Post-op Instructions

POST-OPERATIVE INSTRUCTIONS (General)

A good outcome from surgery is the result of a combined effort by surgeon AND patient. These are some general guidelines that apply to virtually all the procedures we do.

There may be some instructions specific to your operation, listed separately.

Wound Care

Whenever possible, surgical wounds do best when allowed to "breathe"
Remove the dressing on Day 2 or 3, and if the wound is dry leave it off.
Some drainage is normal. If this occurs, apply a dry dressing. Gauze, tape.
Tape irritates the skin. Use as little as possible.
Change the dressing as often as needed to keep the wound dry.
Antibiotic ointment isn’t necessary, but wipe off dry blood gently with peroxide and gauze.
We rarely use staples or external sutures. If we do, the same wound instructions apply.

Shower / Bathing / Swimming

When the wound is sealed (3 days), and dry, shower normally.
Blot the wound dry with a clean towel. Try not to remove steri-strips.
Do not submerge (bath, pool) until seeing your surgeon post-operatively.

Diet

Normally, there are no restrictions.
Red meat and iron supplements are helpful for post-op anemia.
This is not a good time to diet. You need calories to heal and prevent infection.

Activity

We discourage bedrest. This causes pneumonia, blood clots, and skin breakdown.
Walking is needed for normal circulation. There is no optimal amount. Go as far as you can.
Running is probably not a good idea early on. Discuss this with your surgeon.
Driving is not restricted beyond common sense and good judgement.
void “excessive” lifting, bending, twisting, sitting, standing.
Return to sex as tolerated avoiding the “excessive” list above.

Return to Work

Limitations are according to the Activity section above
Consider your commute. Perhaps part time work to avoid commute hours.

Fever

Fever is normal in the first 35 days (even as high as 102+).
Take Tylenol if it makes you uncomfortable.
If fever (over 101) persists, call the office during the day so we can see you if necessary.

Medications

Surgery hurts. We try to minimize it, but it’s unavoidable, so use medication if necessary.
We generally prescribe a narcotic for pain. You may substitute Tynelol if that works.
They cause constipation. Use the minimum to get the job done.
Muscle relaxants are often prescribed. They can be helpful. Think Valium as to how they work.
Avoid NSAID’s (Advil, Aleve, etc.). They cause bleeding and impair bone growth.
Antibiotics are not routinely used beyond those given in your IV during / after surgery.

FAQ's

When can I fly? When we are sure the wound is healed, and no visit is needed for a while.
Physical therapy? Unless there is a specific indication, PT is not necessary or helpful.
Sometimes patients need PT while in the hospital to help get walking and to learn to safely get in and out of bed without excessively bending or twisting. Occasionally we will have a PT visit you at home to be sure your environment is safe. Usually one visit is enough.
Do I need antibiotics for dental work? Generally, no. even with spinal implants or hardware.
Will I set off the metal detector at the airport? Possibly. If it makes you feel more comfortable, bring a copy of your xray. The truth is that someone trying to smuggle a dangerous object past TSA using a spinal implant as a excuse is capable of producing false paperwork. So there is nothing we can give you to get you through. It’s rare that spinal implants set off metal detectors. When they do, as common as surgical hardware is, the TSA is prepared to screen you without unnecessary delay.
Special equipment? Sometimes we prescribe bone growth stimulators (BGS), or braces, or walkers. We (or our surgical coordinators) will give you our preferences for how they should be used.

POST OP INSTRUCTIONS (microdiscectomy)

See the above general rules. Activities are limited to prevent recurrence of the herniation. This occurs approximately in 6% of cases, and most are in the first 12 weeks. Hence the following guidelines:
Weeks 1-6, seated hamstring stretch, 100/day, walk as much as tolerated.
Weeks 6-12, continue the hamstring stretch and walking. Add some light core strengthening.
Week 12 and beyond, begin to resume normal sports and activity, starting slow, increase 10% per week.

POST OP INSTRUCTIONS (anterior cervical fusion)

Infections are very rare. Covering the wound is not necessary.
Braces have not been shown to alter outcomes. Use yours for comfort only if it helps.
Fusions take roughly 3 months to begin to heal. Avoid twisting activities (golf), and hyper neck activities
(roller coasters) to protect the hardware and delicate early forming bone until then.
Avoid the use of NSAID’s for the first 3 months so as not to impair bone growth.

POST OP INSTRUCTIONS (lumbar fusion, anterior, posterior, combined)

Avoid the use of NSAID's for the first 3 months so as not to interfere with bone growth.
Follow the wound care and general activity guidelines above.

POST OP INSTRUCTIONS (disc replacement, Co-flex)

Follow the wound care guidelines outlined above.
Since there is no bone growth expectation, resume activities as tolerated.