LOWER BACK SURGERY
For patients Minimally Invasive Lumbar Interbody Spinal Fusion
ALIF – Anterior Lumbar Interbody Fusion
PLIF – Posterior Lumbar Interbody Fusion
TLIF – Transforaminal Lumbar Interbody Fusion
XLIF – eXtreme Lateral Lumbar Interbody Fusion
- This procedure is usually done as both an inpatient and outpatient procedure depending on the duration and severity of your back condition(s).
- Advancements in Minimally Invasive spine surgery technologies used for spine fusions has allowed most of my patients to go home within 24 hours, although some patients may sometimes require longer periods of time
- You will be issued a lumbar back brace prior to your surgery, it must be worn when out of bed, when ambulatory, but is usually not needed for sleeping but recommended if you can tolerate it.
- Please be sure to bring your back brace with you on the day of your surgery as you will be expected to mobilize early (within 2 hours after your surgery) and with the help of Physical and Occupational therapist.
THINGS TO AVOID AFTER SURGERY
- Lifting or carrying anything more than 3 pounds until further instructed
- Avoid bending, lifting, or twisting (BLT’s) as lifting and carrying will put extra stress on your back healing – especially the recovery of your disc(s) and back muscles
- Avoid sitting for prolonged periods of time (greater than 2 hours) as this puts extra stress on your back healing. Try to get up and move every 30 minutes
- Removing the back brace for any reason other than to shower or sleep.
POSITIONS OF COMFORT
- Sitting, reclining, and/or lying flat – as long as there is not a great deal of pressure on your most surgical location
- Showering is acceptable after the first 24 hours of surgery
- After your surgery, you are not allowed to drive during the first 2-4 weeks as your driving reflexes are severely diminished not to mention the pain/spasms that may occur with sudden movements of your back or legs
- Upon discharge from the hospital, you will be transported by wheelchair to your vehicle. Using gentle, deliberate movements, take your time getting into your car, and try to minimize the amount of bending or twisting
- Once you are seated, it is ok for your to put your seat back to a comfortable level (usually close to lying in the flat position)
- Please be careful of the shoulder harness, as you do not want this to lie across or catch your neck in case of an accident
- You will be able to ride in a car as long as you are in your brace, comfortable, and in the car only for short periods of time. If the car ride is greater than 1 hour, you will need to pull over so that you can get out of the car and stretch
- Although you should be avoiding any bending, lifting, or twisting motions including stooping, you will also want to minimize your sitting too. It is important for you to try and stand and better yet, walk in increasing amounts every day to build up your conditioning.
- Make a determined effort to walk at least 3 times a day
- Your initial walking time may only be 5 to 10 minutes the first time, and that is ok to do, but this should increase every day so that by 3 weeks after surgery, you are walking up to 1 mile
DRESSINGS AND WOUND CARE
- It is important to keep the dressing dry on your back. Most of the time, dissolvable sutures were used and there will be no stitches to be removed later
- You will either have special water-resistant “glue” called Dermabond or Staples over your incision site. Although you may shower within the first 24 – 48 hours after surgery, your wound must remain covered and wrapped for protection. Often patients will use a wash cloth covering the bandage with some Saran Wrap-like covering around their waist. You cannot shower with the wound uncovered for at least 7 days after your surgery.
- When you do take a shower, please have someone there to help you if in the event you drop the soap or need shampoo. I would rather you not bend over to pick it up, but instead have someone retrieve this for you
- Please do not submerge your incision site(s), this includes avoiding pools, hot tubs, or baths until further instructed
- If your dressing does get wet for some reason, get some help in changing your dressing immediately with a sterile piece of gauze (usually 2 x 2 inch or 4 x 4 inch size) which you can get at any drug store and secure with a piece of medical tape
- If your wound begins to bother you or you begin to notice any drainage of any sort on the dressing, it is worth a phone call and possibly a sooner follow-up appointment to look at the wound – CALL IMMEDIATELY!
- Occasionally, the suture ends or “tails” are outside of the skin and might be secured with steri-strips (bandaid on steroids), this is normal
- If there is any concern regarding the incision site(s) – such as any significant redness, warmth, discharge, or excessive swelling around the incision, please notify me immediately
STOCKINGS AND BLOOD CLOTS
- You will have TED hose stockings when you leave the hospital. These special stockings help to prevent blood clots in your legs
- Please wear these stockings at least 23 hours every day until your follow-up visit within 2 weeks. They may be removed for brief periods of time for personal hygiene purposes or to wash/dry them
- Please remove them only at a time when you can be up walking around. This walking helps to further prevent blood clots. Do Not Remove the stockings when lying down.
- Occasionally, I may prescribe a daily Aspirin such as 325mg that will be used to help prevent blood clots. This Aspirin is usually started on the the 3rd day after surgery (Post-Op Day #3) and you should continue to take until further instructed at your first post-operative visit.
- The best way to prevent blood clots is to do “ankle pumps” that the physical therapist showed you in addition to walking
- If you do get significant swelling of either leg, especially if accompanied by pain in the calf, it is important to notify me IMMEDIATELY!
- Be sure to take your incentive spirometer home when you are discharged from the hospital.
- This is “Breathing Machine” that you used at your bedside.
- Try for at least 10 times every hour while you are awake with a goal of 2500 liters.
- Use this a home on a regular basis for the first 3 weeks after surgery. This helps to get oxygen to your lungs and helps to prevent pneumonia.
- You will be provided with your prescriptions prior to your discharge from the hospital. This will usually include medications for pain, muscle relaxants, and a number of different supplements to help in your healing process.
- We will also go over in detail what home medications you can/cannot take prior to your discharge. Some of these medications can cause side effects and interactions that we would like to avoid.
- We recommend that you check with your pharmacist and medications you may have at home to help minimize the cost of the medications. Very often, you may have Vitamin C or a Calcium with Vitamin D supplement that you will not need to have filled.
- At the time of your pre-operative visit, a follow-up appointment will be made for you. Usually my follow-up appointments are within 2 weeks after surgery or sooner if something should occur unexpectedly.
- Your first post-operative visit will include a thorough evaluation of your wound, medication review, dressing changes, and a X-ray after surgery.
- At that time, if you are doing well, the TED hose stockings will be discontinued and your activities will be advanced accordingly
- Please call if you do not already have a scheduled, follow-up appointment.
- The usual sequence of follow-up appointments are within 2 weeks immediately following your surgery, then every 4 to 6 weeks for follow-up evaluations.
RETURN TO WORK
- Most patients with work-related activities will not be allowed to return to work of any type unless it is a sedentary-type of position
- We may be able to place some restrictions on you, and your work may be of limited capacity for at least 4 weeks following your back surgery
- For those whose job is more demanding and require heavier lifting and/or carrying, the earliest return to work will be no sooner than 2 months immediately following your surgery
- Usually occurs at least 2-3 times a week for at least 4 to 6 weeks after your surgery
- At each post-operative appointment, your physical therapy will be addressed for your functional status
- Your Physical Therapist will recommend specific exercises and movements that I have reviewed, please try to utilize these exercises to enhance your successful outcome
- Consider also adding cardiovascular exercises to your regiment, as it is helpful towards maintaining the health of your back
- Please avoid smoking as it has been shown to many detrimental effects towards your health and healing processes