probably be given pain medications that are injected into your IV line or directly into your arm or buttock. These medications are usually much stronger and faster acting than pills taken by mouth. Tell your nurse if you are uncomfortable due to pain. It is important to keep your pain in check so you can participate in your rehabilitation program.
- Diet — how quickly you recover from anesthesia varies from person to person. Your diet will be ordered by your doctor at first, and it will be adjusted as your intestinal function gets back to normal. Usually you will be allowed to have clear liquids as soon as you are able to eat. If you feel okay after drinking clear liquids, you will be given food that is more solid. Special precautions will be taken if you had surgery from the front of your neck.
- Activities — your PT will work with you to begin moving safely in bed and up to a sitting position. You will gradually progress to standing and walking. You may require the use of a walking aid (cane or walker) for a short time. He or she may suggest exercises to relieve soreness in your legs, such as tightening and releasing your thigh and buttock muscles and pumping your ankles back and forth to keep fluid from pooling in the lower limbs and help prevent blood clots.
- Tests — you may need to have blood checked every day if your doctor has placed you on blood thinning medications. These tests are needed to regulate anti-coagulant (blood thinning) therapy. During the first few days, your doctor will monitor your blood thinning level.
By your second day in the hospital after spine surgery, you may expect the following:
- Treatments — your IV line may be removed. If you have a urinary catheter, that may also be removed. You will probably continue to use the spirometer to help prevent pneumonia, and your wound dressing may be changed or removed.
- Medications — it is natural to feel some pain during the first few days after spine surgery. The pain can usually be controlled with medication, so let your nurse know if you are in pain. By Day 2, you will begin switching from medications given through injection or your IV to pills that can be taken by mouth. Taking medications by mouth will make things easier when you are ready to go home.
- Activities — it is important to continue doing the exercises that have been prescribed by your doctor or PT to help improve motion and keep your muscles from getting sore and tight. Ice packs may be applied before and after therapy treatments to reduce swelling and relieve pain. With assistance from your PT, you will gradually increase the distance you are walking in preparation for going home.
Day 3 and Beyond
- Treatments — your wound dressing will be changed if needed or removed.
- Activities — your physical therapy will continue to focus on safety with mobility, with the goal of enabling you to be independent. In spite of any mild discomfort, it is important that you do your deep breathing and exercises as instructed. Breathing and moving well will help improve your lung capacity and circulation, and may help you heal faster. You will be able to return home when your doctor feels that your medical condition is stable. You may be instructed to limit your activities for a period of time to give your body a chance to heal. As you prepare to leave the hospital, be sure to follow the instructions given by your health care team.
What Can I Expect When I Get Home?
After spine surgery, people often report feeling better soon after they awake from the surgery. Although you may see and feel immediate benefits, you will get the maximum benefits of surgery by participating in a comprehensive rehabilitation program. When you are leaving the hospital, your doctor or PT may recommend some or all of the following to help you get better at home:
- Ice and Heat — cold treatments are usually recommended in the first few days after surgery. Ice makes blood vessels vasoconstrict (vase-oh-con-strict) (get smaller), decreasing the blood flow. This helps control inflammation, muscle spasm, and pain. Heat may also be recommended. Heat makes blood vessels vasodilate (vase-oh-dye-late) (get larger), increasing the blood flow. This helps flush away chemicals that cause pain. It also helps bring in healing nutrients and oxygen.
- Relaxation — pain after spine surgery can be physically and emotionally draining. Relaxation exercises can help you control pain and the stress that comes with it. You may be given instructions for breathing exercises to help air reach even deep into your lungs. You may also be instructed to slow your breathing to a more relaxed pace. Slower breathing can help muscles relax, while bringing much needed oxygen to sore tissues.
- Rest — giving your body a chance to rest can help ease soreness after surgery, giving your spine time to heal. Follow your doctor's instructions for using any prescribed supports or braces.
- Positioning — your PT may suggest ways to position your spine for greater comfort. These positions may include the use of pillows or towels to support your spine and help take pressure of the surgical area.
- Movement — careful movements suggested by your PT can safely ease pain by providing nutrition and lubrication in the areas close to the surgical area. Movement of joints and muscles also signals the nervous system to block incoming pain. Using safe body movements can help you avoid extra strain on your spine in the weeks after your spine surgery.
- Lying in Bed — avoid lying in positions that twist or angle your spine. Do not curl up in the "fetal" position. Choose a firm mattress. Do not lay on a soft bed or sofa. Keep enough pillows nearby to support your head, shoulders, trunk, and legs.
- Moving in Bed — when getting in or out of bed, use the "log roll" technique. To get out of bed, roll onto your side and sit up while keeping your spine steady and secure. Instead of twisting your upper body when you roll to one side, try to roll your whole body as a unit, like rolling a log. Then let your legs ease off the edge of the bed toward the floor as you push yourself up into a sitting position. This reduces strain from twisting your spine and gives the surgical area time to heal. To get into bed, do just the opposite: sit first with your legs hanging off the side of bed, then lie on your side and roll like a log onto your back.
- Sitting — keep your spine upright and supported when sitting. A safe, upright posture reduces strain on your spine. Choose a chair that supports your spine. Avoid soft couches or chairs. Place a cushion or pillow behind your back while driving or riding in a car. When standing up, keep your spine aligned by leaning forward at the hips.
- Bending — your doctor or PT may tell you not to bend for a few weeks after spine surgery. Always follow your doctor's instructions. If and when you are given the okay to bend, do so safely. Keep your back straight and secure as you bend forward, making sure your spine is straight. Consider using a "grabber" to avoid bending over at the waist to put on socks or shoes, and to pick up items from the floor.
- Lifting — your doctor may tell you not to lift or carry anything for a period of time after surgery. Do not test your back by trying to lift or carry anything until your doctor says it is okay. If you must pick up or carry lighter items, squat down by bending your knees. Do not lean forward by bending your spine forward. Keep the item close to your body, even if it is light. Holding the weight out in front of you puts extra strain on your spine. Check with your doctor or PT if you have any questions about the safety of lifting or carrying.
- Outpatient Therapy — your doctor may prescribe outpatient rehabilitation once your condition has begun to stabilize. Your recovery from spine surgery can be improved by learning new ways to strengthen your spine and prevent future problems. Your PT will teach you ways to help reduce your pain now, and help you develop new habits to keep your spine healthy.