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 five days.

What can I expect in hospital after the operation?

After the operation you will have some local wound discomfort and you may be aware of some soreness and stiffness in the lower back but you should find that you will get moving reasonably quickly 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. Sometimes the bowel slows down for about 24 hours after the surgery but the nursing staff will check on this and will limit your intake until things are working properly. 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 gentle maintenance 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 cage and screws will be checked on x-ray, usually the day after your operation.

Once you are comfortable and happy with your ability to get around you are about ready to go home. This is usually about four and five 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?

Not usually but in some circumstances Mr Boeree may suggest a brace to provide you with some additional support for the first three months or so after the operation.

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
The fusion process usually takes about three months or so to become reasonably solid. This is similar to a fracture healing and it is worth remembering that, just as you wouldn't put excessive demands on a fracture that had recently been fixed , it is better not to overload your back at this stage. During these first few months our aim is to keep the muscles of your back supple. As your back starts to feel better there is an understandable desire to want to do more, to see steady progress in your levels of activity. Try and resist this. Although the back is very strong due to the fixation with the STALIF cage and screws we need to let the biology catch up with the technology.

Initially your physiotherapist may use treatments to help settle soreness and muscle spasm and bruising from the operation. You will be taught what to do to protect your back and how to position yourself when you sit or lie down.

An individual programme of exercises and physiotherapy will be set up for you and this won't change very much over the first three months. At The Spine Clinic we have found regular hydrotherapy to be helpful over this period and if you are local or have this facility near your home this will be arranged for you. In addition to hydrotherapy or gentle gym based physiotherapy once or twice a week you will be encouraged to undertake some gentle daily exercises and this should include short walks (up to half a mile or so) two or three times a day. Walking helps to get the muscles working and also stimulates the fusion process.

As time goes on you will feel more confident about a reasonable range of normal day to day activities. Returning to these activities 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 three months after your operation. 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.

The back muscles tend to fatigue quite quickly during the first few weeks after spinal surgery. As a result you may find sitting, or any static position, uncomfortable after a while. This will improve with time. At The Spine Clinic we advise that you limit sitting to thirty minutes or so for the first few weeks.

Driving and Travel
It is probably best to avoid driving or long car journeys for the first six weeks after your operation. After that you can return to driving once 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.

For a while after any major surgery you may be at somewhat greater risk of developing a deep vein thrombosis (DVT). Since DVT can also occur after long haul flights it is probably better to avoid any such travel for the first three months after a fusion operation. Shorter flights should not present a problem although you are likely to find sitting for long periods uncomfortable for the first few weeks. 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 at about three months following your surgery. You can discuss appropriate exercise with your physiotherapist. It is best to wait until you have built up a little more fitness and endurance before returning to golf and competitive sports.

Return to Work
You may be able to consider returning to light semi-sedentary work at about six weeks but if your work is more physically demanding you may benefit from a longer period of recovery. If your work is strictly sedentary (at a desk) bear in mind that you may find it uncomfortable to sit for long periods to start off with. 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

You may experience a deep seated aching discomfort in your back. This is very much to be expected and it should gradually ease as time passes. If bone graft was taken from your pelvis this area will be a little sore for the first week or two and you may feel a pulling discomfort on that side with walking. This should ease after a couple of weeks.

The STALIF cage is, of course, very deeply sited and you won't feel this in any way.

It is not unusual to experience some leg pain after your surgery. The nerve root may be affected by some inflammation or bruising and discomfort sometimes develops a few weeks after the surgery. Don't panic if you experience this; it is quite common. However, if you are worried, or if your leg pain is getting worse, please contact the ward or Mr Boeree's office.

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 three months from your operation, at which point x-rays will be obtained to check on the position of the STALIF cage and the progress of your fusion. 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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