After Lumbar Fusion or Disc Replacement

The big picture

After a fusion, the screws and rods hold your spine still so that bone can grow across the level and make it one solid piece. That takes months. Everything in this playbook protects the fusion while it forms: no bending, lifting, or twisting; steady walking; no nicotine; and no anti-inflammatory medicines. After a disc replacement there is no fusion to protect, but the implant and the front incision need the same careful first six weeks, so the same rules apply unless I tell you otherwise.

The first week

• Walk. Begin with 5 minutes, 6 to 8 times a day, and build up. Use the walker or cane the therapists gave you until you are steady.
• Do not sit for more than an hour at a time. Get up, walk, change position. Sitting loads the low back more than standing or lying down.
• Log-roll to get in and out of bed: bend your knees, roll onto your side as one unit with hips and shoulders together, then push up with your arms. No twisting. A pillow between the knees helps on your side.
• You may shower starting the second day after surgery. Let water run over the incision, do not scrub, and pat it dry. No baths, pools, or soaking for six weeks.
• Leave the clear glue or mesh over the incision until it peels off on its own, around two weeks. If a thread end is visible at the end of the incision, leave it until two weeks, then it can be trimmed flush to the skin after cleaning with alcohol.
• Send the office a photo of the incision at 2 weeks and at 4 weeks.

No BLTs

For about three months after a fusion, and six weeks after a disc replacement:

• No Bending at the waist. Bend your knees and hips instead. Do not bend forward further than it takes to brush your teeth.
• No Lifting more than 10 to 15 pounds. A gallon of milk is about 8 pounds.
• No Twisting. Turn your whole body, feet first.

Move the things you use every day to waist height before surgery so you are not tempted. A "grabber" tool is worth its price.

Pain and medicine

• Acetaminophen (Tylenol) on a schedule is the base, up to 3,000 mg a day unless told otherwise.
• Opioids are for the first one to three weeks, tapered down steadily: if you were taking two tablets every four hours, go to one every four hours, then one every five, and so on. Do not combine them with any opioid you took before surgery unless we planned that together. Refills are handled during office hours; call a few days before you run low.
• No anti-inflammatories (ibuprofen, naproxen, meloxicam, celecoxib, aspirin for pain) for at least three months after a fusion. They slow the bone from fusing. After a disc replacement, I will tell you when they are allowed.
• A nerve-calming medicine or a muscle relaxant may be part of your plan for the first weeks.
• Constipation is expected. Start the stool softener on day one. If no bowel movement by day three, double the softener; by day five, add polyethylene glycol (MiraLAX); by day six, a suppository; by day seven, call us. Nausea, vomiting, or a hard, swollen belly: call the same day.
• Bone medicines: if you take a bone-building injection (teriparatide or abaloparatide), it is usually restarted a week after surgery. Bisphosphonates (alendronate, zoledronic acid) usually wait until about four months.

Front-approach extras (ALIF, lumbar disc replacement)

• The bowel is slower after an abdominal approach. Start with liquids, advance slowly, and follow the bowel plan from day one.
• Bruising on the belly, and in men swelling of the scrotum, is normal in the first week or two. A supportive undergarment helps. Call if it is painful, hot, or growing.
• One leg may feel warmer than the other for a few weeks. This comes from nerves that control blood vessel size being moved during the approach, and it fades.

Side-approach extras (LLIF / XLIF)

• A sore, numb, or weak front of the thigh on the side of surgery is expected and usually fades over days to weeks. Report it to us at each visit so we can track it. Weakness that gets worse rather than better needs a call.

Driving, work, and life

• Driving: when you are off opioids and can turn and brake comfortably, usually about four weeks. Ride as a passenger whenever you like, in the front seat, slightly reclined, stopping every hour or so on long trips to walk.
• Desk work: usually three to six weeks. Physical work: not before the fusion is forming, often three months or more, in stages. I will write your letters.
• Walking is your exercise for the first four weeks. A pool for walking or gentle swimming is encouraged after four weeks once the incision is sealed. A stationary bike at six weeks. Physical therapy usually begins at the four- to six-week visit. Running, impact sports, and heavy lifting wait for a solid fusion on X-ray.
• Nicotine in any form delays or prevents fusion. This is the time to be strict.

Your follow-up

• 2 weeks: incision photo, or a wound check if needed.
• 4 to 6 weeks: visit with X-rays. Physical therapy ordered if needed.
• 3 to 4 months: visit with X-rays; most restrictions lifted if the fusion is forming.
• 1 year, 2 years, and periodically after that: X-rays to confirm the fusion and watch the neighboring levels.

Call the office the same day for

• Spreading redness, drainage, or an opening in the incision. Fever over 101.5°F.
• Clear fluid from the incision, or a headache that is much worse upright and better lying flat.
• Calf pain or one swollen leg, which can mean a blood clot.
• Pain that is getting worse after the first week, or new leg pain.
• No bowel movement by day seven, or vomiting and a swollen belly.

Call 911 or go to an emergency room for

• New trouble controlling bladder or bowels, or numbness in the groin.
• New or rapidly worsening leg weakness.
• Chest pain or sudden shortness of breath.

Learn more

OrthoInfo, Spinal Fusion: orthoinfo.aaos.org (opens in a new tab)

My guide to spine emergency warning signs lists the symptoms that should never wait.

This playbook is general guidance for Dr. Wey's patients. Your own discharge instructions come first. If anything here does not match what you were told, what you were told wins: please ask us.