FAQ’s

This will depend on the operation.  Each patient has their own health factors that may impact their recovery.  Before going home patients will have their pain controlled, will be independent in their activities of daily living and mobilising (getting in and out of bed/ chairs, walking) without assistance.  Generally speaking for ACDF/ cervical arthroplasty surgery patients will stay around two nights, for discectomy/ simple decompression surgery around two nights, fusions- 5-7 days, major deformity correction surgery may require a stay in the acute ward of up to 2 weeks.  Patients are considered for inpatient rehabilitation on an ‘as needed’ basis.

Patients will have various of the following, depending on the operation and their particular health status

• Intravenous cannula (IVC) = ‘Drip’ for fluids, antibiotics and  delivery of Patient Controlled Analgesia (PCA)
  • May have a ‘central line’ – Drip into a large vein (groin, neck, beneath the collar bone). Larger fluid volumes can be administered more quickly than through a standard drip.  This is typically placed if the chance of major blood loss is considered high, such as in long construct decompression and fusion cases and some anterior lumbar approach cases.
• Arterial Line – used during surgery to accurately monitor blood pressure.  It is usually removed at the end of the surgery.  Arterial puncture sites tend to be tender and bruised.  This usually settles over the first few weeks.
• IDC – InDwelling urinary Catheter (draining urine from your bladder).  This is removed when you are able to move about more freely.
• Wound drain.  This is usually removed on the first or second post-operative day.

In addition to these ‘lines’ patients will typically also have:

• Graduated Compression Stockings and Sequential Compression Devices – Compression stockings and airbags attached to your legs which periodically inflate to aid return of venous blood – a strategy to reduce the risk of Deep Vein Thrombosis.
• Most patients will also be prescribed Heparin to further reduce their risk of DVT.
• Antibiotics are used at the time of surgery and the early post-operative period to minimise the risk of wound infection.
• Analgesic medications will be prescribed.  In the early phase a PCA (Patient Controlled Analgesia -intravenous opioid medication that the patient can self deliver at the press of a button) is common.  Patients are converted to oral medication as they recover.
• Some patients may also have local anaesthetic infusion into the tissues surrounding their wound (‘Pain Pump’).  This infusion lasts 48hrs.

The aim is to get patients out of bed from Day 1.  This is usually with a physiotherapist. Taking frequent short walks is the goal in the early post operative period.

Your physiotherapist will go through this with you while you are in hospital. For most patients exercises focus on simple core strength activities and frequent short walks.  Being able to ascend/ descend stairs may be necessary to be ‘cleared’ for discharge home.  Most patients are advised to be careful with bending, twisting and lifting activities.  A lifting limit may be advised.  Sitting limits are usually related to comfort levels, with many patients needing to change posture/ activity frequently.

Patients will often be advised to engage with their local physiotherapist from around the two-four week mark to help guide them through the next steps in their recuperative process.

• Patients are generally advised to avoid extremes of bending and heavy lifting, especially during the early phases of their recovery, noting that ‘heavy’ will vary from person to person.
• Lifting restrictions will remain for patients who have undergone fusion surgery.  This is typically a load limit of 15-20kg until true bone fusion (a healed bridge of bone from one vertebral level to the next) has been confirmed on imaging studies (around the 12 month mark)

There is no special need to not drive. Many patients after spine surgery find sitting uncomfortable.  This may impact your driving tolerance.  When you can move your arms and legs as needed, are able to check your blindspots and are not taking medication that will impact your thinking and concentration (such as opioids or other pain management medications) then you may be able to drive.  Most people refrain from driving for the first 2-4 weeks following surgery.

The purpose of rehabilitation is to help patients to return to independent living.  ADLs (Activities of Daily Living) include mobilising, showering, dressing, preparing food and performing chores. Rehabilitation is considered for patients who are demonstrating challenges or who feel that they may not cope at home for various reasons.  An assessment will be arranged with a Rehabilitation Consultant and a plan for inpatient of outpatient therapy implemented.  The full spectrum allied health team (physiotherapists, occupational therapists, speech pathologists and others) are included as needed.

The need for rehabilitation is not condition nor surgery specific – as a general rule of thumb, the bigger the operation, the more likely that you will need rehabilitation.

Patients are seen around two weeks after leaving hospital and then at around the 6 weeks, 3 months, 6 months and 12 months marks.

This is a guide schedule only with some patients requiring more frequent reviews and others less so.  Fusion is usually checked with a CT scan prior to the 12 month review.

External bracing is generally not required.

Most patients benefit from pain medication early in their recovery period. The aim is to minimise this as your comfort allows – the weaning process varies from days to weeks. Patients will often have a local anaesthetic infusion into the tissues surrounding their surgery site for the first 48hrs, together with a Patient Controlled Analgesia (intravenous opioid) which is usually removed around Day 3.  Some patients require other agents such as ketamine.  Most will step down from their PCA to oral opioids such as Tapentadol.  It is common for patients to be discharged with prescriptions for ongoing analgesic medications.

Consultation with a Pain Management Specialist is arranged for those patients who continue with difficult to control pain.

• There are risks related to every procedure. Some of the following can occur with any surgical procedure, whereas others may be specific to a particular procedure or position at the time of surgery.  Most complications can be managed and patients can still have good outcomes though their hospital stay may be prolonged and further specific investigations, treatments or procedures may be necessary.
• This is a broad summary of the major/ most common/ most concerning complications related to spine surgeries
  • Ongoing, worsening or new nerve symptoms- pain, tingling, altered sensation, weakness
  • Hoarse voice (anterior cervical procedures)
  • Swallowing difficulties (anterior cervical procedures)
  • Unintended durotomy with leaking of cerebrospinal fluid
  • Blood vessel injury (anterior lumbar approach surgeries)
  • Wound infection
  • Urinary tract infection
  • Pneumonia
  • Impaired fertility (anterior lumbar approach surgeries, especially L5/S1)
  • Deep Vein Thrombosis
  • Pulmonary Embolus
  • Non-union (fusion surgeries)
  • Construct Failure – metalwork loosens or fractures, subsidence of intervertebral devices, vertebral collapse
  • Adjacent segment degeneration (fusion procedures)
  • Need for blood transfusion
  • Need for further procedure
  • Cardiac dysrhythmia or infarct
  • Stroke
  • Blindness (prone/ face down body position during surgery)
  • Anaphylaxis
  • Death