The type of operation will determine how long you will need to stay in the hospital and how much assistance you will need shortly after surgery. Many procedures for the spine only require one to three nights in the hospital.
The day after surgery is considered “day one.” Some spine surgeries require the use of a brace for a period of time afterward. If so, keep your brace on until your surgeon specifically instructs you to remove it. Patients are often encouraged to stand and sit (with assistance if needed) within twenty-four hours after surgery. Supervised by a physical therapist, you’ll sit on the edge of the bed and stand with support. 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.
A 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. Surgical tape, sutures, or adhesive tape will have been used to close your incision. This dressing may be removed and changed. 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 day or two.
Antibiotics may be given intravenously for 24 hours to help prevent infection. Pain medication is available to ensure your comfort. During the first 24 hours after surgery, you will probably be given pain medications that are injected-either through the IV line or into the arm or buttock. These medications are usually much stronger and faster acting than pills taken by mouth. Alert the nurse if you are uncomfortable due to pain. It is important to have a level of comfort so you can participate in your rehabilitation program.
Your doctor will order your diet. Recovery from anesthesia varies from person to person, so your diet will be adjusted as your intestinal function gets back to normal. Usually you will be allowed to have clear liquids as soon as you are able to eat. If you are able to tolerate these, you will be given food that is more solid. Special precautions are used for patients who have had surgery from the front of the neck.
A physical therapist will work with you to begin moving 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. Exercises may be suggested to ease soreness in your legs. You may begin static tightening of the thigh and buttock muscles. Pumping your ankles back and forth keeps fluid from pooling in the lower limbs and prevents the formation of blood clots in the legs.
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 (blood thinning) therapy. During the first few days, your doctor will monitor your blood thinning level and determine your need for additional blood transfusions.
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 or removed.
There is naturally some pain during the first few days after surgery. This should be expected. But pain can be adequately controlled with medication, so let your nurse know if you are uncomfortable. After the first day, you’ll begin switching from medications given through injection or IV to pills that can be taken by mouth. Taking medications by mouth will make things easier when you are ready to go home.
It is important to continue with the exercises to promote motion and prevent muscle soreness and tightness. Ice packs may be applied before and after therapy treatments to reduce swelling and relieve pain. With assistance from a therapist, you will gradually increase the distance you are walking in preparation for going home.
Day Three and Beyond
The wound dressing will be changed or removed if needed.
Your physical activity will continue to focus on safety with mobility and moving 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 and move well gain improved lung capacity and circulation. And they often heal faster.
Using Your Neck Brace
You may require the use of a brace after surgery. You may have been fitted before surgery with two different types of cervical collars. The Philadelphia collar is made of foam and is used for short periods, such as when you take a shower. The other, called a Miami J, is a hard plastic collar.
The bandages will be removed after surgery. You’ll be able to shower wearing your Philadelphia collar when you feel strong enough. You may also shampoo your hair while in the shower, as long as your collar is securely in place. After your shower, towel dry as normal, while keeping your Philadelphia collar on securely. Then lie flat on your back with the Miami J collar by your side. Undo the Velcro on the wet collar and remove the front portion, while keeping your neck still. Wash your neck area with water and mild soap, and then pat dry. You can also shave in this position. Have a family member or friend inspect your incision for signs and symptoms of infection(see your discharge sheet). Or you can use a hand-held mirror to inspect your wound.
Replace the front portion of the wet collar with the dry collar. Holding the front portion of the Miami J collar firmly with one hand, roll like a log to your side. Be careful to keep your neck still, and remove the back portion of the wet collar. Wash the back of your neck, and then pat the area dry. Replace with the back portion of the dry collar. Roll like a log onto your back, and attach the Velcro straps in place. The Miami J (blue and white) is to be worn full-time until the first time you return to your doctor after the surgery.
Do not use lotions, powders, or oils on your incision while it is in the healing process. If skin irritation occurs, try wearing a silk scarf under your brace. This can be very soothing and help decrease irritation.