You have had a fusion with or without decompression (laminectomy) and with or without instrumentation (screws and rods). Now you are on your way home. The first day after surgery will be the most painful. Hopefully after a few days you will think that your surgeon is not such a bad guy after all!

This brochure will cover these topics:

When should I go home? Instructions for home The Incision Bruising Pain Pain Medication Constipation Diet Activity

Shoes Sitting Driving Corset/Brace instructions Sleeping surface Sex Follow-up Recovery expectations

When Should You Go Home?

You should go home as soon as you are moving well. If you stay in the hospital a long time, you are likely to get "sicker". Go home as soon as possible to home cooking - it's better than hospital food!

A physical therapist will help you get up and walk. You will also be taught how to properly get in and out of bed. Get out of bed on your own as soon as you can. Walk to the bathroom. Walk in the hallway. Walk, even if you need a walker or a cane. When you can do this, it is time to go home.

Instructions for Home

Be active! Walk! Walk! WALK!

Your only exercise should be walking. Your goal is to be able to walk for 45 minutes at a time, twice a day.

When you are not walking - lie down and rest.

Eat healthy foods.

Remember your multivitamins with iron and your calcium. Taking two TUMS a day will provide you with the required calcium.

The Incision

Leave your incision uncovered (no bandage). Uncovered incisions seem to heal better. The incision is held closed by dissolvable suture and skin tapes.

Shower or bathe each day and pat the incision dry.

The skin tapes should have fallen off in one to two weeks. If not, remove them.

A tail of dissolvable suture will be present at each end of the wound. Don't worry! These will simply fall off within a few weeks.

It is not uncommon for swelling to appear around the incision.

Please call the office if you have a lot of drainage and/or redness at the incision site.

Bruising

Several muscles have to be cut to be able to do the fusion. Some patients get a large bruise and have a bit of muscle cramping around the surgery areas. The bruise and cramping will go away with time.

Don't be surprised if the graft site incision bothers you the most. This area is often more sensitive. Use ice to the area to help decrease the pain.

Pain

You will be uncomfortable and need pain medication for a number of weeks. Many patients have more pain and bruising at the graft site than in the back incision.

Don't be a hero - take the medication. You will be more comfortable when taking the pain medication and feel more like doing the walking that you need to do. You should need a lot less pain medication within a month.

Again, use ice on the surgery area to help decrease the pain.

Pain Medication

You will be sent home with pain medication.

If you live out of state, fill your prescription before you leave Denver.

Remember to take your TUMS (two per day) for calcium and a multivitamin with iron. 

Constipation

Some patients find that they have trouble getting their bowels to move after surgery. This can happen because of:

• Decreased activity
• Pain pills
• Iron pills
• Effects of anesthesia

You can help prevent this by eating a lot of fresh fruits and vegetables, and drinking plenty of water.

There are several stool softeners that can be bought without a prescription (e.g. Surfak, Correctol) if you do have trouble with bowel movements. Along with the stool softener, use Metamucil on a daily basis. Suppositories and enemas are also at the drugstore, if you need them. Again, the best treatment is prevention.

Diet

Eat a well-balanced diet. There are no special food restrictions. Be sure to take your vitamins, iron and calcium. 

Activity

As the days and weeks go by, you will notice that you are doing more - but bending, lifting and twisting should be avoided until you are seen in the office post-operatively.

Walk everywhere - in your home, in the mall, up and down stairs. Walk outside as much as possible.

Work up to walking twice a day, 45 minutes at a time, or a total of two to three miles of walking per day by the time your are seen, two months after surgery.

Shoes

Always walk in comfortable, flat-soled shoes that someone else ties for you.

Sitting

Sitting will be very uncomfortable.

Your best position is resting in bed, on the sofa, on the floor or in a reclining chair.

Your next best position is walking. Standing is OK, but you will not want to do it for any length of time. When you need to sit to eat, pick a firm dining room chair with arms.

Driving

Obviously, you have to sit to drive or be driven, but don't do too much sitting in the car for about four weeks. 

Don't drive for six to eight weeks. 

Most pain pills cause drowsiness.  Avoid driving while you are taking pain pills. 

You must be off the pain pills and able to pay attention to your driving, not to your back.

Corset/Brace Instructions

It is best to wear your brace when you are up for any length of time after having a fusion.  You don't need the brace if you are heading to the bathroom and back to bed, or if you are going to lie down at home. 

If you are going to be on your feet for any length of time or you are heading outdoors, then you will most likely feel better with the brace on.  It will also remind you not to bend!

Sleeping Surface

It will be hard for you to get in and out of your regular bed, but you should try.  Avoid all waterbeds.  They are even more difficult to get in and out.  Waterbeds do not provide the support that you need.  It will be hard to get upstairs to your bedroom, but again, you should try.  After a week or so, it will get easier and you will have done your own physical therapy!

Sex

Personal relationships can be resumed when you are comfortable enough, usually in two to four weeks.  The non-dominant or bottom position is the least stressful. 

Follow-up

About a week after you are home, we will call you to see if you have any questions and to schedule your follow-up appointment.  Our assistants are available any weekday to answer your questions.  They can locate your surgeon, if necessary.

You should be seen in the office about two months after surgery.  An x-ray will be taken at that time to see how the fusion is progressing.  We will then decide on further use of the brace and what your activity level should be.

Four things will destroy your fusion:

1. Smoking (or the use of any tobacco products will greatly increase your complication rate and may prevent a solid fusion)
2. Excessive drinking of alcohol
3. Anti-inflammatory medications (some are listed below) or aspirin products (see our "Non-Steroidal Anti-inflammatory Drugs" [NSAIDS] pamphlet)—
4. Any form of steroid use.  Do not use nasal sprays that contain steroids (e.g., Flonase®, Nasacort®, Beconase®, Nasarel®, Rhinocort®).  Use an antihistamine spray which your primary care doctor can prescribe.

When Should I Expect My Fusion to Become Solid and My Pain to Lessen?

If you treat yourself well (no smoking, limited alcohol, TUMS® for calcium and multivitamins), and if you are a "good healer"—your fusion will be getting strong, and you will be comfortable when you are seen in the office in six to eight weeks. 

It will take another two to four months for your fusion to get solid enough for you to throw your brace away and do what you want. 

A fusion can take a long time to become solid if you don't treat yourself well or you are a slow healer.  In some cases, fusions have taken over a year to become solid.  Unfortunately, in spite of the best surgical efforts and your cooperation, some fusions never become solid (about 10%). 

To get the best results from your surgery, take an active role in your recovery—walk, eat well and don't smoke.