Most patients who undergo lumbar spine surgery experience good to excellent results following the operation. Some patients experience significant relief of pain and the return of good functional movement and strength, enabling them to walk, sit, drive a car and cope with the activities of daily life more easily.
The surgical procedure for lumbar spine surgery can last from one to eight hours. Spine fusions tend to last much longer than simple discectomies. Some patients report improvements in the way they feel immediately after they awake from the surgery. However, strengthening the weakened muscles and soft tissue surrounding and supporting the trunk requires a longer-term program of exercise and therapy. Although many patients see and feel immediate benefits, they need the support of a comprehensive rehabilitation program for several months to recover fully.
The type of lumbar procedure that is used determines how long the patient will need to stay in the hospital and how much assistance he/she may need after surgery.
The day after surgery is considered day one. Under the supervision of a physical therapist, the patient may sit on the edge of the bed and stand with support. Patients are often encouraged to stand and sit (with assistance if needed) within twenty-four hours after surgery. Walking, however, is approached gradually and in a guided manner to avoid injury and complications. It is important for the patient to not overdo it the first few times they get up and walk. Building up gradually is recommended to avoid a flare-up of symptoms.
The patient may need to have blood drawn daily if his/her physician has placed him/her on blood thinning medications. These tests are needed to regulate anti-coagulant therapy (blood thinning). During the first few days, the doctor will monitor the blood thinning level and may determine the need for additional blood transfusions.
A nurse will check the circulation and motion of the legs and feet and may have an incentive spirometer (blue inhalation tube) to help expand the patients lungs and prevent pneumonia. The drain may be removed from the incision and the dressing changed. Surgical tape, sutures, or adhesive tape will have been used to close the incision. An ice pack or cooling pad may be used to help decrease swelling and increase the patients comfort. It is common to continue intravenous fluids for the first two days.
The patients physical therapist will work with him/her to assist the patient in moving safely. Ideas will be given to help him/her move safely in bed and up to a sitting position. They will gradually progress to standing and walking, which may require the use of a walking aid (cane or walker) for a short time following surgery. Exercises may be given to ease soreness in the legs, such as static tightening of the thigh and buttocks muscles, as well as ankle pump exercises can help fluid from pooling in the lower limbs.
Recovery from anesthesia varies from person to person, so the patients diet will be adjusted by the doctor as his/her intestinal function returns to normal. Usually as soon as the patient is able to eat, he/she will be allowed to have clear liquids. If the patient is able to tolerate those foods, he/she will be given more solid food.
Antibiotics are given intravenously for 24 hours to help prevent infection. Pain medication is available to ensure comfort. It is important for the patient to have a level of comfort so he/she can participate in an exercise program.
The intravenous line may be removed, as well as the urinary catheter, if applicable to the patient. The nurse will continue using the incentive spirometer and changing the dressing.
It is important to continue with the exercises to promote motion and prevent muscle soreness and tightness. Ice packs may be applied before and/or after therapy treatments to reduce swelling and relieve pain. With assistance from a therapist, the patient will gradually increase the distance he/she is walking in preparation for going home.
Day Three and Beyond
Daily blood testing for anti-coagulation therapy may continue. If needed, the wound dressing will be changed or removed. Self-care aids may be used to reduce stress on the back, such as chair cushions, a raised toilet seat, or bathing aids.
During the first few days after surgery, there is naturally some pain, which should be expected. However, it can be adequately controlled by medication. A nurse will administer the medication to the patient.
Physical activity will continue to focus on safety with mobility and helping the patient toward independence. In spite of any mild discomfort, it is important that the patient work on the deep breathing and physical therapy exercises as instructed. Patients who breathe well and work at tightening their muscles are able to improve their lung capacity and circulation, which promotes faster healing.
To learn more about this treatment, view our spine animations.