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What should I expect after L5-S1 PLIF?

AmieAAmie Posts: 7
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
I am being scheduled to have a L5-S1 PLIF later this month. What should I expect after surgery? From the moment I wake up until, well, forever?

Is there anything I should buy to prepare for this surgery (button down pajamas, shower chair)?

How long before I can grocery shop, drive a car...?

Any input would be greatly appreciated!!




  • I am 7 weeks post op and can tell you a bit about my experience. I am in the UK so it might be a bit different for you.

    Despite all the posts saying how bad it is when you wake up I was actually not in pain when I came round. I think the anaesthetist gave me quite a lot of analgesic through the IV and the surgeon had dumped a load of diamorphine in my spine before closing me up.

    I took a few clicks on the PCA because the nurse said to as I had said my pain was about a 4. I wish I hadn't - it made me sick and the pain wasn't that bad. The surprising thing is that paracetamol actually worked. After all the months of sciatic pain that wasn't touched by anything to have pain taken away by a simple OTC drug was amazing!

    I did not have a catheter and had to use a bed pan. That was hard. The first time it took quite a while but the second time I tried for over an hour to go. That was one of the worst things. After that it was ok.

    I had a drain in my back that pulled a bit when I moved - that was a bit uncomfortable. It was taken out two days after surgery. It doesn't really hurt but feels odd when it comes out.

    I had blow up leg massagers on. The first night they were quite soothing because I didn't associate the noise with the leg thing because of the after effects of the anaesthetic. The next night they were quite irritating!

    The first time you get up is difficult but it does get easier. The thing that made it hard for me was that the hand I had to use to push myself upright was the one with the IV in it and that hurt.

    I came home after 3 days. To start with you can't do much. Getting dressed needs help because of socks etc. When you drop something it is annoying.

    I got a wound infection at 11 days post op which leaked for over three weeks. That wasn't nice.and it meant that my activity was restricted so as not to stir it up. Be vigilant - make sure whoever is changing your dressing after a shower has a good look.

    I can now walk quite a bit further - about 30 minutes without too many ill effects. I would be able to do more if not for the infection putting me back. I have just been allowed to return to swimming but haven't gone yet. I tried to drive but my abdominals are giving me some grief. In fact that has been quite a shock. I thought I was quite fit but it turns out my abdominals aren't so hot and they are used loads to compensate for the weakness in my back. My advice - do a load of strenghtening exercises now while you still can! Wish I had!

    I have been to the shops a bit but not alone. So much stuff is low down and I don't think putting stuff in and out of the car would be a good idea. Maybe if you had help at the store and again at home.

    My house is a tip despite my husband being off work. I can see all the jobs that need doing but am ignoring them!

    The main thing you need is patience. Also remember that everyone heals and recovers differently. I thought I was doing badly because some people are back at work etc by now but then I read about others who are still suffering with pain at this stage.

    I hope it all goes well for you. The anticipation was worse than the actual op for me. I know I was terrified so I hope you aren't worrying too much.

    Good luck.

  • Morning to ya, and good luck with your surgery. I had that same surgery done and am just shy of one month out. In fact, I go for my one month check up Monday morning. Well, you asked, so here's my story.

    I went in for surgery at 0530. There I had the SSEP leads hooked up and several other details and then off to anesthesia. I'm going to guess the anesthesia too effect about 0730 and then by time they had me prepped and on the table (ya know, it's a special table they'll have you on for this surgery) it was about 1000. Next thing I remember was waking up in ICU and it was almost 1130PM.Surgery was almost 12 hours; there were some complications and I had to have like 4 units of whole blood and several of platelets. I remember the ICU nurse being there and some of my family there too. I was in a great deal of pain right then. I don't think they let me stay awake too long though. In a couple days, I was in my own room. First day there, pain was bad and appetite was nil. I really felt like crap. Second day was marginally better and the third day was better still. I was in hospital 8 days and really, each day in there I got to feeling better by a good margin.By the time they let me out, I was really feeling pretty good. I mean, there's still all this hardware implanted in your back, and yes you can feel that, but all in all it ain't bad. Oh, I did have the catheter and I'm glad. It hurt way to bad to be messing around going to the bathroom all the time.

    At home: I'm spending most of my time in the guest room, where my 'recovery room' is. Boredom is one of he biggest problems now. Pain, luckily isn't. I'll still take the odd pain pill, but not every day. I have a TV in here and I can get up and out each morning and afternoon for a few hours. I walk about 1/4 mile most days. Showering isn't really too hard. I installed a shower head on a hose prior to surgery and it really helps me. I don't use the shower chair, but that's just me.

