Some people who undergo lumbar surgery experience good to excellent results following the operation. Some people experience significant relief of pain and the return of good functional movement and strength, enabling them to walk, sit, drive a car, and cope with the activities of daily life more easily.
The surgical procedure for lumbar surgery can last from one to eight hours. Spine fusions tend to last much longer than simple discectomies. Some patients report improvements in the way they feel immediately after they awake from the surgery. However, strengthening the weakened muscles and soft tissue surrounding and supporting the trunk requires a longer-term program of exercise and therapy. Although many patients see and feel immediate benefits, they need the benefits of a comprehensive rehabilitation program for several months to get the total benefit.
The type of lumbar procedure that is used will determine how long you will need to stay in the hospital and how much assistance you may need after surgery.
The day after surgery is considered day one. Under the supervision of a physical therapist, you may sit on the edge of the bed and stand with support. Patients are often encouraged to stand and sit (with assistance if needed) within twenty-four hours after surgery. Walking, however, is approached gradually and in a guided manner to avoid injury and complications. Try not to over do it the first few times you get up and walk. Build up gradually to avoid a flare-up of symptoms.
You may need to have blood drawn daily if your physician has placed you on blood thinning medications. These tests are needed to regulate anti-coagulant therapy (blood thinning). During the first few days, your doctor will monitor your blood thinning level and may determine your need for additional blood transfusions.
Your nurse will check the circulation and motion of your legs and feet. You may have an incentive spirometer (blue inhalation tube) to help expand your lungs and prevent pneumonia. The drain may be removed from your incision and the dressing changed. Surgical tape, sutures, or adhesive tape will have been used to close your incision. An ice pack or cooling pad may be used to help decrease swelling and increase your comfort. It is common to continue intravenous fluids for the first two days.
Your physical therapist will work with you to help you begin moving safely. Ideas will be given to help you move safely in bed and up to a sitting position. You will gradually progress to standing and walking. You may require the use of a walking aid (cane or walker) for a short time following surgery. Exercises may be given to ease soreness in your legs. You may begin static tightening of the thigh and buttocks muscles. Ankle pump exercises can help fluid from pooling in the lower limbs.
Your physician will order your diet. Recovery from anesthesia varies from person to person, so your diet will be adjusted as your intestinal function returns to normal. Usually as soon as you are able to eat, you will be allowed to have clear liquids. If you are able to tolerate these, you will be given more solid food.
Antibiotics are given intravenously for 24 hours to help prevent infection. Pain medication is available to ensure your comfort. If you are uncomfortable, please let your nurse know. It is important to have a level of comfort so you can participate in your exercise program.
The intravenous line may be removed. If you have a urinary catheter, that is also often removed. You will probably continue using the incentive spirometer. Your wound dressing may be changed.
It is important to continue with the exercises to promote motion and prevent muscle soreness and tightness. Ice packs may be applied before and/or after therapy treatments to reduce swelling and relieve pain. With assistance from your therapist, you will gradually increase the distance you are walking in preparation for going home.
Day Three and Beyond
Daily blood testing for anti-coagulation therapy may continue. If needed, the wound dressing will be changed or removed. Self-care aids may be used to reduce stress on your back, such as chair cushions, raised toilet seat, or bathing aids.
During the first few days after surgery, there is naturally some pain, which should be expected. However, it can be adequately controlled by medication. Please let your nurse know if you are in pain.
Your physical activity will continue to focus on your safety with mobility and helping you toward independence. In spite of any mild discomfort, it is important that you do the deep breathing and physical therapy exercises as instructed. Patients who breathe well and work at tightening their muscles are able to improve their lung capacity and circulation, and they often heal faster.