From the first visit to full recovery, your care with Dr. Ronjon Paul is designed to be thoughtful, individualized, and transparent.
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Naturally, once anesthetics have worn off, pain will become increasingly evident in the areas involved in a surgical procedure. You may not have much incisional pain after surgery because local anesthesia is injected at the time of surgery. This will wear off in the evening. We recommend you use the pain medicine prescribed or muscle relaxant to avoid the potential for getting behind your pain.
Dr. Paul will prescribe painkillers, also known as analgesics, to reduce the discomfort of this post-surgical recovery period. Medications prescribed can range from over-the-counter NSAIDs (after the first five days) to potent prescription opioids, depending on the projected severity of pain. If you are or have undergone a fusion procedure, you should avoid NSAIDs for the first 6 weeks. Patients should take care to manage their dosing relative to the pain experienced. Opioids can usually be tapered off within the first two weeks of surgery. NSAIDs may be taken with protective measures for the gastrointestinal system, such as proton-pump inhibitors (PPIs) such as omeprazole, antacids such as TUMS, and bismuth salts such as Pepto Bismol to reduce the risk of ulcer formation.
Taking proper care of your incision is essential for healing. Follow these guidelines to ensure a smooth recovery:
Your incision may drain for the first week following surgery. This is normal and should decrease as you heal. Look out for concerning signs such as foul-smelling drainage or a very red (“tomato red”) wound—these may indicate an infection and should be reported to your doctor.
If you cannot keep the wound dry in the shower, consider taking sponge baths until your postoperative visit.
It is very common to have increased pain at night and when you first get up out of bed. Any time you remain in one position for an extended period of time, the muscles may tighten and swell, and you can experience pain. As a result, transitioning can bring on pain. Transitioning includes lying to sitting, sitting to standing. Anticipate this and use medication appropriately and or take time to do these activities. Do not try to move quickly. You won’t do anything to harm your surgery but you may have an increase in pain. This will improve with time.
After your surgery, it’s important to follow these guidelines to ensure a smooth and successful recovery. Daily walking is highly encouraged as part of your healing process. Start with short distances and gradually increase both the distance and duration each day. If you need to climb stairs, you may do so as necessary, but take your time and avoid overexertion.
Please adhere to a 10-pound lifting limit until your follow-up appointment. Additionally, avoid bending or twisting at the waist, as these movements can strain your healing body. Driving is not permitted while you are taking pain medications or muscle relaxants, so plan accordingly.
Refrain from sexual activity for the first two weeks after surgery to allow your body adequate time to recover. If physical therapy is deemed necessary, it will be arranged during your first follow-up appointment to support your rehabilitation journey.
There are no post-operative restrictions in climbing or descending stairs.
You may experience mild to moderate discomfort when using stairs immediately after surgery, but this is normal and won’t harm your healing. Take your time and use handrails for support. Similarly, getting on and off the toilet may feel uncomfortable initially. For lower toilets, a raised toilet seat or grab bars can provide added comfort and stability. Remember to move carefully as your body adjusts during this recovery phase.
We often talk to patients about the first 2 weeks being the most difficult after spine surgery. The first 2 days are the hardest in those 2 weeks. Although some procedures produce less pain than others, they all have some discomfort. The more generally active you are, the less muscle soreness you experience. Please do not just lie in bed.
In the early weeks, gradually increase activities. Remain on your feet for more extended periods and improve your walking distances. You may return to a sedentary job in as little as 2-3 weeks, but with no bending, twisting, or lifting more than 10 pounds. Sit only in chairs with good lumbar support.
You may start a regular aerobic activity such as vigorous walking, stairmaster, or low impact aerobic exercise classes if allowed after the first follow up appointment. This is typically within 2-3 weeks. Once you are off of any narcotic pain killers, you are free to drive from our standpoint.
For spinal fusions, it’s important to understand that from a mechanical perspective, you inevitably lose some motion. The question becomes how your remaining levels and hip joints compensate to retain your function and everyday lifestyle. Dr. Paul’s team rarely relies on braces and extensive immobilization. The instrumentation and current spinal techniques generally create enough stability to allow the bones to fuse. As a result, we allow people to move sooner after surgery. This also helps to maintain strength and flexibility in the remaining portions of your core and spine. If necessary, we typically order physical therapy after your two-week visit with Kevin. Exceptions would include fusions involving four or more levels and people with osteopenia.
Dr. Paul’s team often utilizes a physical therapist matched to your unique needs to help with your rehabilitation in the early weeks.
After the first six weeks, we typically decrease restrictions. If you were given a brace, it is typically no longer required, and we allow for more bending or twisting as required for normal everyday activities.
We will often raise the lifting restriction to 20 to 30 pounds. You may return to light duty or physical labor if pain-free and allowed by your surgeon—with minimal bending or twisting. We do not recommend returning to work if you commute more than one hour each way. You may swim after six weeks. Continue your physical therapy exercise program. You may be shown specific therapeutic exercises at your six-week visit.
The most dramatic changes will take place in the first 8-weeks post-op. Even if you experience some of your pre-op pain during this time you should not be too concerned. We follow our patients for a year post-op knowing the nerves may take a long time to heal. Most feel significantly better after the first week or two.
You may travel by car for more than 3 hours in 2-3 weeks, but with frequent breaks. You may travel by plane in 4 weeks for trips less than 4 hours. After 6 weeks, you can resume all travel. You may drive as soon as you are off narcotic painkillers.