Having completed your surgery, all of us at CCSI now want to see you steadily return to health. To help you understand the recovery process you are beginning, we've outlined below the main steps in this process.
The length of stay in the hospital can vary greatly between procedure types as well as amongst individual patients. In general, a cervical surgery requires a two day hospital stay. A lumbar decompression surgery has a similar length of stay. Fusion surgery can require a four to five day stay in the hospital. Minimally invasive lumbar fusions may require only a one to two day stay. Complex scoliosis or other revision and reconstruction surgeries may require more time in the hospital. The individual patient's general condition and age may greatly influence the length of stay and each patients situation is unique. This description is therefore a generalization only. Your needs may be different.
The first day after surgery is mostly a day of rest. Pain medications will be adjusted and blood tests will be performed as needed. The therapists will allow you to stand up and walk as tolerated with their help. A (PCA) Personal Analgesia Pump is often used to allow you to control your own pain medication.
Small drainage tubes are often placed in the incisions. These are removed on the second day. The PCA pump is also slowly decreased and replaced with oral pain medications. Dressings are changed. Physical therapy is continued with more walking, sitting and education.
The priority is more rehabilitation as required. The patient should be working towards a regular diet and voiding normally at about this point in time. The decision as to when you are ready to go home is made during this time. It is based on all of the issues already described as well as clearance by the Physical Therapists. If more rehabilitation is required, we will usually transfer you to the rehabilitative unit at this point. This unit is part of the same hospital but is run by physiatrists such as Dr. Aznin. Your surgical team will visit you there but are no longer your primary (decision making) doctors for the duration of your rehabilitative stay.
The day of discharge brings a flurry of activity. Prescriptions are provided and discharge instructions reviewed. These are all provided in a written format as well. You will need to arrange for transportation home. You are allowed to ride in a regular car but make sure it is one that is easy to get in and out of. You of course, will not be allowed to drive your own vehicle home. At this time, is a good idea to already call the appointment desk at CCSI to set up your first office visit which should occur in about 10 days.
During these first few weeks, you will find yourself to be very tired. As such, you will be spending half of your time resting in bed and the other half, up and around. You will certainly be able to go to the bathroom and manage your surroundings without additional help. You will most likely be using pain medications on a routine basis. It is a good idea to have someone available to help you for the first two weeks or so at home.
Activities at this point should include a progressive walking program. Use of a stationary bicycle or treadmills are also allowed, although it may be too early to begin this program as of yet. Do what you feel you can do, but be conservative and safe. In any event, no lifting of greater than 10 pounds is allowed. Also, no stooping, twisting, lifting, housework, or yardwork are allowed at this time. A return to sexual activity may occur when you feel ready.
During this period of time, the wound must be kept clean and dry. It is recommended to keep a dry 4x4 inch gauze over the incision at all times. This dressing should be changed on a daily basis. Cover the wound with a cut piece of Saran wrap, secured with tape, for showering purposes. This will keep the incision dry during this process. Change this to a dry gauze once again after the shower. Place no lotions, powders, or ointments on the incision unless instructed to do so.
Keep track of your prescription medications. Write down a schedule as to when they may need to be taken. Please remember, narcotic pain medications usually require the actual written prescription. Do not wait until you are entirely out of medication to call the office for a refill. A 3 to 4 day warning to our office of your refill needs will make the whole process run more smoothly.
As the weeks progress, you can gradually increase your amount of activity however, your restrictions do not change at this point. Returning to work is based on your type of surgery, type of work, level of energy, and general comfort. In general, a laminectomy surgery allows you to return to a sedentary type of job within two weeks. A more involved fusion surgery combined with more physical types of work may require up to two or three months of recovery prior to returning to work. Discuss the specifics of your situation with your doctor for a better prediction of your particular needs.
Your next visit in the office will occur at about six weeks after surgery. We will now begin to increase your level of activity. This may include progression towards a basic exercise program. Again, the magnitude of your particular surgery will influence this time frame. For instance, laminectomy surgeries allow for rapid return to abdominal and back strengthening exercises. Fusion surgery requires a longer period of time. In any event, with exercise, excessive motion of the lumbar spine and pelvis is to be avoided. Physical therapy may or may not be initiated at this point.
An office visit at three months after surgery is the norm. At this time, a more vigorous physical therapy exercise regimen will be initiated. X-rays will usually be obtained as needed. This is done to check the healing of the fusion, if performed. If you're surgery was a straightforward laminectomy, a full release to all activities may well be provided at this time. Fusion surgery however, will require the same restrictions for another three months.
The office visit at this time will again focus on your rehabilitative agenda. X-rays will also be obtained to further assess the fusion process. It is expected, that most fusions will be approaching maturity at this point. As such, most all restrictions will be lifted at this time. Understand however, the fusion is not as strong as it will ever be until closer to one year after surgery. It is therefore one year before it is expected that your recovery is totally complete.
A routine check in the office after a major spine surgery is recommended on a yearly basis. At this time, your exercise program will be reviewed and recommendations made to maximize your strength, agility and endurance. X-rays will also be obtained as needed to monitor the fusion and adjacent areas of the spine. Tips on lifestyle improvements to further help your spine throughout the years will be a major focus as well. The medical staff at CCSI have a strong commitment and dedication to the long-term health of your back.