What about driving?
Driving is not as easy as simple sitting. Try and limit driving for 2-4 weeks after surgery unless it is essential, such as travel from the hospital, to a doctor’s appointment, or to work. When you do drive yourself for the first time, go with someone else in case your pain gets worse. If you are taking narcotic pain medication, you should NOT be driving.
Do I need to see my primary care physician prior to surgery?
Our office will do a pre-operative assessment for most patients. However, we may have you see your primary care physician if you have significant medical issues they are managing. This will be discussed with you by our surgery scheduler prior to surgery.
Does Dr. Stone have hospital privileges?
Dr. Stone has hospital privileges at EvergreenHealth, Overlake Medical Center, and Swedish Medical Center (Providence).
When can I return to work?
This varies significantly depending on the procedure performed as well as your job requirements. In general, patients can return to work sooner for a decompression surgery compared to a fusion. Patients with sedentary jobs may be able to return to work in 1-2 weeks. However, if your job requires a lot of bending and twisting, you may need to be off work for at least 6 weeks. Discuss this with your surgeon before surgery to determine an estimated time when you can return to work.
Will I wear a brace or corset?
We do not routinely provide patients with a brace (i.e., soft collar or abdominal binder) after a lumbar decompression surgery (no fusion). We will occasionally prescribe a soft collar after a cervical decompression (no fusion). However, after a fusion, many patients like the added support a brace provides. Therefore, patients who have undergone a fusion of their spine may be fitted for and given a brace following their surgery. You may discuss this with your surgeon.
How much can I walk?
Once home, taking short walks for ten minutes or so in your house every few hours is advised. When you tolerate these short walks, you can take longer walks outside. Use the 5% rule to increase the duration of your walking. If you increase your walking 5% during the day, we would expect that you feel more pain at the end of the day. You should recover overnight and hopefully feel well in the morning. If you recover as expected, you can increase your next day’s walk by 5%. If you do not recover overnight (pain remains higher than expected), we suggest you rest one day and decrease your total day’s activities by 5% until you feel good the next morning. Continue this process as tolerated. It is better to do frequent short walks than one long walk that increases your pain or tires you out excessively. Flat surfaces are better than hills.
When can I resume my exercises?
Unless you have been given approval by your provider, please do not resume exercises other than walking until given further instructions at your first follow-up visit.
How long can I sit?
You may sit in a recliner in a reclined position as long as you would like unless it causes pain. Most patients find 20-30 minutes to be a common limit before they feel the need to change positions. Begin sitting in a straight chair four to six times per day for short periods of time (5-15 minutes). Do not slump or slouch. Gradually increase your sitting tolerance. Maintain your neutral position during sitting. You may wish to use a lumbar roll (pillow) for comfort. Simply rolling up a towel and placing it behind your lower back may provide comfort. Learning to bend from the hips and use your elbows on the table to support yourself will usually allow you to eat a meal comfortably at a dining room table. When getting up from a chair, contract your stomach muscles and use your legs to raise yourself.
When can I have sex?
Let pain be your guide and limit spinal motion. While there is no exact timeframe, we find most patients do not feel comfortable attempting sexual activity for a few weeks after neck or back surgery and some take longer. If you can walk a mile without an increase in pain, chances are you have enough strength and ability to control pelvic motion during sexual intercourse. Be willing to try positions that limit pelvic motion if this is painful. It may also be helpful if your partner assumes the more active role. Generally, however, side-lying positions are easier to control pelvic motion.
How do I turn in bed and get out of bed?
You will find log rolling to be the most helpful technique to turn in bed (page 25). Contract your stomach muscles and move your shoulders and hips at the same time as you roll over from your back to your side, or side to your back. The goal is to avoid twisting the spine. Move your body as one unit. When you get out of bed use the log rolling technique as well. Log roll to your side. Slightly bend your knees and hips and push up with your elbow and opposite hand, keeping your stomach muscles tight and simultaneously letting your legs slide over the edge of the bed. Gently move your buttocks to the edge of the bed. Push off of the bed with your hands and raise straight up with your legs to stand. Avoid bending your back. If you are admitted to the hospital, a physical therapist will teach you this technique.
I’ve heard that I have to stay flat in bed after surgery. Is this true?
The only time your surgeon may recommend lying flat in bed is if there is a leak of cerebospinal fluid (CSF) at the time of surgery and a repair has been performed. Loss of cerebrospinal fluid can cause spinal headaches. Laying flat helps prevent headaches as one’s body produces more cerebrospinal fluid. Luckily this is rare and typically only a short term (24-48 hour) requirement. In general, you can have your head up immediately following surgery. However, remember to keep a neutral spine posture. When the bed is flat, you can lie on your side with your knees drawn up and a pillow between your knees as well as under your head, or on your back with a pillow under your head/neck and knees.
What if I have to use the bathroom?
