After the Operation

What is the period of hospitalization?

This will vary according to your individual circumstances and medical condition, but most people are able to go home after about three or four days.

What can I expect in hospital after the operation?

After the operation you will be aware of some soreness and stiffness in the lower back but you should find that you quickly and easily get moving after the operation. The nursing staff will work with you to try and ensure that any post-operative discomfort is kept to a minimum. Initially this may well be through the use of pain killing medication through a line which you control through the simple press of a button (Patient Controlled Analgesia, or PCA), but quite quickly you will be able to switch to simple tablets.

We will usually aim to get you up, standing and taking a few steps later the same day or the day after the operation. Hydrotherapy (pool based physiotherapy treatment) is available at the hospital and is a great way to gain confidence with movements and mobilization. Your wound will be protected by a waterproof dressing when you go in the pool. Your mobility will quickly improve and as it does so the physiotherapist will work with you on a programme of muscle strengthening exercises which will continue after you go home. Your therapist will show you ways to protect your back while doing everyday things such as getting in or out of bed, dressing, getting up out of a chair or getting into a car.

To minimise the risk of a deep vein thrombosis (DVT), which is the formation of a blood clot in one of the deep veins in the leg, you will be provided with special elasticated stockings. When you are resting in bed you will be fitted with A-V impulse boots and we will ask you (and remind you) not to cross your legs and to do special foot exercises. All these measures help to reduce the chance of a thrombosis forming, as will walking which is another reason we encourage you to get up and start mobilising quite early.

The position of the screws will be checked on x-ray, usually the day after your operation. Parts of the flexible rods do not show up on x-ray so don't be alarmed if there seems to be a gap between the screws.

Once you are comfortable and happy with your ability to get around you are about ready to go home. This is usually sometime between two and four days after your operation. By this stage you will be safe to sit, walk and travel in a car for moderate periods.

Will I need a brace?

No, there is no need for a brace after dynamic stabilization.

What will my convalescence involve after leaving hospital?

The Surgical Wound
The clips are removed once the wound has healed, usually at nine days after your operation. This is not uncomfortable and is very simple. You can either come into the hospital or we can arrange for your district nurse to remove the clips for you at home.

Activity and Movement
You will need to continue with your programme of active home exercises and supervised physiotherapy after your discharge from hospital. This will usually involve attending the physiotherapy department about twice a week, either at the Nuffield Hospital Hampshire or locally to your home. Initially your physiotherapist may use treatments to help settle soreness and muscle spasm and bruising from the operation. Regular walks are also helpful. You will be taught what to do to protect your back and how to position yourself when you sit or lie down. Quite soon you will move onto more active treatments to build up your strength and improve your flexibility. It can be quite daunting when you first start gentle bending. Working steadily on both strengthening and movement exercises will soon instil confidence and help you gain flexibility. Endurance exercises such as treadmill walking and static cycling further help muscle strengthening. Our physiotherapy department has developed a detailed protocol for treatment after Dynamic Stabilization and are always happy to discuss this with your own physiotherapist.

Over the next few weeks you will find that you should be able to return to most normal day to day activities. This should be a gradual and progressive process, guided by how you feel and by the progress you make with your physiotherapist. Take care and don't try and be too ambitious. It's important to achieve good muscle control of movements before you try and push your range of movements too far. We prefer that you avoid excessive bending movements in the first two or three months after your operation to allow the screws to become properly anchored in the bone. Make sure you are happy with one stage in your programme before you try and move onto the next. As you gain confidence in your movements you can incorporate these in everyday tasks and activities.

Driving and Travel
You can return to driving as soon as you feel reasonably confident about getting in and out of your car and happy that you will be able to sit comfortably for the necessary time. You shouldn't drive if your concentration is impaired, for example if you are uncomfortable, or if you are taking medication which might make you drowsy.
There are no specific concerns about airline travel after Dynamic Stabilization but if you do plan to travel take an aisle seat so you can get up for a stretch and do a little walking periodically. You may want to take an anti-inflammatory to help reduce stiffness and discomfort.

Sports and fitness training
You will probably be able to return to light aerobic fitness training at your health club during the first six weeks after your surgery. You can discuss appropriate exercise with your physiotherapist. It is best to wait until about three months before returning to golf and competitive sports.

Return to Work
You will be able to consider returning to light semi-sedentary work in four to six weeks but if your work is more physically demanding you may benefit from a longer period of recovery. In the weeks after an operation you will tend to tire more easily and may be better to return on a part time basis initially.

What to expect in terms of symptoms after your surgery

One of the advantages of Dynamic Stabilization is that it is less invasive than fusion procedures. The muscles will feel somewhat bruised and sore and the wound tender and sensitive to start off with but this should settle over the days and weeks following your operation.

The screws and rods are quite deeply seated and you generally won't feel them through the skin, although you may be aware of a sense of 'fullness' in the lower back initially.

Medical Follow-Up

When you leave hospital we will contact your doctor to ensure he or she is fully aware of the operation you have had and any necessary care needs you may have. If you have clips to be removed we will arrange for this to be done at the hospital or by your district nurse.

You will be given an appointment to be seen by Mr Boeree six weeks after your operation. Your physiotherapist will, in the meantime, have kept Mr Boeree informed about your progress. You will have a further appointment with Mr Boeree at three months from your operation, at which point x-rays will be obtained to check on the position of the screws and rods and the movement of your back. During this time if you have any concerns please feel free to contact Mr Boeree's office, although it is often worth discussing these first with your physiotherapist or GP.

 

 

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