Understanding Rehabilitation and Care Following Posterior Lumbar Fusion

Article written by Larry Kurz, MD

WOUND CARE
Most wounds are closed with metal staples which are usually removed by the surgeon or his staff 6-14 days following surgery. An actual staple remover is used. Following this, multiple tiny strips of tape are placed along the wound edges to keep the edges closed during the rest of the wound healing. The strips should be allowed to fall off on their own. The wound may get wet during bathing, but should be patted dry with a clean towel and covered by a dry gauze and some tape. If the wound is draining bloody or blood-tinged fluid, the dressing should be changed as frequently as it gets soiled. Any drainage for more than 1 or 2 days, or any sign of infection should be discussed with your surgeon promptly.

MOVEMENT
Movements should be watched quite carefully to avoid injuring your surgeon's handiwork. The patient should have in mind that the muscles, other soft tissues, and deep stitches, all take at least 6 weeks to heal. The metal instrumentation, which is in your low back, is unlikely to be pulled out by movement after this period of time, depending on a lot of factors, only one of which is the speed at which the bone chips are fusing (welding together) in your spine. Although sitting, standing, walking and lying down are usually acceptable positions/activities, the patient should avoid any movements which are repetitive, or sudden. In general, climbing ladders, bending at the waist, twisting, squatting, or stooping should be avoided. Climbing stairs, one at a time, are usually permitted, if the patient has practiced at least one time with supervision. These restrictions usually apply from 6 weeks to 3 months after surgery. However, leaning over a sink to brush teeth, or wash, is permitted, even within a few days after surgery. Items on the floor should be picked up with a "grabber" that you may obtain during your hospital stay.

DRESSING
This activity is permitted provided the restrictions of movement, as outlined above, are observed.

LIFTING
A gallon of milk weighs approximately 8 pounds. This weight should be your maximum lift for the first 6 weeks. Be sure to keep the item as close to your body as possible.

EXERCISE
Permitted exercise, during the first 6 weeks, involves walking on level ground. Following this, you may go in a swimming pool, and in fact, may swim if desired. Jumping, diving and kick turns or flips should be avoided. Use of a stationary bicycle, regular bicycle, stair-climber, weight machines, elliptical machines or sit-ups should be avoided until instructed otherwise by your surgeon or physical therapist.

BATHING
Because of the excessive stresses placed on your lumbar spine, during entering and exiting a bathtub, it is recommended that only showers be taken during the first 3 months following surgery. Sitting on a shower-seat is advantageous as it decreases the chance of slipping or falling.

NUTRITION
Although the ability of a patient to form an adequate spinal fusion is based on many factors, few are as important as adequate nutrition. In order for the bone to grow into a solid fusion, it requires protein. The fusion gets the protein from 2 possible sources: food and drinks, or from the breakdown of muscles into protein-forming building blocks. If you do not provide the fusion with adequate protein, in the form of food and drinks, it will rob your muscles of the protein it needs to function, and your fatigue will increase. Therefore, you must increase your protein intake during the first several months after the surgery. Protein-rich foods should be stressed, including: dairy products, fish, eggs, chicken, turkey, and red meats. Of course, the healing fusion also needs increased calories in general, so you should still eat a balanced diet. Because your appetite is typically diminished for a period of time following surgery, your intake of vitamins (that are contained in that food) is also diminished. Supplemental vitamins may be helpful in providing needed factors which are helpful in healing your fusion. A multivitamin which contains iron should provide this adequately, and also helps in restoring the iron needed to correct your anemia due to blood normally lost during surgery.

BRACE
With the advent of technological advances in instrumentation systems, most patients do not need external immobilization of their lumbar spines with braces. However, if your surgeon gives you one, it typically should be worn for 3 months, and may be removed for showers and sleep.

DRIVING
Driving is usually permitted by 2-3 weeks following surgery. It might be limited because of the patient's inability to step on the brake suddenly, pain from prolonged sitting, or pain from getting in and out of the car.

MEDICATIONS / PAIN PILLS
The spinal fusion process is adversely affected by certain medications, and unless absolutely necessary, they should not be taken for at least 6 months following surgery: Oral cortisone preparations, and non-steroidal anti-inflammatory medications such as ibuprofen, Aleve, aspirin, Motrin and Advil. Most patients require narcotic medications for a few weeks after surgery. These medications should be weaned as pain diminishes.

OFFICE VISITS
Your surgeon will want a number of follow-up visits in the office in order to assess your progress, as well as to take and review x-rays to assess the progress of the spinal fusion.

METAL DETECTORS
Most spinal instrumentation is made of titanium. This metal is not usually detected by commercial metal detectors such as those in airports.

SMOKING
Cigarette smoking is detrimental to your spinal fusion, and prevents its formation. Cigarette smoking and second hand smoke are not permitted until your surgeon tells you that your fusion is solid. This rarely occurs before 6 months after the surgery.

FATIGUE
Most patients feel fatigued, sometimes to the point of exhaustion for up to 4 months after surgery. This is usually due to deconditioning, anemia and some situational depression. These usually resolve.

WEIGHT LOSS / GAIN
It is common for patients to lose or gain weight in the first few months after surgery. This is a balance between weight loss from diminished calorie intake due to poor appetite, and weight gain from diminished activity. With time, weight can increase from improved appetite, and can decrease from increased activity, especially beginning with physical therapy.

PHYSICAL THERAPY
Physical therapy typically begins 3-4 months after surgery, and usually lasts 6-12 weeks. Initially stretching exercises are performed to provide maximum flexibility. This is usually followed by aerobic exercises to improve body conditioning. What usually follows is resistance training, frequently with weights, to improve strength and stability to the body, and especially the spine. Maintenance programs are key in maximizing your result.

RECREATIONAL ACTIVITIES
Restricted or unlimited participation in sports activities are variably permitted by your surgeon after the fusion has healed.