What to expect from spinal decompression and fusion surgery

If you have severe, ongoing pain related to nerve compression and or spinal alignment, it’s likely you’ve tried therapeutic options to ease the pain in your neck or back. If those therapies haven’t helped, your doctor can refer you to a surgeon, who may recommend spinal decompression and fusion surgery. Patients who have pain, weakness, or numbness from a compressed nerve in the spine, spinal malalignment or spinal instability may benefit from this procedure to take pressure off compressed nerves by realigning and stabilizing the spine.

During spinal decompression and fusion surgery, your surgeon removes overgrown bone and disc bulges. Next, the surgeon realigns the spine to take the pressure off pinched nerves and fuses two or more vertebrae together. This makes your spine stronger and helps the compressed nerve regain function. Injured nerves are not always capable of returning to “normal” function.

“Our main goal with this surgery is to decompress–or take the pressure off–the nerves. Nerve compression is what leads to nerve pain, often called a pinched nerve or sciatica in the legs,” said Dr. David Stockwell, an IU Health neurosurgeon. “To stabilize the bone where we’ve decompressed the nerves, we fuse the vertebrae together. Fusion involves using hardware, like rods or plates with screws, to hold the bones in position. The bone grows from one vertebra to another, fusing them together.”

Your surgeon will review recommendations for how you can safely return to activity following surgery. If your surgery involves fusion, the level of stiffness you experience will depend on the number of vertebrae that are fused together. The vertebrae that are instrumented and fused together can no longer move independently from one another. Physical therapy will help you learn how to safely bend, twist or flex with a fused spine.

Preparing for spinal decompression and fusion surgery

Spinal fusion surgery is a year-long journey to surgically repair your spine, recover from the procedure and strengthen your back. It begins with surgery preparation.

In the weeks before your surgery, you’ll complete preadmission testing. This makes sure you are healthy enough for surgery. You’ll also learn how to prepare your home and remove clutter to reduce the risk of falls after surgery.

A day or two before your procedure, your surgeon’s office will call you to go over your pre-surgery instructions:

• Do not eat or drink anything 12 hours before surgery, including water, coffee, gum or mints.
• Using small sips of water, take only the medications your doctor has approved.
• Follow your doctor’s instructions for sterile bathing.

On the day of your surgery, you’ll arrive about two hours before the procedure begins. Once you check in, you will be sent to the presurgical area to change into a hospital gown and begin preparation for surgery, including:

• Having an IV placed
• Signing consent forms
• Meeting your anesthesiologist
• Drawing any pre-op labs
• Discussing any last-minute questions with your surgeon

Your surgical team will mark incision site, and you will be placed under anesthesia for your procedure. During spinal fusion surgery, bone tissue and spinal instrumentation are used to reinforce your spine by fusing together two or more vertebrae.

Once surgery is complete, your surgeon will visit your family in the waiting area to update them on how your procedure went.

Immediate recovery after spinal decompression and fusion surgery

If you are having an outpatient surgery, you will return home once you’ve recovered from the anesthetic. If you are having an inpatient procedure, you will stay in your hospital room for two days to a week, depending on the complexity of your surgery.

After surgery, occupational and physical therapists will help you safely begin moving and assess your stability to plan a safe discharge. You may be safe to return directly home, or they may recommend admission to a rehabilitation hospital or nursing facility. These facilities help you work on strength and stability so that you can safely return home and function independently. Case managers and social workers will arrange home care or admission to a rehabilitation facility.

You will receive instructions on medications to help with pain, activity restrictions and how to care for your incision. While you can expect some pain after spine surgery, there are ways to keep your pain under control. It’s important that you communicate your pain levels and needs honestly and accurately so your care team can help you address them.

Your surgeon will explain your rehabilitation plans and activity restrictions following surgery. After-care instructions will include information on:

• How to move, what movements to avoid and how much you can safely lift
• When to take medicine
• How to care for your incision
• How to bathe

Spinal decompression and fusion surgery recovery timeline

Recovery time following spinal decompression and fusion therapy varies from person to person. It often takes four to twelve weeks to return to normal activities and one to two years to recover entirely.

First few days after surgery

It’s normal to feel exhausted after surgery, so be sure to get plenty of rest and stay hydrated. You’ll have medicine to address the pain. You can also apply hot or cold packs at 20-minute intervals. You will work with physical and occupational therapists to start moving again. The therapy teams will give you instructions to help you safely return to normal activities. Your doctor will recommend that you avoid movements like bending, twisting, lifting and driving a car (riding in a car should also be limited to 30 minutes.) You’ll clean your incision site daily to check for signs of infection. If possible, have someone at your home with you who can help prepare food and complete basic tasks

First six weeks after surgery

As your spine heals and strengthens, you’ll continually increase the distance you are walking. If needed, you will start physical therapy exercises to strengthen your back. Your surgeon may recommend that you wear a customized brace for four to twelve weeks after spine surgery. A brace can limit motion, offer support and help hold your spine in place.

For most patients, pain from surgery doesn’t last beyond four weeks. You’ll shift from prescription pain medications to over-the-counter medicine like acetaminophen, ibuprofen, aspirin or naproxen. If you have a fusion surgery, your surgeon will likely ask you to avoid anti-inflammatories like ibuprofen and naproxen as those medicines can slow down the bone healing process. While you’ll be moving more and can begin light chores, you still should limit your movement. Your surgeon will provide lifting restrictions specific to your surgery and spine. You will likely need to minimize bending, lifting and twisting for the first few months. Depending on how physical your job is, you might return to work during this time.

Six months to a year after surgery

Your surgeon will monitor your recovery process to ensure your nerves and spine continue to heal as expected. Once your spine has healed sufficiently—around six to twelve months after surgery—your surgeon will clear to return to regular activities. It can take up to two years to fully recover from spinal fusion surgery.

When to be concerned

Spinal decompression and fusion surgery has a very high success rate. While your recovery is likely to be smooth, you should contact your doctor with any concerns. Contact your surgeon immediately:

• If you have pain, swelling or redness in your arm or leg. It could indicate something serious, like a blood clot.
• If your pain increases or isn’t helped with pain medicine.
• If your incision opens. Cover it with a clean dressing and call your surgeon immediately.
• If you experience worsening nausea or are vomiting.
• If you have a fever over 101.5 degrees.
• If you develop new or worsening weakness

It’s rare, but if you experience chest pain, trouble breathing, a racing heartbeat or you feel like you may faint, call 911 or get a ride to the emergency room.

Maintaining follow-up appointments with your surgeon is important throughout your spinal decompression and fusion surgery recovery. A safe and monitored recovery can help you rebuild strength and return to normal activities. To learn more about other people’s experience with spinal fusion surgery, check out Joetta’s story or Chris’s story.