Dressings
When you return from surgery, you will have a surgical dressing over your incision. The dressing will be removed several days after your surgery. You may have stitches (sutures) under your skin, which will dissolve as healing occurs. Some patients may have stitches (sutures) or staples that are visible. They are usually removed two to three weeks after surgery by a visiting nurse or in the surgeon's office.

Keeping You Comfortable
The amount and type of pain you may have will vary and may be sharp, dull or achy. Before surgery, it is important to talk to your doctor and anesthesiologist about pain management. Pain relief may include medication by mouth and IV medication. If you feel that the medicine is not giving you relief, please talk with your doctor or nurse.

Intravenous (IV) Therapy
An intravenous line (IV) in your arm will give you fluid and nourishment. Once you resume eating and drinking, these IV fluids will be stopped. You will also have blood transfusions through the IV, if needed. You will receive an antibiotic through your IV every few hours for several days after your operation to prevent infection. The IV should not be painful. If it is, let your nurse know so that he or she can check it.

Diet
You will be allowed to have ice chips or small sips of water for the first 24 to 36 hours or until your stomach is ready for food. You will progress from liquids to regular food as soon as you are able to tolerate eating. Some patients will not be allowed to eat or drink for 24 to 48 hours.

Medications
In addition to medications you were taking before surgery, laxatives and sleeping pills will be available to you if you need them. Please ask your nurse or doctor any questions or concerns you have about your medications.

Preventing Breathing Problems
It is important to practice deep breathing exercises after your surgery.

• Place your hand on your stomach. Breathe in through your nose. Notice that your stomach rises and your chest expands. Hold your breath for two seconds. Breathe out through your mouth. Notice that your stomach goes down. You should always cough following the deep breathing exercises. This will help clear your lungs.
• Take several deep breaths.
• On your next breath, breathe in through your nose and hold your breath for two seconds.
• Then cough two or three times in a row
• You may need to do several 'double coughs' to clear your lungs. Your nurse will also teach you how to use an incentive spirometer, a device that helps you to breathe deeply. You should use this 10 times an hour while awake.

Preventing Circulation Problems
Maintaining good circulation in your legs after spinal surgery is very important. You can help your circulation by doing your leg exercises and walking. You will also wear sequential compression boots that automatically inflate and deflate, helping to pump the blood in your legs back up to your heart.

Activity Following Lumbar Fusion Surgery Positioning
You will be in bed on the day of your surgery. The nurse will help you "logroll" from side to side as needed to prevent stiffness and promote good circulation. Logrolling is turning your hips and shoulders at the same time without twisting your back. You may have a pillow placed under your knees to decrease stress on your back. You should not lie on your stomach, as this can cause unnecessary strain on your back. You should ask for help when you feel ready to change your position.

Moving In and Out of Bed
When you are allowed to get out of bed, the nurse will assist you.

To get out of bed

• Logroll to the edge of the bed.
• Lower your feet over the edge of the bed and push on your elbow to get to a sitting position while keeping your back straight. To get back in bed Sit on the edge of the bed
• Lower yourself onto the bed on your side, coming down on your elbow. As you do this, lift your feet into the bed.
• Once you are lying down you can logroll onto your back or other side.

Activity Out of Bed
It is good to take short walks in the hallway. Remember though, walking should not increase your back pain or cause leg pain. When you are sitting, choose a firm, hardback chair. Don't sit for longer than 20 minutes at a time. It is better to walk around or lie down to rest. Do not bend or lift. If you must stoop, bend your knees and keep your back straight while stooping and straightening up.

Exercises
Your exercise program will vary depending upon what your doctor prescribes and your type of surgery. Your therapist will tell you which exercises you can do. You should do these exercises three times a day, in three sets of 10 each.

Ankle Pumps
Lying on your back or sitting, move your ankles up and down as far as possible without moving your legs. This helps your circulation.

Quadriceps setting exercises
Lying on your back, tighten your thigh muscle by pushing the back of your knee down on to the bed. Hold for a count of five seconds and relax.

Gluteal setting exercises
Lying on your back, squeeze your buttocks together. Hold to the count of five and relax.

Depending on your surgery and your doctor's orders, you may need to wear a back brace. These braces usually extend from your armpits to your groin and may be made of rigid plastic or canvas with metal stays. You should always wear a cotton tee shirt under the brace to help decrease irritating your incision. The staff will teach you and your family how to apply the brace correctly and how to care for it when you go home. Ask your doctor or nurse for specific instructions on when and how to wear the brace, and whether or not you can remove it to shower.

Discharge Instructions

Incision Care
If you have visible sutures or staples, they will be removed about two weeks after surgery either by the home care nurse or at an early doctor's visit. Small pieces of paper tape, called Steri-strips, will be placed over your incision. These strips will fall off on their own; so do not pull them off, since this could disrupt your incision. If your doctor allows, you may shower and wash your incision with a mild soap and water and rinse thoroughly. However, you should not take tub baths, go in a swimming pool or immerse your incision in water in any way until permitted by your doctor.

Activity
Activity is a very important part of your recovery. Walking is the best way to recuperate and heal tissue. There are no restrictions for walking or stair climbing. Avoid sitting for long periods of time. Sitting is recommended for 20 minutes three times daily, preferably for meals. Avoid bending and twisting motions. You should not lift any objects heavier than 10 pounds for the first month at home. You may not drive. However you can take short car rides (no longer than 20-30 minutes). You can resume sexual activity when you are comfortable (usually six weeks).

Back Brace
If your doctor has ordered a brace for you, you will receive specific instructions about its use before you leave the hospital. When your doctor allows, you may remove your brace for showering.

Medications
A prescription for pain medication, if needed, will be provided at the time of discharge.

First Post-Op Visit
The first postoperative visit should be scheduled for four to six weeks after discharge from the hospital.

When to Call Your Doctor
Please call the doctor if you notice any of the following symptoms or you are worried or have questions.

• Increase in redness, swelling, warmth or tenderness of your incision, or drainage from your incision.
• Flu-like symptoms, body temperature above 101.5 degrees F for more than two days.
• Numbness, tingling or change in sensation in your legs.
• Difficulty controlling your bowels and/or bladder.

To learn about Dr. Albert’s practice, click here.

Authors:
Rothman Institute
Department of Home Healthcare
Department of Nursing
Department of Orthopaedic Surgery
Department of Rehabilitation Medicine