The larger and more complex procedure of a multilevel spinal fusion surgery typically includes a longer healing period compared to single-level fusions. 

The time to recover from a multilevel fusion surgery varies and usually depends on several factors such as:

  • The extent and type of surgery
  • The number of levels fused
  • The patient’s age and concomitant medical conditions
  • How closely the care instructions are followed

Complete recovery from a spinal fusion surgery usually takes up to 6-9 months, with the fusion process continuing to evolve for 12 to 18 months.

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Multilevel Spinal Fusion Recovery Time

Patients are usually discharged 2-5 days after the surgery. 1 Gruskay JA, Fu M, Bohl DD, Webb ML, Grauer JN. Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis. Spine J. 2015 Jun 1;15(6):1188-95. doi:10.1016/j.spinee.2013.10.022  After the hospital discharge, patients continue to take pain medications, which are tapered over time. It usually takes about 2 weeks to taper and completely stop pain medications, after which more demanding physical activities can be slowly resumed.

Average time frames to return to work, physical activities, and sports after multilevel spinal fusion

Daily activities, such as sitting, walking, or sleeping, may be less painful and performed more easily compared to the pre-surgical period. While most patients begin to feel better after a few days, activities that involve excessive bending, twisting, and lifting must be avoided for several weeks or months. 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982

The average time frames to return to basic activities and sports after a multilevel spinal fusion surgery are included below, though specific recommendations for each patient should be discussed with the surgeon:

  • Driving: It takes a minimum of 2 weeks to resume driving 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982 , but patients usually start driving only after 2 or more weeks.
  • Light physical work: Jobs that include sitting and working on a computer, such as administrative or clerical work, may be resumed after 4-6 weeks. 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982
  • Medium duty: Jobs that include a combination of sitting, standing, walking, and light lifting, such as nursing, truck driving, and forklift driving, may be resumed after 8 weeks. 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982
  • Heavy labor: Jobs that demand heavy physical labor, such as construction and bricklaying, may be resumed after 3 months. 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982
  • Low-impact exercises: Walking can begin as soon as a patient feels stable on their feet. The use of a stationary bike or elliptical machine may be considered after 3-6 weeks. 
  • Non-contact sports: Participation in non-contact sports, such as tennis, softball, and weightlifting, may be resumed after at least 3 months. 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982  
  • Contact sports or high-risk activities: Engaging in contact sports and high-risk activities, such as riding a roller coaster or playing football, may be resumed after at least 6-12 months. 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982  

It’s important to note that each patient’s healing and recovery is different, and physicians analyze several factors about each patient’s health and type of surgery before allowing the resumption of a variety of activities, including strenuous physical activity. 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982  

Effect on Back Strength After Multilevel Spinal Fusion

While the surgery itself does not improve muscle strength, it helps reduce back pain, which makes activities like bending or twisting easier to perform compared to the pre-surgical period. 3 Tarnanen S, Neva MH, Kautiainen H, et al. The early changes in trunk muscle strength and disability following lumbar spine fusion. Disability and Rehabilitation. 2013;35(2):134-139. doi:10.3109/09638288.2012.690496

  • Research suggests that following a spinal fusion surgery, pain and disability improve considerably during the first 3 months after surgery and then remain the same for the next 2 years. 3 Tarnanen S, Neva MH, Kautiainen H, et al. The early changes in trunk muscle strength and disability following lumbar spine fusion. Disability and Rehabilitation. 2013;35(2):134-139. doi:10.3109/09638288.2012.690496
  • By the 3-month mark, physicians and patients can identify if the recovery is not as expected and if further treatment is necessary. 3 Tarnanen S, Neva MH, Kautiainen H, et al. The early changes in trunk muscle strength and disability following lumbar spine fusion. Disability and Rehabilitation. 2013;35(2):134-139. doi:10.3109/09638288.2012.690496  

In general, spinal fusion surgeries result in some level of disability—which is usually higher immediately after the surgery and gradually improves with time if the care instructions and exercises are followed as prescribed. 

See Guide to Physical Therapy After Spinal Fusion

Effect on Back Stiffness after Multilevel Spinal Fusion

Fusing motion segments of the spine results in some degree of spinal stiffness. The extent of stiffness is directly related to the number of levels that are fused. 4 Kimura H, Fujibayashi S, Otsuki B, Takahashi Y, Nakayama T, Matsuda S. Effects of lumbar stiffness after lumbar fusion surgery on activities of daily living: SPINE. 2016;41(8):719-727. doi:10.1097/BRS.0000000000001300  However, if the surgery is successful, there will be considerable pain relief and the overall lumbar stiffness will not be significant, making patients feel more mobile after surgery.

