Spinal fusion surgery, 0-6 weeks This leaflet gives information about how you can prepare for surgery, what you can expect when you come into hospital, and how to recover after surgery. If you have any further questions, please speak to a doctor, nurse or therapist caring for you.
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Contents 3 Introduction
3 Getting in and out of bed
4 Post-operative recommendations
6 Pain and pain relief
7 Fatigue
8 Going back to work and driving
9 Why moving is so important
10 How to pace your daily activities
11 Factors which may affect your recovery
13 Checklist
14 Notes
15 Contact details
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Introduction This booklet was designed to give you guidance on what to expect in the early stages after spinal fusion surgery. It is essential to remember that everybody’s recovery is different and these are suggested time frames. If you need to spend a little longer at the 0-6 weeks stage, this is completely okay. Listen to your body and what it is able to do. You will be supported by your physiotherapist and healthcare professionals.
Getting in and out of bed
On day 1 after your surgery you will have been shown how to get in and out of bed by one of our physiotherapists, using the log roll technique. Over the next six weeks it is important that you continue to use this technique to get in and out of bed, mainly for your comfort. It also uses much less energy which is helpful during the early stages of your recovery. How to log roll • Roll onto any side (or if you’ve had a lateral lumbar
interbody fusion (XLIF) operation the non-operated side).
• Move your feet over the side of the bed. • Use your elbow on the bed to push up and sit on the
edge of the bed. • Stand up from the bed. • Return to bed in the same way by reversing the
steps.
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Post-operative recommendations Remaining Active In the early stages of your recovery, remaining active is very important. This may lead to some discomfort. Increased discomfort does not mean that you are causing any extra strain on your spine, as the metalwork is stable and able to sustain day-to-day activities. While you are an inpatient and at home, we advise you to gently increase the amount you walk each day to remain active.
Lifting and carrying For the first 0-6 weeks, we advise you to lift objects no heavier than a cup of tea or a kettle. After surgery your spine is stable but lifting heavy objects can lead to discomfort. At your 6 week follow-up, your consultant will advise you on when you are able to start lifting heavier objects. You will also be referred to your local musculoskeletal physiotherapy department, and you will see them 8-10 weeks after surgery. Your local physiotherapist can advise you further on lifting and carrying at this stage.
Dressing and washing Having a bath is not recommended until your surgical wound is completely dry and you are able to get in and out of your bath safely. You are able to have a light shower but avoid soaking your dressing. If you do not have a shower, you could have a strip wash instead while sat on the edge of your bath/toilet, or you can purchase a perching stool before your surgery.
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Wound care Please do not remove your wound dressing unless it accidentally gets soaking wet. You will be discharged with replacement dressings which you or a family member will be able to apply. Contact your GP to arrange an appointment if you are unable to change the dressings.
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Housework, shopping and cooking In the early days after surgery you may find that you need a little help from family and friends to complete your housework, shopping and cooking. If you do not have this support think about ordering your shopping online, or before your surgery, do a larger shop to see you over these few weeks. Heavy housework, such as changing beds and washing windows, will have to wait until you feel more physically able. Listen to your body and get help where you can. You may find that making a light dinner is what you can tolerate for the first week, however by week 2, you’re able to make a dinner and help with the washing up. It depends on what you feel you can do. Signs and symptoms to be aware of If you develop increased leg or back pain with a new onset of weakness in your legs, you will need to contact the orthopaedic secretaries to arrange an appointment before your 6-week follow-up appointment. The contact details can be found on the top right hand corner of your clinic letters.
