Post-surgical Spine Rehabilitation

Some of the traditional spine surgery procedures are laminectomy, diskectomy, foraminotomy, and spinal fusion. Laminectomy is the procedure used to remove two small bones that

make up a vertebra or to take the pressure off the nerves. Diskectomy is a surgery to remove all or part of your disc. Foraminotomy is a surgery to enlarge the passageway where a spinal nerve root exits the spinal canal. Whereas, spinal fusion is the fusing of two bones in your back. 

Once you are home from the spine surgery center, it’s time to focus on crucial aspects of your recovery. 

Factors affecting recovery after spine surgery

Everybody recovers at a different pace, and the factors that affect spine recovery are:

1. Type of surgery

• Fusion/ disc replacement- This type of surgery requires 6-12 months of recovery time. 
• Discectomy/laminectomy: The recovery rate in this surgery is 3 to 6 months.
• Less invasive surgeries: This type of surgery has fewer surgical interventions hence the patient recovers well and quite early. 

2. The health of the patient

• Fitness: The wound recovery rate is high when the patient is fit and active. 
• Medical health: if the patient is not having any comorbidities, then the recovery rate is pretty high. Diseases like diabetes slow down wound recovery. 
• Age: sadly it’s true that older patients will take a longer time to recover. 

Post-surgical spine care

Post-op care includes physical therapy and most of all consistent extra efforts towards wound care and a healthy lifestyle. Recovering from spine surgery can take months or a year, and it starts right after the surgery when you are in a spine surgery center. 

1. Hospital care after spinal surgery

A hospital stay after the surgery is typically 2 to 4 days, and it focuses on pain management and guiding the patient on how to move. Pain medications are administered daily. Blood tests are also done following surgery to have check and balance of the hemoglobin and other blood components. Physical and occupational therapists continuously work with the patients to guide them about the safest ways of walking, standing, or sitting. To avoid twisting the spine while getting out of the bed, therapists also teach a technique called log-rolling. 

A patient needs to have a sound rest. The patients will keep on doing exercises as guided by therapists, then they are moved from bed to chair and eventually to a walker.

1. Recovery after discharge: 

After the patient leaves the hospital, they need to take good care of their wound at home and follow all the guidelines. At-home care is classified according to as:

• Pain management: pain is likely to continue for some time, and the patients are advised to have their medications on time as prescribed by the clinician. 
• Sleep: A good sleep is a vital part of wound recovery but the patient needs to follow proper sleep positions. patients back should always be kept straight when in a recovering phase even when getting into or out of the bed. Patients are advised to use the log-roll technique when getting out of the bed. 
• Sitting: everyone wants to sit on a comfy soft sofa and watch tv for hours, but for patients who recently had a spinal surgery it’s advised to sit on a sturdy chair with arms. Patients are advised to change positions every now and then. 
• Wound care: It’s very important to keep the wound clean and dry. Patients should clean the wound site with soap and water and pat dry it. patients can take a bath if the dressing remains clean, dry, and secure. A doctor or a nurse is supposed to remove sutures after 10-14 days. 
• Physical therapy: As the pain level decreases and the wounds heal, it’s time for the patient to get active again. Walking is the most ideal and the easiest part of early exercise. Patients are advised to walk slowly and stop when the pain flares up. Special exercises to strengthen the backbone muscles are also advised. Physiotherapy focuses on guiding the patient about improving functions at home, work, leisure, and doing other daily life activities effectively. 
• Nutrition: Healthy diet and nutrition play a key role in wound recovery. A well-balanced diet with a good amount of protein, fresh vegetables, and fruits is crucial for wound recovery. Protein or nutritional shakes are also advised. After surgery, the body needs more protein and other nutritions then it did before to heal properly. 

What activities are restricted after spinal surgery? 

People who recently had spinal surgery are advised to limit many of their activities for a specific period. The activities that are restricted are Bending, twisting, lifting, or driving. House Chores such as washing, cooking, cleaning, or shopping are also avoided as they involve bending or lifting. 

Adapting the home environment

It is very beneficial for the patients to have a home environment that is convenient and support for them. Patients should be having a caring family member who is there to help all the time. The patient must be having these items for a good recovery:

• A walker: if a patient is unable to walk by himself then a walker is necessary and it should be available so that the patient does not fall. 
• A recliner or extra cushions: using a recliner takes the pressure off the lower back and it helps the patient to have a good time. Extra cushions must be available to make the patient more comfortable.  

Factors that can Delay wound healing

Usually, it takes 3 to 6 months for a wound to heal but if the following things are observed, wound healing delays. 

• Smoking
• Obesity
• Certain medical conditions such as diabetes
• Depression, anxiety or any other mental illness
• Malnutrition
• Prolong use of opioids before surgery
• Doing heavy exercise or movements during the early phase of recovery

When to call the doctor?

Patients should contact their physician/clinician when they notice the following:

• Chills or fever of 101
• Swelling
• Chest pain, shortness of breath
• Back pain that is worsening day by day

REFERENCES

1. Carragee EJ, Vittum DW. Wound care after posterior spinal surgery: does early bathing affect the rate of wound complications?. Spine. 1996 Sep 15;21(18):2160-2.
2. McGregor AH, Dicken B, Jamrozik K. National audit of post-operative management in spinal surgery. BMC musculoskeletal disorders. 2006 Dec;7(1):47.
3. Skolasky RL, Mackenzie EJ, Wegener ST, Riley III LH. Patient activation and adherence to physical therapy in persons undergoing spine surgery. Spine. 2008 Oct 1;33(21):E784.