Postoperative Care for Spinal Fusion Surgery

The extended healing period required after lumbar spinal fusion surgery makes post-operative care especially important.

Posterior Lumbar Interbody Fusion (PLIF) VideoPosterior lumbar interbody fusion (PLIF) patients typically spend more time recovering in the hospital.
Posterior Lumbar Interbody Fusion (PLIF) Video

This article details the main aspects of a typical lumbar fusion recovery process. It is important to remember, however, that each individual's recovery process will vary to a certain extent depending on a number of factors. These factors include the patient's pathology, prior physical condition, prior and overall health, the type and extensiveness of lumbar fusion method, the surgeon's skill and expertise, and the individual's perception of pain and recovery.

Prolonged Recovery after a Lumbar Fusion

Despite the name of the surgery, the spine is not actually fused during lumbar spinal fusion surgery. Instead, during the surgery a bone graft is placed in the spine so that two parts of the vertebrae can gradually grow together into one longer bone. The long bone will serve to immobilize the spine at that segment. Screws, cages, plates, and rods may be placed during surgery to stabilize the area while the bone heals and becomes solid, a process that usually takes about three months. Some patients also wear a brace that limits motion.

The bone continues to mature and solidify over a prolonged period, usually for 12 to 18 months after the surgery. Because it is a major surgery and the fusion takes a long time to set up, the recovery period plays an important role in the success of a spine fusion.

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Factors that Affect Recovery

A one- to five-day hospital stay following fusion surgery is typical, but experiences vary. Patients must be able to get up and walk around on their own before they can go home from the hospital. At times there is a need for more structured rehabilitation before returning home.

There are several types of lumbar spinal fusion surgery. Patients whose surgery was done from the front of the body—also known as the anterior approach (commonly an ALIF)—generally spend less time in the hospital than those whose fusion is from the back (posterior approach, such as a posterolateral fusion or PLIF, transforaminal approach or TLIF).

There are several factors that can extend one's hospital stay and/or negatively impact the recovery process and clinical success of the surgery. These factors include, but are not limited to:

  • Smoking (nicotine)
  • Obesity
  • Osteoporosis
  • Chronic steroid use
  • Diabetes Mellitus and certain other chronic illnesses
  • Prior back surgery or attempted fusion
  • Malnutrition
  • Post-surgery activities
  • Depression
  • Long-standing use of narcotics before surgery

Smoking After Spine Fusion Surgery

A major damaging complicating factor is smoking, or any form of nicotine intake. Nicotine is a bone toxin, hampering bone-growing cells (osteoblasts). If a person continues to smoke or have any form of nicotine after spine fusion surgery—especially right after surgery—it becomes much harder for the body to grow the bone needed for a fusion.

The risk of non-healing fusion is 3 times more likely if nicotine is used after surgery. Smoking may also make pain medication less effective. While smoking is a difficult habit to break, there are major advantages to quitting smoking before having lumbar spinal fusion surgery.

Planning Ahead for Spinal Fusion

Concerns about pain control with a lumbar spinal fusion are common. Talking with the surgeon beforehand about pain relief options helps people know what to expect. Obtaining refills for medications containing oxycodone or morphine is often more time consuming than in the past, so checking with the surgeon in advance about the refill process may avoid problems.

Preparing the home in advance also makes a smooth recovery more likely. Stocking up on microwaveable meals (or cooking and freezing food for later use) and placing everyday items in easy reach are helpful strategies. Arranging for someone to assist with heavier chores, such as laundry, may be necessary. The surgeon is also a good resource about whether a patient will be able to use stairs.