Please contact your GP if you have
increasing redness around the wound
wound leakage
a high temperature
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Pain and pain relief You will be discharged with enough pain relief medication for two weeks. You must make an appointment with your GP within these 2 weeks to get a repeat prescription. Your GP will receive a discharge letter from the ward about your surgery and the medications you were discharged with. It is important that you take your painkillers on a regular basis for the first few weeks. Taking the medicine regularly will keep it at a constant level in your body, so will control your pain better. After surgery you should expect to be in some discomfort due to the type of surgery you have had. It is important that you take regular pain relief to manage your symptoms. It is common that you may still experience some discomfort or mild pain up to a year after surgery, so it is very important to remain active. Pain is expected after surgery, but there are other factors which may make your pain worse. Recognising these factors and taking steps to manage them may ease the pain you experience. Factors include:
Interrupted sleep – Good sleep where you wake feeling refreshed is important for pain management and your recovery.
Mental health – Depression, anxiety etc. If you have been suffering with low mood, speak to your GP to discuss management options and local resources.
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Stress – Discuss with work, family members and local mental health teams your stress triggers and how to manage them. Planning ahead may reduce stress and worry.
Physical health – Smoking, poorly controlled diabetes, poor nutrition and long-term illnesses may have a negative impact on your healing.
Loss of work and income – Plan ahead and discuss with your local council to make sure you’re on the correct benefits.
Useful sources of information NHS managing depression website, w: www.nhs.uk/conditions/stress-anxiety-depression/dealing-with-depression/ MIND, w: www.mind.org.uk
Fatigue Many patients say that they feel increasingly tired after surgery. There are many reasons for this which can be related to your body recovering after surgery. Not being as active, pain relief, interrupted sleep and pain can all make you feel tired.
Managing fatigue
If you feel tired during the day, it is okay to take short naps as long as they do not interrupt your main sleep at night.
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If you are not a good sleeper and have a history of interrupted sleep, we advise you to put down all communication devices, such as iPads, tablets and mobile phones, one hour before you go to sleep. This enables your brain to switch off and you to relax. Research suggests that good sleep is important in pain management, fatigue and physical recovery after surgery.
Regular activity and walking will increase your activity tolerance and improve symptoms of fatigue over time.
Useful information for monitoring sleep issues NHS sleep advice, w: www.nhs.uk/live-well/sleep-and-tiredness/how-to-get-to-sleep/ Headspace, w: www.headspace.com (also available as an app) Sleepio, w: www.sleepio.com
Going back to work and driving Work You will need to take some time off work after surgery. How long you need will depend on the type of job you do. As a guide, we suggest if you have a desk-based job you should arrange at least four weeks off work. This will allow you to dedicate this time to your recovery and will help you manage symptoms of fatigue and pain. If you have a heavy manual job it may take up to three months before you can return to full-time work.
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Whatever work you do, it is a good idea to discuss with your workplace a phased return to work (doing fewer days, or reduced hours). Some people find this helps them to manage their fatigue when returning to work. This will also encourage you to return to pre-surgery life. Research shows that those who return to work and their way of life earlier, have better long-term recovery. Driving Your surgeon should give you guidance on when you can return to driving. You must check with your insurance company as some have their own guidelines. They may not meet any claims if they feel you have driven too soon. You must be able to carry out all manoeuvres (including an emergency stop) safely, confidently and consistently. It is not advisable to drive for long periods after surgery. If you are planning a long drive, take regular breaks where you get out of the car and go for a small walk to stretch your legs.
Why is moving so important? Movement is very important for your overall health. It helps keep your heart and lungs healthy which will help your recovery. After surgery, you may find that you get tired easily. Take regular rests, move a little, frequently through the day, and change your position often. After surgery walking is the best activity to do regularly. It promotes healthy circulation and aids healing and recovery. Walking can also reduce the risk of blood clots.
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You may find in the first few weeks that your walking is limited to 5-10 minutes. This is completely normal. You should see your walking tolerance improve each week. There are no limits on how long you should be walking. Listen to your body, and walk as much as you can tolerate regularly. Gentle activities to keep you active in the early stage There is no exact amount you should be doing. Try to pace yourself and listen to your body if you start to feel discomfort. The discomfort should only be 4 on a scale of 1-10. Sit to stand Sit down and stand up. Do this as many times as you comfortably can. If it is too hard, try to use a higher chair Stairs
Walking up and down stairs is great exercise. Walking Walking inside and outside is great for your overall health. You may find for the first two weeks that you cannot do very much but, over time, you should be able to cope with longer walks.
