When driving for the first time after surgery, patients should make it a short drive only and have someone come with them, in case the pain flares up and they need help driving back home. Patients should not drive while taking pain medicines (narcotics). Patients may begin driving when the pain has decreased to a mild level, which usually is between 7-14 days after surgery. Patients should not take a bath until the wound has completely healed, which is usually around 2 weeks after surgery. The dressing should otherwise be changed every 2-3 days when at home. After the shower, patients should change the bandage, and dry off the surgical area. Patients can shower immediately after surgery, but should keep the incision area covered with a bandage and tape, and try to avoid the water from water hitting directly over the surgical area. The bandage should generally be changed every 1-2 days, especially after showering. The wound area should remain covered with a gauze bandage secured in place with tape. Patients undergoing multilevel fusion surgery for scoliosis, kyphosis, spinal infections or tumors are typically issued a custom molded thoracolumbar brace. Occasionally, patients may be issued a soft or rigid lumbar corset that can provide additional lumbar support in the early postoperative period, if necessary. Patients are generally not required to wear a back brace after surgery. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Most patients are usually able to go home 2-5 days after surgery. The total surgery time is approximately 2 to 5 hours, depending on the number of spinal levels involved. A sterile bandage is applied, and is changed daily while in the hospital.
#Spine fusion skin
The skin is closed using stitches or surgical staples. The deep fascial layer and subcutaneous layers are closed with a few strong sutures. The wound area is usually washed out with sterile water containing antibiotics. All surrounding areas are also checked to ensure no compressive spurs or disc fragments are remaining. Small dental-type instruments and biting/grasping instruments (such as a pituitary rongeur and kerrison rongeur) are used to remove the arthritic, hypertrophic (overgrown) bone spurs and ligamentum flavum. The nerve roots and neurologic structures are protected and carefully retracted, so that the bone spurs can be visualized and removed. Two small pedicle screws or hooks are placed at each spinal level of the fusion, and connected by titanium rods.Ī complete or partial laminectomy (removal of lamina portion of bone) and foraminotomy (removal of bone spurs near where the nerve comes through the hole of the spine bone) may also be performed if necessary, thus allowing the nerves to return to their normal size and shape when the compressive lesions are removed. At the levels to be fused, the facet joints and transverse processes are decorticated and bone graft is placed along side of the vertebrae. The lamina, facet joints, and transverse processes are exposed on both sides of the spinous processes. After the retractor is in place, an x-ray is used to confirm that the appropriate spinal level(s) is identified. The fascia and muscle is gently divided in the midline, and retractors are used to allow the surgeon to visualize the posterior (back part) vertebral arches. Sterile drapes are placed, and the surgical team wears sterile surgical attire such as gowns and gloves to maintain a bacteria-free environment.Ī 4-8 centimeter (depending on the number of levels) longitudinal incision is made in the midline of the low back, directly over the spinal levels to be fused. The surgical region (low back area) is cleansed with a special cleaning solution. Patients are positioned in the prone (lying on the stomach) position, generally using a special operating table/bed with special padding and supports. Preoperative intravenous antibiotics are given. A breathing tube (endotracheal tube) is placed and the patient breathes using a ventilator during the surgery. The surgery is performed utilizing general anesthesia.
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