Patient education: Thoracic or lumbar spinal fusion – Discharge instructions (The Basics)

What are discharge instructions? — Discharge instructions are information about how to take care of yourself after getting medical care for a health problem.

What is thoracic or lumbar spinal fusion? — Spinal fusion is surgery to permanently join 2 or more bones together in the spine. Then, there is no movement between those bones anymore. "Thoracic" and "lumbar" mean the middle and lower parts of the spine (figure 1).

Typically, the doctor uses a "bone graft" to join, or fuse, the bones together. They might also use screws and rods to hold the bones in place. Sometimes, they will also remove bone or tissues that are pressing on the spinal cord or nerves before doing the fusion (figure 2).

How long will it take to recover from surgery? — How long it takes for you to recover, and what you need to do, depends on which type of surgery you had. If you had minimally invasive surgery, you might be able to return to your normal activities sooner. With open surgery, it usually takes longer to recover.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

You should also:

●Try to keep your spine straight. Limit bending, turning, and twisting movements until the doctor says that it is OK. Be extra careful when getting in and out of bed (figure 3).

●Wear your back brace as instructed, if your doctor recommended one. This helps with healing. In some cases, you can remove the brace while you shower or are lying down.

●Do ankle circles or move your ankle up and down like you are pressing on a gas pedal, as instructed. If you were given compression socks or hosiery, wear them, unless you are bathing or showering. This helps prevent blood clots.

●Take all of your medicines as instructed.

•Use a stool softener to help prevent constipation, if needed. This is a common problem if you take opioid pain medicines.

•Take non-prescription medicines to relieve pain, such as acetaminophen (sample brand name: Tylenol). These can be used instead of opioids.

•Avoid "NSAID" medicines unless your doctor says that it is OK to take them. NSAIDs can delay bone healing. This includes ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve).

●Take care of your incision – You might have stitches, skin staples, surgical glue, or a special skin tape on your incision. If you had minimally invasive surgery, you might have more than 1 incision.

•Keep your incision dry and covered with a bandage for the first week or so after surgery. Your doctor or nurse will tell you exactly how long to keep your incision dry.

•Once you no longer need to keep your incision dry, gently wash it with soap and water whenever you take a shower. Do not put your incision underwater, such as in a bath, pool, or lake. This can slow healing and raise your chance of getting an infection.

•After you wash your incision, pat it dry. Your doctor or nurse will tell you if you need to cover your incision with a bandage or gauze.

•Always wash your hands before and after you touch your incision or bandage.

●Increase your activity slowly – Start with short walks around your home, and walk a little more each day.

•Avoid heavy exercise or activity for at least 4 to 6 weeks. (Your doctor or nurse will tell you exactly how long to avoid specific activities.)

•The doctor might tell you to not lift anything heavier 10 pounds (about 4.5 kg).

●Eat when you are hungry – If you have an upset stomach, it might help to start with clear liquids and foods that are easy to digest, like soup, pudding, toast, or eggs. You can eat other types of foods when you feel ready.

●Use ice or heat to help ease pain or muscle spasms:

•Place a cold gel pack, bag of ice, or bag of frozen vegetables on the sore area every 1 to 2 hours, for 15 minutes each time. Put a thin towel between the ice (or other cold object) and your skin.

•Place a heat pack or heating pad on the sore area every 1 to 2 hours for 15 minutes at a time. Never go to sleep with a heating pad on your body.

●Try to stop smoking, if you smoke. Bones take longer to heal if you smoke.

What follow-up care do I need? — The doctor will want to see you again after surgery to check on your progress. Go to these appointments.

If you have stitches or staples, you will need to have them taken out. Your doctor will usually want to do this in 2 to 3 weeks. Some stitches absorb on their own and do not need to be removed. If the doctor used skin glue or skin tape, it will fall off on its own. Do not pick at it or try to remove it yourself.

The doctor might have you work with a physical therapist (exercise expert) after surgery. They can teach you exercises to strengthen and protect your back.

When should I call the doctor? — Call for advice if:

●You have a fever of 100.4°F (38°C) or higher, or chills.

●You have redness, swelling, or drainage around your incisions.

●You have new or different pain, weakness, or numbness in your legs.

●You have problems standing, walking, or moving.

●You have problems urinating or having a bowel movement.

●You have a severe headache.

●You have nausea or vomiting for more than 2 days after going home.

More on this topic

Patient education: Thoracic or lumbar spinal fusion (The Basics)
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Patient education: Posterior cervical spinal fusion (The Basics)
Patient education: Low back pain in adults (The Basics)
Patient education: Vertebral compression fracture (The Basics)
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