Lower Back Treatment Options Introduction

This page is written for you, the patient, and for your family. It will help you understand what to expect before, during and after your operation. This is necessary in order for you to make an informed decision regarding spine surgery. This page will describe the reasons your surgeon has chosen this procedure, the operation itself, the expected results, as well as a detailed list of possible complications that occasionally occur. Please take the time to read this page carefully, and feel free to discuss any questions that you might have with your doctor before deciding to undergo the operation.

You are about to undergo an operation known as posterior lumbar interbody fusion. You have been experiencing backache and sciatica (a pain down one of your legs). This happens because the disc between the two vertebrae in your lumbar spine either wears out (degenerates) or slips out of its normal position and starts compressing on your nerve roots. A worn disc dries out, causing the disc space to collapse. The two vertebrae holding the disc come together and begin degenerating. This produces further pressure on your nerve roots and increases your pain.

In time, normally within 4 months, the bone grafts will unite with the vertebrae above and below to form one piece of bone.

If you bend forward during this period of bone union, the bone graft may slip out of position and ruin your operation. Therefore, we strongly advise you to follow the instructions in this booklet.

You can get out of bed the day after your operation, but to get out of bed, FIRST turn on your side to avoid forward bending.

As an additional precaution, and also as an external support to promote the process of bone union, you will receive a Knight spinal brace. For your comfort, a Camp belt has been incorporated, like a corset, within the brace. You will only be allowed to get out of bed AFTER you are fitted with the brace.

Once you learn how to get out of bed, you can walk freely on the floor and sit in a chair ONLY to have your meals. You should not sit up in bed. This will place pressure on your spine. The head of the bed should only be elevated 10 degrees. You may have a pillow for sleep.

Upon discharge, you can go home in an ambulance, although this is not necessary. Ambulance regulations require that you be strapped into a stretcher which, for a patient like you, is not comfortable. You can travel home comfortably in a large, four-door car. If you do not own such a car, you can request a friend or a relative to arrange one for you.


When a disc is removed, the vertebral bodies will settle, resulting in recurring nerve irritation or instability.	Normal lordotic curvature of the lumbar spine will enhance the locking mechanisms of the graft within its disc space.

Bone removed from the patient's body is packed tightly into the emptied disc space, serving as a disc replacement.

INSTRUCTIONS FOR WHEN YOU ARE HOME

Upon discharge, you will still have the dressing on your back. Underneath the dressing are waterproof Steri-strips so that you can take a shower. After 4 or 5 days, you can remove the Steri-strips and throw them away. You will not need another dressing.

You can take a shower THREE times a week. WEAR THE BRACE INTO THE SHOWER, BUT REMOVE IT BEFORE TURNING THE WATER ON. Make sure that you do NOT bend forward to wash your legs. You can wash your legs by lifting them upward or by having a family member help you.

You should wear the brace at all times EXCEPT when taking a shower. The brace gives external support and helps to prevent undue movement of the spine, which can cause stress and delay bone union. It also maintains the natural lordotic curvature of the spine, which is so essential for your body.

If you wish, you can be provided with an elevated toilet seat. You should have regular bowel movements at least every other day, either with dietary regulations or a mild laxative.

Avoid sexual intercourse for the first month. During the next 3 months, you can resume sexual activity with moderation, but you should be in the supine (face up) position.

During the next 2 months, you may feel an ache in your right buttock. The pain comes from the healing process of the pelvic bone, from which the bone graft was taken. The pain may become worse if you overexert yourself or, sometimes, with a sudden change in the weather, but there is nothing to worry about and you will feel relief with a Tylenol tablet.

From now on, you should practice picking up things WITHOUT bending forward. During the first 4 months, there is a possibility that the graft may slip out of its position. After 4 months, bending forward may put stress on the discs above and below. If you have to pick up anything light, you should BEND YOUR KNEES TO REACH THE FLOOR. You should NOT lift anything heavy. You are also advised against taking part in sports like bowling, tennis, or water-skiing, which may twist and sprain your back. You CAN swim after 4 months.

Exercise is a very important part of your recovery. The muscles in your back have become weak because of your operation, and your legs are weak since you have not been doing exercises because of the pain. Exercises help to

Since you have just been operated on, all exercises may not be suitable for you. There are several back- conditioning exercises that you can do, however. Walking is an excellent exercise. It does not require supervision; it improves circulation in the back area operated upon; and you can walk in the house in case of bad weather. While walking, you can also go up and down the stairs, BUT DO NOT JOG because it is NOT good for your back. Going up and down the stairs strengthens your thigh and calf muscles, and your newly acquired habit of bending your knees to pick up things does not become an ordeal for you. Short of climbing the stairs, half-bent knee exercises can be done on a flat surface. In the early days of your recuperation, excessive walking may bring on pain, so that you must use your own judgment as to the distance that you can walk each day without discomfort. Generally, in the first month, you should walk half a mile twice a day; during the third month, 3 miles a day; and during the fourth month, at least 4 miles a day in two sessions with a speed of 15 minutes per mile for males and 20 minutes per mile for females. If you follow these instructions carefully and adhere to the exercises regularly, the success rate of your satisfactory bone fusion is enhanced.

You will be prescribed medications for pain and for muscle relaxation. THESE MEDICATIONS SHOULD BE TAKEN ONLY IF NECESSARY. THE SOONER YOU ARE OFF THESE MEDICATIONS, THE BETTER IT IS FOR YOU.

Scientists have realized that our bodies, especially women's bodies, lack calcium. For example, calcium is now being given regularly to normal females from the age of 30. You require extra calcium to promote healing of your bones. Without calcium, bones become soft and osteoporotic. Therefore, you should take 1 to 1.6 g of calcium every day for the rest of your life. In addition, a glass of milk daily is good for you. To make sure that enough calcium is absorbed into your bones to strengthen them, you will also be given a daily, 4-month supply of vitamin D, calcitriol (0.25 mg/day), and fluoride tablets (about 10 mg/day).

Extra weight and fat are harmful to your back. Extra weight puts pressure on the spine and leads to degeneration. A protruding abdomen causes exaggerated lordosis and swayback. Also, high- heeled shoes further increase swayback and are not advisable for you.

If you are overweight, you MUST shed those extra pounds before you go in for your operation. If, however, because of back pain, you are not in a position to wait to have your surgery, you must begin losing weight soon after your operation. We will advise you as to your ideal weight.

Smoking has been found to delay bone fusion. This would be the ideal time to eliminate the smoking habit.

We will see you in our office 1 month after your discharge from the hospital and, thereafter, as you feel it necessary. X-ray films of the spine will be taken after 4 months. After reviewing the films, we will speak with you about discarding the brace and the possibility of your returning to your original job.

Keep your back healthy, and achieve good physical fitness. It is your responsibility to avoid further strain to your spine. Follow these instructions diligently. In the meantime, should you have any problems, such as increasing pain, puffiness of the dressing, or tenderness of the incision, you should immediately call the office and speak with your surgeon. We will be glad to help you.

NOTE: If there is anything you do not understand about the information provided here, it is your responsibility to ask a member of your health care team for assistance before you make your final decision.