This is a generic discharge instructions. Your instructions may vary depending on your surgery and medical condition.
Going home after spine surgery can be a very scary experience. I and my team completely understand, and we are committed to helping you with successful discharge and transition back to life.
After surgery, you can expect your back to feel stiff and sore. You may have trouble sitting or standing in one position for very long and may need pain medicine in the weeks after your surgery. It may take 2 to 4 weeks to get back to doing simple activities, such as light housework. It may take 6 months to a year for your back to get better completely. You will have some good days and bad days but overall you should notice steady improvement in pain, range of motion, and overall condition.
You may need to wear a back brace while your back heals or see a physical therapist.
This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.
What to expect after spine surgery: The Journey
Finally, the big scary surgery is behind you and you are back home. There are millions of questions and worries as you get back to your life. Going home after spine surgery can be a very scary experience. Dr. Hwang and his team completely understand, and we are committed to helping you with a successful discharge and transition back to life. Here are some helpful tips and information that we have learned from helping many people through their spine surgeries.
Is it normal?
It is very common during the first weeks post surgery to experience the following:
The nerve always takes time to recover, especially if you had a lot of nerve pain before the surgery. It is very common to experience lower limb pain 2-4 days post surgery and again after 3 weeks. Usually this pain is less than the pain you had before surgery but in some cases it can be severe and quite stressful. If this happens, reduce your activities and to restart or increase your pain killers. Anti-inflammatory pain medications are usually very helpful and in some cases a short course of oral steroids may help.
Remember that a nerve that has been compressed for many weeks or months will remain slightly irritable for a while. This usually resolves within a matter of weeks but you can experience some funny feelings, pins and needles or pain in the legs and feet if you do too much. It is also very common to experience tightness and muscle spasms in the hamstring muscles.
Many people complain about a “new” reported onset of numbness in the area where the pain is now gone following the decompression of the nerve(s). The pain covers up these feelings before surgery and, only after surgery when the pain is resolved do these feelings start to be noticed.
Numbness in the leg or foot is often the symptom that takes the longest to resolve, taking a few months to disappear or become fairly tolerable. However, sometimes the sensations mentioned above can be permanent.
Most people experience a dramatic improvement in their back pain following surgery. It is unrealistic however to expect it to disappear straight away or even
completely. The goal of spine surgery is to alleviate severe disabling, pathological pain. It unforunately cannot get rid of normal aches and pains which would be considered nond pathological.
It is also very common during the first few weeks to experience some pain on the side and quite often below the incision. This is usually caused by some mild spinal joint inflammation and tends to resolve by itself over the course of a few weeks.
Post Surgery Milestones
This is still very early days and you will likely experience different sorts of pain compared with before your surgery. We will make sure you go home with enough pain medications.
Once you are home, walking is an excellent activity to start as soon as you can. Start with short lengths of time then work your way up to 20 to 30 minutes of continuous walking four or five times per week. People with more severe problems or older age groups may not be able to achieve this goal. Do not let this concern you but discuss it with Dr. Hwang at your post-operative appointment.
Try to avoid sleeping during the day as you will have more difficulty getting a good night’s sleep however avoid overdoing it and get plenty of rest. Eat a balanced diet such as fruit, and fiber, and drink plenty of water. It is an excellent time to think about making long-term changes to your diet.
Try to minimize your sitting to less than 20 to 30 minutes because this will increase the strain on your back. Changing position frequently will be good for your back for the rest of your life.
Unless you are told to do so, do not start any core muscle strengthening exercises until you are cleared by Dr. Hwang at your 6-week post-surgery appointment. You can get a gentle massage and stretching if needed after two weeks.
Most people feel quite tired after all the stress of the surgery and it is a perfectly normal physiological response called “adrenaline fatigue”. Your initial stress reaction to the surgery produces a large rise in cortisol, adrenaline, and other adrenal hormones that mobilize your energy, and mental and physical resources to take action. Once the stressful events are behind you, the levels of cortisol and other adrenal hormones drop, making you feel really tired and without energy for a few days to weeks.
You have now progressed quite a lot but hitting a plateau. That is normal. It is normal to experience pain following surgery and many patients experience a few days of strong pain during their recovery, usually around the second or third-week post-discharge from the hospital.
Do not stop the painkillers too quickly but when the pain gets better try to slowly reduce the dose. For example, cutting by half the morning dose for a few days and then the evening dose before stopping the morning dose. As a general rule, painkillers at this time should only be used at a minimal dose and always favor acetaminophen (Tylenol) over stronger painkillers.
You may start feeling stronger but remember that it is still the very beginning of the healing process and do not overdo it.
Week 4 to 3 months
This is the time to get healthy again. Start involving yourself in physical activities. Discuss with Dr. Hwang which ones are the best for you. There is not a big difference between physical activities in terms of protection against chronic low back pain and it is better to do something you like consistently rather than working on your core muscles for a few weeks only. If you had a lot of pain for a long time you have probably lost most of your muscle mass and it will take time to rebuild it again but do not get discouraged.
The pain in the back itself may be due to many factors and may improve slowly or persist to some degree.