    I'm off work a month already, and I can see easily going three or four months off (but I ain't the Dr).
    So far, I'm glad I did the surgery, but it is a REAL big deal. Please try to have someone to help you the first couple weeks. My wife and mother in law were priceless there at first. Now a month on, I'm pretty much where I can do for myself, but that first bit is a doozy.

    Please feel free to PM me if there's any specific question I may answer for you. Good luck and don't worry too much. I look forward to hearing how your procedure goes.

    Peace and Love
  • Thank you for telling me your story Helen!
  • There is a list at the top of this section with suggestions from members on post-op "must-haves":

    Reading through it gets you thinking about life post-surgery and what types of things YOU will want afterward. For me the most important items were a satin bottom sheet and a raised toilet seat. With a PLIF surgery the muscles are cut and it is difficult to reposition yourself. In the hospital, I felt like I was stuck to the bed with velcro. The satin sheet makes this much easier.

    What you wear will depend on whether your surgeon requires a brace, or not. My nights and days all ran together so I didn't bother with pjs. So many of the clothes today are multi-purpose...lounge clothes/yoga pants/type things...and that's what I lived in for the first couple weeks. I couldn't stand having anything around my waist so anything with an elastic waistband worked for me.

    Prior to surgery try to rearrange your kitchen so things you need often are at waist-high level -- anything around the house you will want and need should be available so you won't have to bend or reach up overhead. You will have these movement restrictions for quite some time, so it is worth the effort to do some rearranging now.

    All the other questions are difficult to answer as it varies so much from person to person, and the particular type of procedure. I didn't drive for the first eight weeks as I was on strong pain medications. It was also the middle of the winter in the north and was cold and icy out and I had no desire to go outside! In my case, the first eight weeks were not great, with the first two being fairly nasty. But a month later (12 weeks) I was well enough to fly half-way across the country with my son, to look at real estate for five straight days...and I danced at his wedding at five months (just 2 dances... ;) ).

    I think most people will tell you that healing from an open PLIF is a long, slow task. It requires patience as at times things move much more slowly than it seems it should. Most people start feeling more like themselves anywhere from three to six months, but complete healing will take a year or even longer if a nerve has been compressed for awhile, or if there is nerve damage for any reason.

    PLIF is a BIG surgery. You will be tired afterward and it takes awhile to get your energy and stamina back. How long depends on how long you were laid up prior to surgery...your prior conditioning, level of activity, etc.

    Please post often with your questions and comments. There are many of us on the board who have been through what you are facing and will be happy to share our experiences.

  • I highly recommend getting a toilet seat riser! I didn't think I'd need one, so I didn't buy one... and on the 2nd day I had my family run out and purchase one and it was a LIFE SAVER!
  • The shower wand helps. The suction cup based grab handles help. Make sure you have a rubber floor mat. You do not want to have a slip in fall in the shower. That is critical post surgery you not fall down. The wand makes it pretty easy to hose yourself down. I tried an old plastic garden chair and found it more annoying than useful.

    The toilet seat riser. Most definitely. The taller you are the more it helps. Especially some of these toilets that sit really low. They're probably just fine if you're 5ft. I got riser that is like 4"-5" thick and it has arm/hand rails on each side. This is great to stabilize yourself when lowering and mostly getting yourself off the toilet. First couple of times have someone in front of you to make sure you don't slip backwards if you don't have enough strength. I like my throne seat :-)

  • SpineAZSpineAZ WiscPosts: 1,084
    I bought one years ago for a surgery and it's been great for all subsequent surgeries. And now we use it for a variety of stuff and have it available for when one of us is sick or just had surgery.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Was my surgery, so it will be 1 week tomorrow. I had a 2 level lumbar fusion, anteror and posterior approach (I don't know the acronym for that?) Honestly, the pain was bad but not as bad as I thought it was going to be. I had myself really prepared for the worst. I was on the pain pump for 2 days, then they switched me to percocet, pill form. I had a catheder for the first day, thank God. They had me up and going to the bathroom the second day, with a walker, very hard at first but I just pushed through it. Once they took me off of the pain pump it was easier because I didn't have to drag that thing around. The physical therapist started working with me on day two, they had me walking, practicing stairs etc. They kept stressing how important it is to walk, not just sit all the time. I didn't get to eat for 4 days because my bowels refused to "wake up". They insist that you start passing gas before you can eat. I have a brace that I have to wear all the time except when I am in bed, I like the brace, it feels good when I have it on. I will be out of work approx. 6-8 weeks is what they are estimating. Hmmmm, I can't think of anything else. I wish you all the best!!!!
  • Thanks for you story Aaron. How did your one month check up go. I hope you are healing well and fast!

    What kind of restrictions do you currently have. How much can you lift, how long can you stand/sit, etc....

