Minimally Invasive Transforaminal Lumbar Fusion - Recovery

Incision Care

  • Because this surgery is minimally invasive, you will typically have 2-3 incisions on your back.  If navigation was used, you may also have two tiny holes over your hip bone.
  • Your incisions are closed with sutures (also called “stitches”) on the inside of your skin.  These are absorbed over time by your body.  The outside of your skin is closed with a skin glue.  The skin glue will eventually come off in its own time.  
  • Sometimes patients may need sutures or staples on the outside of their skin.  If you have sutures on the outside, these will be removed at your follow up appointment.  These should be removed by Dr Grunch’s office in 10-14 days after surgery.
  • You may take a shower the day after surgery if your incision is closed with skin glue.  If your incision is closed with sutures or staples, you may take a shower in 3 days.  Do not scrub your wound, but gently cleanse it and pat dry. 
  • Do not submerge into water or a tub for 6 weeks.   Leave the wound open to dry unless otherwise directed.
  • It is normal to have a small amount of brown to reddish colored ooze for a few days.
  • Do not apply ointments or creams to the incision. 
  • Some patients need a back brace after surgery.  Dr. Grunch will instruct you on when you need to wear it. 
  • Some patients may also need a bone growth stimulator.  If so, the company will contact you after your surgery.  If you have questions about this, please contact our office.  
  • If you expose your incision to sunlight within 6 months of your surgery, please make sure to place sunscreen over the incision to avoid discoloration.

Pain Expectations

  • It is normal to expect pain after back surgery.  That is why we prescribe medication to ease you through the healing process.
  • After surgery, common pain areas are in the around the incision and in the low back.
  • This pain will get better with time as your body heals, so it is important to be patient as your body is healing.
  • Many patients report that their prior back pain and/or leg pain is much improved soon after surgery
  • It is normal to have a sore throat after endotracheal intubation, and this will improve over the week after surgery. 

Medications

  • You will be given prescriptions for a pain medication and a muscle relaxer. 
  • Do not take pain medication on an empty stomach.  This may make you feel nauseated. 
  • Do not drink alcohol if you are taking pain medication.
  • Patients usually require these medicines for at least 4-6 weeks after surgery.
  • If you feel that your pain is well tolerated, you may begin to wean yourself off of your pain medication sooner than your post-op visit.
  • If your pain requires narcotic pain medication for > 8-12 weeks after surgery, you will be referred to a pain management specialist to help you with your pain.
  • Because pain medication can cause constipation, it is important to have stool softeners and laxatives at home such as Colace or Senna to prevent constipation
  • If you still have constipation after using these medicines, you may use an over-the-counter suppository or enema.  

Medications to Avoid

  • NO Aspirin, Advil, Aleve, Motrin, Naprosyn, Ibuprofen, Naproxen, Mobic, Meloxicam, Celebrex, or any other anti-inflammatory medication.  These are anti-inflammatory medications and may impair fusion.  We recommend trying to avoid these medications for the first 3-6 months after surgery.
  • If you normally take these medications for other medical conditions such as arthritis, we ask that you hold these until otherwise discussed at your office visit.
  • NO blood thinners such as Aspirin, Coumadin, Warfarin, Xarelto, Plavix, etc.  for 5-7 days after your surgery.  We will tell you when you may resume your blood thinners.  

Therapy 

  • You will receive physical therapy while you are in the hospital.  This will help you to walk and move around for normal daily activities before you are discharged.  
  • When you are at home, walk between 30-60 minutes a day, but not all at the same time.   Divide your walks into smaller intervals of 10-15 minutes at a time.
  • It is important to walk for your overall recovery for a number of reasons.  Getting out of bed is good for your lungs, it prevents blood clots from forming in your legs, and speeds your recovery.
  • Do not sit for more than 30 minutes at a time.  Move around to prevent your muscles from tightening and becoming stiff, which can lead to more discomfort.
  • Use your common sense, if your body says that it is tired, listen to it.

Restrictions

  • Activities such as bending at the waist, lifting >10 lbs, and twisting are restricted during your recovery period, which is about 6 weeks.
  • This means NO household chores such as vacuuming and laundry, hobbies such as golfing, and yard work and gardening.
  • If you have young children or grandchildren, do NOT pick them up.  
  • Allow someone else to help you at home.
  • You may drive as long as you are not taking narcotic pain medication. 
  • It is ok to ride as a passenger if you are taking narcotic pain medication.
  • If you are unable to work due to these restrictions, please let us know if we need to complete any paperwork for your employer. 