A study evaluating 93 patients with multilevel spinal fusion found 4 Kimura H, Fujibayashi S, Otsuki B, Takahashi Y, Nakayama T, Matsuda S. Effects of lumbar stiffness after lumbar fusion surgery on activities of daily living: SPINE. 2016;41(8):719-727. doi:10.1097/BRS.0000000000001300 :

  • Patients with 2-level spinal fusion were able to comfortably perform most daily activities but had some difficulty while trying to pick up an object from the ground.
  • Patients with 3-level spinal fusion had moderate difficulty in performing activities that required bending forward for a long time, such as cutting toenails, squatting, sitting on the floor, and climbing stairs. 
  • Patients with 4-level spinal fusion reported considerable difficulty in performing most activities that required bending forward but were able to wear a jacket, get out of bed, shower, and rise from a chair without difficulty. 

While patients who had a higher number of fused levels experienced more activity limitations, most patients (>83%) in the study were satisfied with their surgical outcome due to significant pain relief after the surgery. 4 Kimura H, Fujibayashi S, Otsuki B, Takahashi Y, Nakayama T, Matsuda S. Effects of lumbar stiffness after lumbar fusion surgery on activities of daily living: SPINE. 2016;41(8):719-727. doi:10.1097/BRS.0000000000001300  

Factors That May Help Improve Healing and Recovery After Spinal Fusion

Engaging in gentle physical therapy and exercise under the guidance of a physical therapist can help foster healing and recovery in the spine. An effective post-surgical exercise program can help improve muscle endurance, movement control and coordination, and body balance—reducing pain and disability, and improving function over time. 3 Tarnanen S, Neva MH, Kautiainen H, et al. The early changes in trunk muscle strength and disability following lumbar spine fusion. Disability and Rehabilitation. 2013;35(2):134-139. doi:10.3109/09638288.2012.690496

Additionally, a few lifestyle changes may help enhance the patient’s overall health and boost the healing process, such as:

  • Not smoking or using products containing nicotine
  • Avoiding alcohol consumption
  • Making a conscious effort to keep the spine supported at all times with good posture
  • Eating a nutritious diet and drinking plenty of water
  • Getting adequate restorative sleep
  • Avoiding sitting for long periods
  • Taking multiple short walks throughout the day as advised by the surgeon and/or physical therapist

In general, having a positive attitude enhances the patient’s overall experience and leads to less pain after surgery and a faster recovery process. Preparing well in advance before the surgery can help develop a sense of control and confidence.

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Factors That Can Slow Down Recovery After Spinal Fusion

The presence of certain medical conditions, the use of specific medications, and not following postsurgical care instructions may hamper bone growth and delay the healing and fusion process in some patients. 

Common factors that can slow down recovery time are: 

  • Smoking or using other nicotine products 
  • Obesity and osteoporosis
  • Certain chronic illnesses, such as diabetes
  • Malnutrition
  • Depression
  • Long-standing use of opioids before surgery
  • Use of chronic steroid medications, including prednisone

Some surgeons recommend wearing a back brace for additional lumbar support after a multilevel fusion surgery. Failing to wear the brace as recommended may increase stresses on the newly fused segments, resulting in post-surgical back pain. 

Read more about Postoperative Care for Spinal Fusion Surgery

Patients and caregivers are advised to discuss the surgical procedure and recovery process in detail with their surgeon to get a thorough understanding of what to expect before and after surgery. 

  • 1 Gruskay JA, Fu M, Bohl DD, Webb ML, Grauer JN. Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis. Spine J. 2015 Jun 1;15(6):1188-95. doi:10.1016/j.spinee.2013.10.022
  • 2 Guglielmi GN, Seibly JM. Return to Work Guidelines Following Neurosurgical Procedures. Cureus. 2020;12(12):e11982. Published 2020 Dec 8. doi:10.7759/cureus.11982
  • 3 Tarnanen S, Neva MH, Kautiainen H, et al. The early changes in trunk muscle strength and disability following lumbar spine fusion. Disability and Rehabilitation. 2013;35(2):134-139. doi:10.3109/09638288.2012.690496
  • 4 Kimura H, Fujibayashi S, Otsuki B, Takahashi Y, Nakayama T, Matsuda S. Effects of lumbar stiffness after lumbar fusion surgery on activities of daily living: SPINE. 2016;41(8):719-727. doi:10.1097/BRS.0000000000001300
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