    Thanks again,

  • Wow! What a great list! Thanks!!!! I love the satin sheets idea! And I always need excuses to buy new clothes!

    Thanks Again,

  • Noseovertail,

    Finally someone my age!! Well, almost (27 is in my not so distant past)! Not that everyone else was not helpful!!!! But different age groups I assume would heal differently! How are you feeling now (1 month out of surgery)?
    TLIF, meaning the surgeon went in from the side, right? Also what is a PEEK cage and what is BMP? Did you have a bone graft? If so, was donor bone used or did they use your own bone? What is Metanx used for? What mg are you taking for the Lyrica? @) I take 3 of the 75mg in the morning and three again at night. It helps but I wish it helped a little more. I was wondering if taking 2 three times a day would better control the pain.

    I plan on asking the surgeon in advance for a toilet seat riser from the medical supply store. Thanks for the tip!

    Are you driving yet? How much pain are you in now? Are you able to do any housework?

    I hope you don't mind all the questions. If you don't feel comfortable answering that is fine. I am trying to be the best informed patient in hopes that it will make my recovery smoother!


  • I am thinking the toilet seat riser is the way to go!!!!!

    Thanks Graham!!!
  • Thank you for the recount of your experience!

  • I had the same surgery, same level and it was the best thing I have ever done!

    I was in the hospital for 6 days. I was in pain, mostly when I had to get out of bed and walking at first. The first few days were the worst. I could not get good pain control, because like most with a chronic back condition, my body was narcotic tolerant, meaning the normal doese of pain meds do nothing for me. Even having said that, it was bearable. Everyday gets better.

    I was in a brace for 6 weeks, ever time I stoof up, I had to wear it. (tip, if you have to wear one...bend the hooks on one side so you can leave it hooked, and then you only have to fasten one side each time you put it on.)

    I pushed myself to do what I could everyday. walking each day really did make me feel better. also get a reaching stick to pick things up off the floor. I had the most trouble with the restrictions post-op. I followed them even though I felt good enough to bend, etc. FOLLOW them! I also wore my bone stimulator as much as possible.

    When I came home I had an elevated toliet which helped alot. I never needed anything else.

    Also, I could drive at 2 weeks post-op, and I was leaving my house regularly after 2 weeks post-op. (I know!) I had to have someone assist me at the store for about 6 weeks, especailly with heavy stuff. No bending to load dishwasher and no laundry (bending or lifting, as I have front loaders) for 6 weeks.

    I am 2 and a half months out from surgery and I have a new life! I am doing things I have not done in 12 years. No one I tell can believe that I had this surgery less than 3 months ago (even my dr, said it was a 6-12 month recovery) They think I am exceeding all of our expectations! I feel great.

    Good luck to you. If you have any questions, I will be happy to answer anything!
  • Hi Aime,
    Well, the one month check went well, thank you. I still have a lifting restriction of nothing heavier than a gallon of milk. No bend or lift or twist. there's no bone fusion yet, but it's early for that yet. I don't have too much restriction on sitting or standing. Mostly sitting too much hurts, so I don't do it much. I really spend a lot of time either on the bed or in my recliner. I do get out and walk every day up and down our road. Not far or not fast, but I feel like if I don't, I'll get weak. Dr said walking is cool, but not to go fast or run.

    All in all, it still ain't too bad! I hope you have it pretty easy too. I see in your pic that you have a young'un, so that's going to complicate things for you I imagine. Wishing you all the best.

  • seat riser and really wish I had. There was no one here to go get me one, so I did without and let me tell you -- getting up and down from the toilet was NOT easy. Also, when I would get up, I would get incredible pains in the back of my legs and have to hurry to the nearest couch or bed to lie down and wait for the pain to go away. I would definitely get one of those. I didn't buy a shower chair because I found that one of the plastic outdoor chairs fit well in my tub/shower. I washed it down well with disinfectant before I left for the hospital. I bought myself some slip-on shoes and a long-handled shoe horn. I'm over a year out from surgery and I still use that long-handled shoe horn. It's the best.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • I had the same surgery in late oct. First it is painful,but just remember walking helps. I was very sore for the first two weeks after, but then it started to get better every day. Yes i was still sore every morning and it was hard to get out of bed but it gets better too. Just rememeber to stay up on your meds. and it will be ok.
  • It might be more than you want to read, but here are links to my post-op posts:

    24 hours: (post-op pain and sick to my stomach) http://www.spine-health.com/forum/back-surgery-and-neck-surgery/24-hours-post-op

    36 hours - further down is 48 hours:(complications and second surgery) http://www.spine-health.com/forum/back-surgery-and-neck-surgery/36-hour-post-op

    5 days: (still in the hospital and having stomach issues) http://www.spine-health.com/forum/back-surgery-and-neck-surgery/5-days-post-op

    Home from the Hospital: (after a much longer than expected hospital stay of 9 days!) http://www.spine-health.com/forum/back-surgery-and-neck-surgery/home-hospital-not-quite-24-hrs

    Now - doing great, in my opinion, no recurrance of CES or the excruciating pain in my left leg. Surgery was a great success - albeit with some complications - but oh, well - I'll take it knowing that if I cough, or sneeze or stumble I'm no longer blinded with horrific shooting pains and no bladder control.

