Patients usually begin to feel a little stronger each day at this point after lumbar fusion surgery, but need to be aware of infection risks and medication safety issues.
Surgical incision site infections are most likely to arise about 2 to 4 weeks after surgery.1 Some symptoms to be aware of include:
- Fever (101 degrees or higher)
- Expanding redness at the incision site
- Increasing back pain
- Change in the amount, appearance, or odor of drainage
If these signs appear, it is important to contact the treating surgeon immediately. A patient who develops a deep infection is typically treated with a long course (usually about 6 weeks) of intravenous antibiotics.2 Further surgery to clean out the incision may or may not be needed. If the infection becomes chronic, the hardware inserted during the surgery may need to be removed.
To keep the incision clean, it is important to clean the site with soap and water at least once a day and pat it dry. Ointment or lotion is not recommended. Any stitches or staples used to close the surgical incision will usually be removed about 2 weeks after surgery, which is when the surgeon may also permit a return to taking baths, swimming, and other water activities if the wound has completely healed.
If an opioid pain medication is used, the prescription will typically include instructions for how to gradually wean off the medication over a few weeks. If these instructions are not provided, ask the surgeon and/or pharmacist for recommendations.
There is usually no need for opioids after about 2 weeks to 1 month.
The shift away from opioid pain medications requires the patient to be aware of some pros and cons of other pain relief options.
Acetaminophen (e.g. Tylenol). Acetaminophen is considered a relatively safe and effective pain medication and can be used when weaning off opioid pain medications. It’s important to monitor dosages closely, however, to avoid liver damage. Because it affects the liver, people who drink alcohol should be especially careful to understand the potential risks of acetaminophen before taking any. There is also a risk of accidentally taking too much acetaminophen because it is an ingredient in many over-the-counter and prescription medications. The daily dose should not exceed 4000 milligrams (8 extra strength Tylenol pills).
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Avoiding aspirin products and NSAIDs—such as ibuprofen (Advil), naproxen (Aleve), or COX-2 inhibitors (Celebrex)—for at least 3 months after lumbar fusion is usually recommended. These products may interfere with growth and development of the bone fusion. In some situations, though, these products may be necessary for treatment of other health conditions.
It is important to discuss one's personal medical history and all medications with the surgeon, primary care provider, and/or pharmacist.
Walking Plays Major Role
Walking is the ideal form of exercise during this period. Not only does it increase muscle strength to better support the healing spine, it helps the heart, lungs, and digestive system. Gradually increasing the amount of walking, and stopping when pain flares up, is the best approach. The surgeon or primary care provider may also recommend other exercises.
Moving around as much as is comfortable puts the patient in good position for the next step in recovery, which often includes outpatient physical therapy and driving.