Constipation early on after surgery is very common and quite frustrating for patients and their caregivers. Bowels are sluggish due to general anesthesia and pain medications. Usually, by the time you are ready to have a bowel movement you are up and able to get to the bathroom on your own or with assistance. Keep your abdominal muscles tight and use your leg muscles to get up and down from the toilet. This will help protect your spine. After you get home, treat constipation aggressively. Use stool softeners, fiber supplements, fruit juices and any medications your providers have prescribed. Narcotic pain medications are the leading cause of constipation after surgery so try to reduce your use of these medications as quickly as possible.
How do we know the fusion is complete?
Your physician determines the status of your fusion by assessing your x-rays, but occasionally we may perform a CT scan. Please remember, we are most concerned with how you feel, not the status of your fusion. Some patients never obtain a solid fusion, but they do very well. Occasionally, a fusion appears solid, but the patient still has pain.
How long will it take for my fusion to heal?
Lumbar (low back) fusions take an average of 6-12 months to become solid. Cervical (neck) fusions are usually healed by 3-6 months. Not surprisingly, different patients heal at different rates. Younger, healthier people might heal their fusions more quickly than older individuals with medical conditions. Activity, especially walking, seems to help fusions heal more rapidly and with better strength. Unless specifically directed by your surgeon, bed rest after surgery is not advised. Be sure to walk, sit, and stand as tolerated letting pain be your guide. You should avoid repetitive twisting and lifting more than 15 lbs for 6 weeks after surgery. Avoid running and other impact sports for 3 months following surgery.
How long will it take to heal from surgery for a herniated disc?
You may experience some discomfort over your incision following surgery. Most incisional pain resolves by 2 weeks following surgery. The incision is typically closed by 2 weeks and healed by 4 weeks. The disc herniation (and microdiscectomy surgery) leaves a small opening in the annulus fibrosus (outer layer of the disc) through which a portion of the nucleus pulposus (inner layer) was removed. This opening will heal with scar tissue within a few months following surgery. You should avoid repetitive twisting and lifting more than 15 lbs for 6 weeks after surgery. Avoid running and other impact sports for 3 months following surgery.
How long after I go home from the surgery center will I see my physician?
We typically see patients in clinic 1-2 weeks following surgery. If you were not given a date for your first post-operative visit, please contact our office at (425) 823-4000 to make an appointment.
How much pain will I have after surgery?
You may experience some discomfort following surgery, however, pain medications, ice, and good body mechanics should keep you reasonably comfortable. Although pain medications take the edge off, most patients still experience some discomfort. Pain can be upsetting and cause anxiety, but it does not always mean there is something wrong. Our providers proactively treat pain, however, medications sometimes require adjusting following discharge from the surgery center or hospital. The first few days following surgery are usually the most painful. However, as you become more physically active, your pain may increase. Pain control is a balance between healing, activity, and medications. We recommend you follow the 5% rule. If you increase your activities 5% during the day, expect to feel more pain at the end of the day. You should recover overnight and hopefully feel well in the morning. If you recover as expected, you can increase your next day’s activities by 5%. If you do not recover overnight (pain remains higher than expected), we suggest you rest one day and decrease your total day’s activities by 5% until you feel good the next morning. Continue the process as tolerated. If you experience severe pain after surgery, please contact us at (425) 823-4000.
How do I know if I have an infection?
Infections following spine surgery are rare but may occur even with good sterile technique and antibiotics. The most common symptoms of an infection include a dramatic increase in pain, swelling, fever, redness or drainage from you incision(s). It is not unusual for some patients to develop a bump underneath their incision. This is from soft tissue swelling and/or a small fluid collection beneath the skin. This is not from an infection and will typically resorb by 6-12 weeks following surgery. If you are concerned about an infection, please contact us at (425) 823-4000.
Can my incision get wet?
You may remove your dressing to shower immediately after surgery, however, do not submerge your incision in a bathtub until the incision is completely healed (~3 weeks). Do not aggresively scrub your incision for 3 weeks. Place a new dressing after showering. Five days after surgery, if your dressing is dry, you may remove the dressing and leave the incision open to air.
When will I have my sutures taken out?
Visible skin sutures are rarely used. The skin is usually held together by absorbable sutures. Therefore, there is rarely a need to remove sutures. Your doctor will let you know if you have sutures that need to be removed. Sutures requiring removal are usually removed 10-14 days following surgery. If you have Steri-Strips on your incision, allow them to fall off on their own. This usually takes a couple of weeks. If you have sterile super glue (i.e., Dermabond) on your incision, it will likely begin to peel off by itself after 1-2 weeks.
What if I have difficulties or problems once I get home?
If you have increasing pain following surgery, review your activities to determine if you have been too active or not following good mechanics. Ask yourself, “was I maintaining a neutral spine position at all times and was I practicing good body mechanics?” Call our clinic if you develop a fever, drainage from your incision, or swelling and/or redness around the incision. If you have any questions, please contact us at (425) 823-4000.