Even if your leg pain was better immediately after surgery you may have flashes of pain when you start becoming more active. It is usually the case the first three weeks after surgery. These episodes of pain can be as strong or sometimes even stronger than before surgery. Do not panic and continue taking your pain killers. If you have any doubts or questions, please reach out to Dr. Hwang and his team.
Managing Your Mood, Expectations and Goals
A successful result after the surgery also depends on a positive attitude and efforts by patients to aid recovery. Your pre-operative symptoms may take weeks or longer to fully improve. Generally, symptoms such as pain shooting into the leg improves first. Numbness is often the last symptom to improve and usually can even be slightly worse than before the surgery (do not worry this is normal).
Quite frequently patients experience a brief period of “let down” or depression after surgery. Some may subconsciously have expected to feel better “instantly” even though they rationally understand that this will not be the case. People commonly question their decision to have surgery during the first few days after surgery. As the healing occurs, these thoughts usually disappear quickly.
If you feel depressed, understanding that this is a “natural” phase of the healing process may help you cope with this emotional state.
Quite frequently this happens around day 3 and we call it “the third day blues” and again after 3 weeks where you become more active but still are not fully recovered.
So you are feeling better and the discomfort you are now in is nothing compared to what you endured before surgery or perhaps you feel quite the opposite. Many people become frustrated for not being able to resume normal activities, for example, driving, going back to work or participating in simple activities of daily living. Having to limit or skip your activities, along with pain and discomfort can leave you with the impression that you will never get better.
Remember your body needs to recover from major surgery. How you take care of yourself in the post-operative period will have a direct bearing on the ultimate result. This is the time to take care of yourself rest, eat a well balanced diet high in fiber and protein, walk every day if possible, take a more positive attitude and feel good about yourself. It takes a great deal of courage and determination to undergo what you have been through.
Back surgery can interfere with your sex life, but we want you to resume normal relations with your partner as soon as possible after surgery. We recommend avoiding sex for 2 to 3 weeks after surgery. Once you have begun the healing process, use the position that is most comfortable. Be sure you communicate your fears and concerns with your partner before you resume sexual relations.
How can I care for myself at home?
- Rest when you feel tired. Getting plenty sleep will help you recover.
- Try to walk every day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. Walking may also decrease your muscle soreness after surgery. Remember that movement is medicine!
- You should avoid lifting anything that would cause excessive strain on your back. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
- Avoid strenuous activities, such as bicycle riding, jogging, weightlifting, or aerobic exercise, until you are cleared.
- Do not drive for 2 to 4 weeks after your surgery or until your doctor says it is okay.
- Avoid riding in a car for more than 30 minutes at a time for 2 to 4 weeks after surgery. If you must ride in a car for a longer distance, stop often to walk and stretch your legs.
- Try to change your position about every 30 minutes while sitting or standing. This will help decrease your back pain while you are healing.
- You will probably need to take at least 4 to 6 weeks off from work. It depends on the type of work you do and how you feel.
- You may have sex as soon as you feel able but avoid positions that put stress on your back or cause pain.
- You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
- Drink plenty of fluids (unless your doctor tells you not to).
- You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. Stay hydrated, walk daily, and consider taking a fiber supplement every day to encourage bowel movements.
- Take pain medicines exactly as directed.
- If you are given a prescription medicine for pain, take it as prescribed.
- If you are not taking a prescription pain medicine, ask if you can take an over-the-counter medicine, such as Tylenol and ibuprofen.
- If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
- If you think your pain medicine is making you sick to your stomach:
- Take your medicine after meals (unless your doctor has told you not to).
- Ask for a different pain medicine.
- To reduce stiffness and help sore muscles, use a warm water bottle, a heating pad set on low, or a warm cloth on your back. Do not put heat right over the incision. Do not go to sleep with a heating pad on your skin.
- Keep incision clean and dry. Remove the dressing in 2 days. You may shower once the dressing comes off. Shower with mild soaps such as baby shampoo. No soaking, rubbing, or picking incision and no lotions, creams, hair products to incision.
The spine should be kept straight as much as possible even when getting into and out of bed. The log-roll technique is very useful in accomplishing this, and it involves keeping the knees together and maintaining a straight back while:
- Sitting down on the edge of the bed
- Lowering the head down to the bed while lifting up the legs
- Rolling onto the back
Other sleep tips include:
- Ensure the bed is not too high or too low for the log-rolling technique
- Try different pillows to see what feels most comfortable
Some people may also find that sleeping in a reclined position is more comfortable shortly after surgery.
- Walk daily and try walk a longer every day. Your goal is at least 1 mile a day.
- Start with light stretching and no-weight or light-weight exercises
- Listen to your body and stop if you experience pain
Call 911 anytime you think you may need emergency care. For example, call if:
- You passed out (lost consciousness).
- You have sudden chest pain and shortness of breath, or you cough up blood.
- You are unable to move a leg at all.
Call the Office or go to the Emergency Room if:
- You have pain that does not get better after you take pain pills.
- You have new or worse symptoms in your legs or buttocks. Symptoms may include:
- Numbness or tingling.