Diet

  • It is important to remember to eat and drink fluids so that your body may properly heal.
  • If you are experiencing nausea, follow a “BRAT diet” which is Bananas, Rice, Applesauce, Toast and advance as tolerated.

Smoking 

  • Smoking constricts your blood vessels which carry oxygen and nutrients to your healing bone and muscles.  
  • It also slows down the bone healing process and may possibly lead to failure of fusion of the bone graft, which is the ultimate goal of your surgery.  
  • Carefully consider quitting smoking during this time.  If you would like help in smoking cessation, please let us know.

Sexual Activity

  • Back and neck pain 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 6 weeks after surgery.  Once you have begun the healing process, use the position that is most comfortable.  You may find that lying on your back is the most comfortable if you can support your partner’s weight or your partner can support him/her self with arms and knees.  Side lying may also be comfortable since neither partner is bearing the burden of the weight. Decide if a small pillow at the waist is helpful in supporting the spine and you will probably want a pillow located under your neck and head.  Be careful not to twist the lower back.  Be sure you communicate your fears and concerns with your partner before you resume sexual relations.

Call our office if you have any of these symptoms:

  • Fever > 101 degrees 
  • Constipation that is not relieved by stool medications 
  • Redness, warmth, or significant drainage from your incision
  • Shortness of breath or Chest Pain 
  • Pain, swelling, or redness in your calves
  • Unexplained incontinence or accidents involving your bladder or bowel, or if you are unable to urinate
  • Worsening pain in the legs than before surgery

Follow up appointment

  • We have scheduled a follow up appointment for you that is about 2-3 weeks after your surgery
  • You will be provided with a card listing the date and time
  • If you need this appointment changed, please call our office 
  • You will typically need an x-ray at that visit.  It is important to keep your postoperative appointments after a fusion procedure, as Dr. Grunch typically performs x-rays over the first year after your surgery to ensure it is healing correctly.

If you are experiencing any problems or have any questions, please call Stacey at 678-207-4231

 

 

6 Tips for Recovery from Spine Surgery

1. Put commonly used items within reach.

In the early stages of recovery from spine surgery, patients should avoid bending, lifting, and twisting.  It is helpful to place items you use daily on the countertops or shelves where you can easily reach them.  Keep toiletry items near the sink.  Place dishes on the kitchen counter.  You may choose to purchase disposable plates, cups, and cutlery to avoid the need to wash dished for the first few days after you return home.  

2. Arrange for someone to stay with you.

If you live alone, it is a good idea to have a friend or family member stay with you for the first few days after surgery.  You may need help with errands or getting around the house.  If you require more extensive help after surgery, Dr. Grunch may arrange for home health services.  

3. Prepare meals ahead of time.  

It can be difficult to prepare healthy meals the first few days you are recovering from back surgery.  Prepare your meals ahead of time that you can keep in your freezer.  You should also stock your refrigerator and pantry with healthy snacks so you are not tempted to reach for unhealthy convenience foods. 

4. Items like slip-on shoes and grabbers can help to avoid bending.

Bending is restricted after surgery.  You may want to have shoes that you can easily slip on to avoid bending over to tie your shoes.  If you are doing physical therapy exercises or walking for longer periods of time, you may want to have someone help you lace up your shoes instead of wearing slip-on shoes.  Grabbers are hand-held devices that are about 2-3 feet long and have a grabber on the end to pick up small items.  They can be purchased at large department stores and pharmacies.  

5. Take precautions to avoid slipping.

Patients are encouraged to get up and walk around to avoid stiffness.  You will want to make sure to avoid any slipping hazards in your walking path.  Before surgery, make sure that the areas where you will be walking are clear of tripping hazards.  Electrical cords should be secured and out of the way.  Rugs should be removed or taped down.  A shower mat can help avoid slipping in the shower.  

6. Make sure you have extra pillows for support when sitting or lying down.  

When lying on your back, a pillow placed under the knees can help to take pressure off your lower back.  If you prefer to lay on your side, you can place a pillow between your knees.  Reclining chairs and donut pillows can sometimes help to increase a patient’s comfort while sitting.  

By taking time to prepare yourself and your home before surgery, it will help to ease your mind to know that everything is in place for you when you return home from surgery. 

Nicholas Morrison