Spinal Fusion Instructions

You are having a SPINAL FUSION. Dr. Taylor has discussed with you why you need surgery and what specifically will be done. The type of surgery you are having is based on where and what your spine problem is and what will best alleviate your symptoms. Dr. Taylor’s nurse will be available to answer any questions you have about the particular procedure you are having. This booklet gives you information on what you will need to do before surgery and what you can expect after surgery.

Before surgery

There are several things to do to prepare for surgery.

1. Before your operation, it will be necessary to have blood tests. If you are over forty, you will also need an EKG and chest x-ray to evaluate your general condition before undergoing anesthesia. If you are over 40, or have significant health problems, you will need a medical clearance by your internist (medical doctor/family doctor).
2. You may want to get your home ready for after surgery. During your six week to six-month recovery period, you will have a weight lifting restriction, and will need to maintain back precautions, which will limit some of your routine activities around the home. Also, if bone graft was used from your hip, you will be experiencing soreness at this site. For these reasons, it will be difficult and risky to bend, stoop, or reach for overhead or under waist objects. It is advisable to place frequently used objects at an easily obtainable height.
3. Loose fitting clothes may be preferred in the immediate weeks after surgery. If you are to be braced post-operatively, you will need tee shirts to wear under your brace. The tee shirt must cover the buttocks. These tee shirts help absorb some of the body’s perspiration, and prevent skin breakdown. Brace application does require the help of another person. You may receive a second brace for showering.
4. You may need to walk with a walker after surgery, due to pain and weakness. Remove all throw rugs or items blocking the walkway to prevent tripping or falling.Donating blood before surgery

   Dr. Taylor may ask you to donate blood for your surgery. The nurse will let you know if you need to donate. Blood loss during this surgery is common, and often the patient needs to get a blood transfusion to accommodate for this loss. The blood from the blood bank is safe and tested for infectious diseases. Dr. Taylor feels it is even safer for the patient to get back his or her own blood. Your nurse will give you specific information on donating blood.

   Incision

   The incision will be made according to the location of the spinal problem. The length of the incision depends on how many levels of the spine that needs to be operated on. Most incisions are no longer than four to five inches long.

   Brace

   You may or may not need to wear a brace after surgery. Dr. Taylor’s nurse will let you know if you have to wear a brace. The type of surgery you have and how many levels are operated on, determine the type of brace you wear. The brace serves to limit motion of the spine, and protect and support the spine while it is healing. You will be fitted for a brace prior to surgery. You may need to wear the brace whenever you are out of bed.

   Risks

   All of the following risks are very unlikely to occur. But, you do need to be aware of them.

   • Side effects from the anesthesia
   • Infection
   • Damage to nearby structures
   • Bone graft shifting or displacement
   • Spinal cord or nerve damage
   • Bleeding or possible need for transfusion
   • Failure of the bone to heal
   • Problems with the metal plates and screws
   • Problems with the bone graft site

   After surgery in the hospital

   The average length of stay for this type of surgery is three to five days.

   The evening of surgery

   1. Activity: You will be on bedrest.
   2. Diet: You will be started on a clear liquid diet.
   3. Pain Control: When you return from the Recovery Room, you will have intravenous (IV) fluids running into your arm. A device called a PCA (patient controlled analgesia) will be connected to your IV fluids. This PCA will allow you to administer your own pain medication by pressing the button whenever you have pain. This is a very small dose, which goes directly into the vein and should relieve your pain quickly.
   4. You will have drains coming out of your incision. The drains collect excess bleeding and drainage from under the skin. This keeps your would from swelling, and helps the nurses and doctors to estimate your blood loss.
   5. You will have a urine catheter, which will drain your bladder until you can safely make it to the bathroom, or a bedside commode safely. Expect the catheter for one to two days after surgery.

   First day after surgery (Post-OP Day 1)

   1. Activity: Physical Therapy (PT) will come in the morning to get you up and ambulating. PT will then determine if you need a walker. It may be difficult to walk at first, due to the soreness from the bone graft. PT will also show you proper ways to position yourself, get out of bed, and instruct on measures to prevent stress on your spine after surgery. You will need to follow back precautions. Following is the list of back precautions.
      1. When turning in bed, the head of the bed should be flat. Hips and shoulders should turn together as a unit, in log roll fashion.
      2. Hips and shoulders need to be in alignment.
      3. No twisting.
      4. Placing a pillow between your knees, when turning, will help maintain alignment and provide comfort.
      5. No bending, stooping, or heavy lifting. DO NOT carry more than five pounds. (One gallon of milk weights 8 to 9 pounds) Your doctor will also prescribe Occupational Therapy. Post-operative precautions and/or the brace can make some self-care activities difficult, if not impossible. The occupational therapist will assist you in learning alternate methods to perform these tasks. The occupational therapist will work with you and address any concerns of how to perform bathing, dressing, toileting, cooking, or light chores safely and independently, at home.
   2. Diet: You should be able to advance to a regular diet. A soft diet may still be needed if you are not passing gas yet.
   3. Pain Control: You have the option of staying with the PCA or starting pain pills.

   Second day after surgery (Post-OP Day 2) and any days after

   Post-op Day 2 and days thereafter are devoted to rehabilitation and sending you home.

   1. 1. Activity: PT will be ensuring that you are safely ambulating independently. By discharge, it is important to be getting out of bed, walking, and going up and down stairs independently. It is possible that you will need a cane or walker for a few weeks after surgery. Occupational therapy will ensure that you are able to perform activities of daily living independently. If you have had an extensive surgery, or had trouble ambulating or functioning independently before surgery, you may need extra rehabilitation. Extra rehab is made possible through home health physical therapy or occupational therapy, or an extended stay in an inpatient rehab facility. Your physical therapist, occupational therapist, and doctor make the determination for extra rehab. Extra rehab is subject to insurance approval.
      2. Pain Control: You will be taken off the PCA and switched to pain pills. Prescriptions for pain pills will be given to you at discharge.
      3. You may be sent for x-rays of your spine.
      4. The spine nurse will give you going home instructions, that include information on incision care, activity, and the back brace.

   You will need to have a bowel movement before you go home, in order to prevent constipation. After surgery, constipation can be a problem because of the pain medication and immobility. If you are having trouble with having a bowel movement after surgery, please inform your nurse or doctor.

   After discharge

   Showering: You can shower 5 – 10 days after returning home. DO NOT take a bath or get into a pool for TWO WEEKS following your surgery.

   CAUTION: The bathtub floor and/or shower stall are potential sites for accidents because of wet surfaces. The bathing environment should be slip free.

   Driving: This will be discussed after surgery and depends on how extensive your surgery was. Your doctor will determine when it is safe to return driving.

   Working: Keep in mind that you will not be able to lift more than five pounds for six weeks to three months after surgery. Working depends on what type of job you have and how extensive your surgery was. If you have a job that does not require physical labor, you can return to work within three to four weeks. If you do have a job that requires physical labor, your doctor may want you to stay off work for six weeks or longer, depending on how you are doing after surgery. Regardless of what type of work you do, your doctor will allow six weeks off, following surgery.

   Conclusion

   The spinal fusion is done to reduce pain, prevent any deterioration of neurological symptoms, and provide stabilization for the spinal column and spinal cord. Before you undergo this operation, you should be fully aware of what the procedure is all about, and that all of your questions are answered in complete detail, and to your satisfaction. If other questions arise prior to surgery, please do not hesitate to call or to make an appointment for another visit. Your spine nurse will be available to answer any questions you have. Every question or concern you have is considered important.