Most people are mostly worried about the actual surgery and of course it is a major undertaking. However, the surgery is done by experts and you can do very little yourself during the actual surgery to affect the outcome. A really important time is the post operative rehabilitation period and it is important that you are well prepared for this. In the sections below you can see what you can expect both while in hospital and also during the initial period after you get home.
On the ward
After your surgery you will go to the High Dependency Unit or HDU. You can ask your nurse if you and your family would like to see the HDU before your surgery.
You will stay on the HDU for at least one night because you have had a big operation and need close monitoring. When the doctors are happy, you will return to your ward.
When you wake up, you will have lots of tubes and wires attached to you. These are for monitoring your observations, giving you oxygen and pain relief.
You will have a pump above your bed with a syringe that contains strong pain relief. This is called patient controlled analgesia or PCA. The PCA has a button attached to it that you can press. The pump will give some pain relief through a tube in your hand. You cannot give yourself too much medication as the machine is programmed to give you a certain amount. While you are on your PCA, your nurse will have to do your observations every two hours. This will mean they will wake you up during the night. This is important as the strong painkillers in your PCA can slow down your breathing and make you feel very drowsy.
You may have an epidural which is a pain killer that goes into your spine through a small tube in your back. A special machine will give you a set amount every hour.
We will also give you regular pain killers such as paracetamol as a tablet or a liquid.
A bag of fluid will hang above your head and a pump will give you a set amount every hour through a tube in your hand. This is to make sure you do not become dehydrated. Once you start drinking, this can be removed.
You might need antibiotics to help prevent or to treat any infection. If you feel sick after your surgery, the nurses can give you medicines to help this. You will be able to discuss with your nurse which way you prefer to take medication, for example, tablet or liquid.
It is very important that you don’t stay in the same position for too long following your surgery as you will become stiff and may get sores on your skin if you have pressure on the same parts of your body for too long. Your nurse will help you change your position at least every four hours by rolling you either on to your back or side with your shoulders and hips moving at the same time. This is called log rolling and helps prevent twisting your back in bed.
As you will not be able to get out of bed to go to the toilet, you will have a small tube going into your bladder. This is called a urinary catheter and it drains your urine into a bag. This will be removed once you are able to walk to the toilet.
It is normal for stools to be difficult to pass after your surgery. You may be given laxatives that will help soften your stools.
You will be given a wash in your bed each day and your sheets changed. You can do as much of your washing as you feel comfortable doing, your mum/dad/carer can help the nurse if you like. Around your urinary catheter site will need a very good wash daily to prevent infection. Once you are able to mobilise, a nurse will help you have a shower.
You will have an X-ray after your operation, before you go home.
The type of operation you have will affect when you start moving out of bed.
If you had a single stage procedure, you should be able to start moving the day after your operation.
If you only had one stage out of two, you may be required to stay on bed rest until your second stage is completed.
Your surgeons will specify what angle you can sit up to in bed while on bed rest.
Your physio will teach you exercises to do in bed, which include deep breathing exercises to help keep your chest clear.
Sometimes your doctors would like you to wear a corset. This can be for comfort or until your brace is ready.
The brace (post-operative TLSO)
You may need to wear a brace after your surgery. This will be decided by your surgeon. Shortly after the spinal operation and when medically stable, you will be individually assessed by the orthotists who designs and manages the TLSO prescription. This measurement process often involves a plaster casting procedure. Your nurse will arrange for you to be casted for a brace. You will be taken to plaster theatre by the porters. The cast can be done when you are standing up or lying down. Your surgeon will let you know what they would prefer. The aim is to prevent accidental damage to the operation site and aid healing, and the design of the brace reflects these aims. Following the measurement process the TLSO is manufactured on-site and, depending upon the complexity of the design the TLSO is normally ready between six and 24 hours of measurement. You may have to wear the brace all day and at night. Your surgeon will tell you when you are allowed to take your brace off. The nurses and therapists will teach you how to put the brace on. The orthotics service provides a comprehensive outreach service both while you are on the ward and after you are discharged to support the course of recovery.