How to pace your daily activities
Sometimes, people find that when they start to do more general activities, their pain flares up and they need to rest to recover. This is often caused by overdoing it. Aim instead to build your activity levels over time and avoid going from too little to too much in a short space of time. Gradually you will be able to do more and more, and need to rest less and less.
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The key is to start gently and progress steadily. Accept that ups and downs of pain are a normal part of recovery. Take care not to overdo it, but at the same time realise that not doing enough isn’t helpful either. Avoiding normal activities due to pain and fear of making things worse may prolong your recovery and reduce your quality of life. Don’t worry if you feel you aren’t doing enough. A little is better than nothing!
Factors which may affect your recovery Some things can make your recovery more difficult. Having made the decision to have spinal surgery you should do everything you can to make sure your recovery goes as well as possible. Most of these lifestyle changes are free and can have a positive impact to your overall wellbeing. Factors which can slow down your recovery include:
smoking
being overweight
long-term steroid use
diabetes or long-term illnesses
not eating healthily
not getting enough exercise. If you are concerned about any of these issues, you should speak to your GP.
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Useful information for rapid improvement Royal College of Anaesthetists. You may have seen the video in the spinal school session you attended before surgery. This is the booklet that goes with it, w: www.rcoa.ac.uk/system/files/FitterBetterSooner2018web-colour.pdf
Useful information for stopping smoking If you would like some advice on how to quit smoking we can refer you to one of our stop smoking services. Southwark community stop smoking service t: 0800 169 6002 or 020 3049 8550 Lambeth community stop smoking service t: 0800 856 3409 or 020 3049 5791 Guy's and St Thomas' Hospital stop smoking service, t: 020 7188 0995, e: [email protected]
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Checklist You are now ready to go home. This checklist may help you remember to take the necessary steps to help your recovery. Medications
I know how many times a day should I take my medications.
I know how to get a repeat prescription.
I know who to contact if my pain is not being well controlled.
I know who to contact if I experience side effects from my medication.
Recovery
I know who to contact if I have a question about my recovery.
I know when my follow-up appointment is.
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Notes
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Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: 020 7188 8748, Monday to Friday, 9am-5pm Your comments and concerns For advice, support or to raise a concern, contact our Patient Advice and Liaison Service (PALS). To make a complaint, contact the complaints department. t: 020 7188 8801 (PALS) e: [email protected] t: 020 7188 3514 (complaints) e: [email protected]
Language and accessible support services If you need an interpreter or information about your care in a different language or format, please get in touch. t: 020 7188 8815 e: [email protected]
Contact details Spine secretaries, t: 020 7188 4467/4468/4442 Queen Ward, t: 020 7188 5431/5433 Sarah Ward, t: 020 7188 5992/5993 Admissions officer, t: 020 7188 7188, ext 50158 Orthopaedics outpatient department, t: 020 7188 7188 ext 50386/50344 Clinical nurse specialist (CNS), t: 020 7188 7188, ext 53472, bleep 2573
For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please
visit w: www.guysandstthomas.nhs.uk/leaflets
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NHS Choices – Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: www.nhs.uk
Get involved and have your say: become a member of the Trust Members of Guy’s and St Thomas’ NHS Foundation Trust contribute to the organisation on a voluntary basis. We count on them for feedback, local knowledge and support. Membership is free and it is up to you how much you get involved. To find out more, please get in touch. t: 0800 731 0319 e: [email protected] w: www.guysandstthomas.nhs.uk/membership
Leaflet number: 4746/VER1
Date published: May 2019 Review date: May 2022
© 2019 Guy’s and St Thomas’ NHS Foundation Trust A list of sources is available on request
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