  • Amie said:

    Finally someone my age!! Well, almost (27 is in my not so distant past)! Not that everyone else was not helpful!!!! But different age groups I assume would heal differently! How are you feeling now (1 month out of surgery)?
    TLIF, meaning the surgeon went in from the side, right? Also what is a PEEK cage and what is BMP? Did you have a bone graft? If so, was donor bone used or did they use your own bone? What is Metanx used for? What mg are you taking for the Lyrica? @) I take 3 of the 75mg in the morning and three again at night. It helps but I wish it helped a little more. I was wondering if taking 2 three times a day would better control the pain.

    I plan on asking the surgeon in advance for a toilet seat riser from the medical supply store. Thanks for the tip!

    Are you driving yet? How much pain are you in now? Are you able to do any housework?

    I hope you don't mind all the questions. If you don't feel comfortable answering that is fine. I am trying to be the best informed patient in hopes that it will make my recovery smoother!



    Hi Amie, I am so sorry I did not notice all of your questions! I haven't signed on in quite a while, I really do apologize.

    Okay, onto the questions.

    1. How am I feeling now? Well, I feel pretty okay. I still have lower back pain like I used to, which I'm hoping is just from everything being so inflamed back there. It seems to be right under my incision, so I'm guessing it's hardware or muscular pain. I dunno. I never had any sciatic or leg pain prior to surgery, but I do have some now in my right leg. It has lessened but is still there just a little bit. If I stand, it hurts. If I walk or lay down, it goes away. This leads me to believe it will go away completely in time.

    I still need my pain meds. I can walk for long periods of time, my husband just took me to the mall to walk around and I did pretty well for an hour or so before I had to sit and rest for a min. I can walk up and down stairs no problem, shower by myself, and I can generally get around okay. Getting up from a laying position is challenging, but it's more because I don't want to move the wrong way.

    2. In my TLIF my surgeon went in through my back. My scar is about 2" long, maybe 1.5" even.

    3. A PEEK cage is a plastic cage that they placed in me, it takes up the space of where my disc would be, I believe. BMP is "Bone morphogenetic protein", which means it's a manmade protein which is known to induce bone & cartilage growth. My surgeon uses it a lot, I think it works more quickly than using your own or cadaver bone? Not sure 100%. They filled my PEEK cage with a tiny sponge that is soaked with BMP. The sponge gets absorbed by the body. I hope I explained this okay, I'm trying to do it from memory.

    4. I did not have a bone graft. I did not use cadaver bone either. To my knowledge they solely used the BMP.

    5. The Metanx medication is used to help with my nerve pain. My doctor said that diabetic patients are given it sometimes when they lose feeling of their legs. After being on Metanx for just a short amount of time, they get their sensations back! It is pretty much just highly concentrated folic acid and Vitamin B.

    6. I am taking two 75 mg of Lyrica a day. Once in the morning, once in the evening. From reading around on the forum, I notice that lots of people are on higher doses of Lyrica. I'm wondering if my surgeon will up the dose once he learned my leg pain is still there. I don't really know if it helps or not since I haven't tried not taking it yet.

    7. I am not driving yet, though I will have to tomorrow to go to my first surgeon follow up appointment. I had no issues sitting in the car with my husband while we went to the mall the other day, but to be honest I'm a little nervous about driving by myself.

    8. As for pain, I have the minor lower back pain still. I also have the leg pain that I believe is from the nerves being irritated and inflamed due to surgery. I don't really do any housework, but if I feel like I'll straighten up the kitchen (only things at my height though, I try really hard not to bend, squat, kneel, etc.). I'm lucky that my husband doesn't mind taking care of the household work in addition to being the only one working right now.

    I hope that helps! Feel free to ask me any question, anytime.

    OH one more thing I want to add. My surgeon never told me to walk a lot. I keep seeing everyone on here saying "walk walk walk walk walk!" but since my surgeon didn't tell me to do it, I haven't been walking a ton. I walk around the house, to the bathroom, etc. I walked the dogs outside when it was warm, I walked once around the mall. But that's it.
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