Sitting over the side of the bed
The first step is to sit up on the edge of the bed. It is normal to feel a bit dizzy when you first try this. Your physio will help you to do this.
Sitting to standing
Once you have practised sitting and feel well, your physio will help you to stand up. You may be able to take a few steps to sit in a chair.
Once you are ready, your physio will help you to walk further. You may feel a little weak to start with as you have been on bed rest. You will be able to practise walking with the nurses and your family. You can practise walking up and down stairs before you go home if you would like.
You will have an X-ray before you go home.
The nurses will need to change the dressings on your wounds. Once your wounds begin to heal, the dressings can be removed. This could be before you go home.
Following your operation, it is important for you to resume your normal daily activities as soon as possible while remembering to protect your back. There are some precautions you need to be aware of to reduce the strain on your back, thus allowing the bones in your spine to heal. Bony healing can take approximately three to twelve months to complete, but it may take longer. Your precautions will usually last for this long as well. An occupational therapist will see you on the ward to help you with this.
The main precautions are:
- Avoid bending your hips more than 90 degrees whether lying, sitting or standing
- Avoid twisting your back
- Avoid lying on your stomach
- Avoid being pulled up under your armpits or legs
- Avoid jarring your spine
- Avoid lifting heavy objects (more than 1kg in each hand)
- Reduce the risk of falling by removing hazards from the environment
Your toilet should be as high as your kneecap when standing next to it. This will stop you from bending beyond 90 degrees when you sit as recommended in the precautions.
If your toilet is too low, the occupational therapist will assess/provide you with the necessary equipment to make it the right height.
You will not be able to sit in the bath for your precautionary period. If you have a shower over your bath you can shower sitting on a bath board which the OT will assess and provide for you before you go home.
If you are required to wear a brace, this should be removed once you are sitting on the bath board and then replaced before you get out of the bath. Your OT will show you how to transfer in and out of the bath.
If you have a separate shower, you may be allowed to stand or sit on a shower chair. Your occupational therapist will advise you about this.
It is best to wear loose fitting clothing and front opening garments if possible. Try and sit to dress and undress as this provides more stability. Lower body dressing such as underwear, trousers, socks and shoes will be more difficult as you are not allowed to bend down. You can get assistance from a family member and/or your occupational therapist will show you some techniques which may include using a “helping hand”. Shoes should be comfortable and have low heels. Slip on shoes are easier to manage than laces.
If you are required to wear a brace, you will need to wear a close fitting seamless T shirt underneath the brace. Never wear your brace directly onto your skin.
Caring for your skin
Before you go home, make sure you are comfortable in your brace or plaster jacket. Inspect your skin regularly. If the brace is rubbing or digging, please call the Orthotics Department on 020 8909 5418.
Keeping your brace clean
Wipe the inside and outside with a damp cloth – DO NOT use hot water. DO NOT use a hairdryer or radiator to dry the brace. Canvas fronts may be hand washed and towel dried only.
Your bed should be firm. Get on and off the bed using the “log rolling” method you were shown on the ward.
Sit upright and straight with both feet flat on the floor. Ideally choose a firm, high backed armchair, which supports your back. The seat should be as high as your kneecap when standing next to it. Avoid sitting on low, soft armchairs or sofas, on the floor or on beanbags as this causes you to bend your hips and strain your spine. Aim to gradually increase the time you spend sitting and standing as it may be uncomfortable at first.
You have had major surgery to your back. You should expect to feel tired initially and it is better to rest frequently and avoid getting over tired. You should be back to normal activity levels by six weeks after surgery, excluding those activities you have been advised to avoid during the first few months of your recovery. If you discover any particular issues that are not covered here, please do contact the children's therapies team on 020 8909 5820/5821.