Hospital Stay
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.
Day One
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.
Testing
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.
Treatment
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.
Activity
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.
Diet
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.
Medication
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.
Day Two
Treatment
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.
Activity
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
Treatment
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.
Medication
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.
Activity
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.
