Post-Surgery Care and Concerns After Lumbar Fusion: A Guide

What are the issues after lumbar fusion surgery?

Currently, my doctor said I can go jogging and do some stretching, but I should avoid bending over and lifting heavy objects.
His responses were quite brief, probably because he is too busy to provide detailed information.
My lumbar spine looks like this: https://imgur.com/a/3izs3Mc.
My job requires me to sit for long hours, and the office chair is very poor.
After work, my lower back is very sore, and my legs sometimes feel a bit numb and painful.
When I get home, I just want to lie down.
Honestly, I don't know how to change this situation.
Question 1: After undergoing fusion surgery from L2 to L4, do I need to take special care, such as practicing core strengthening? It seems necessary, right? Can I perform all core exercises? (This is my main concern.) I found many core exercises online, but are some of them really suitable for someone who has had spinal surgery or fusion? Should I consult a rehabilitation physician or a physical therapist to confirm how to proceed? However, the rehabilitation clinics near my home seem subpar, and I wonder what the purpose of heat therapy is...
Question 2: I feel that some movements are noticeably limited, such as tying my shoelaces.
Although I can still bend down, I have to spread my legs outward and cannot fully bend down to tie them.
I also have difficulty squatting; I must go on my toes, as my heels cannot touch the ground, or else my body will lean backward.
If there is no seated toilet, I...
I wonder if these issues can be improved? It seems unlikely, right?
Question 3: If I live long enough (assuming the giant cell tumor does not recur), will the connecting rods eventually break due to metal fatigue over time? Is there any literature that estimates the likelihood of young individuals requiring reoperation due to degeneration after undergoing fusion surgery?

Ming, 20~29 year old female. Ask Date: 2021/11/12

Dr. Wang Shouji reply Orthopedics

Hello, after spinal fusion, it is important to check if the fusion has been completed.
If the fusion is successful, engaging in some core muscle training should not pose significant issues.
If sitting in a chair is uncomfortable, feel free to change it.
Lumbar fusion will inevitably affect the range of motion in the lower back, so it is advisable not to push yourself too hard in the early stages.
The recurrence of tumors is not certain, so regular follow-ups are necessary to avoid the need for further surgery.
It is essential to protect the mobility of the lower back and prevent strain on other segments.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2021/11/12

More Info

Post-surgery care after lumbar fusion surgery is crucial for a successful recovery and long-term health. Given your recent surgery from L2 to L4, it’s understandable that you have several concerns regarding your recovery, physical activity, and potential limitations.

1. Post-Surgery Care and Core Strengthening
After lumbar fusion surgery, it is essential to focus on rehabilitation and strengthening exercises, particularly for your core. Core strengthening is vital as it helps stabilize the spine, reducing the risk of future injuries and improving overall function. However, not all core exercises are suitable immediately after surgery. It is advisable to consult with a physical therapist or a rehabilitation specialist who can tailor a program specific to your needs and surgical history. They can guide you on which exercises are safe and effective, ensuring you avoid movements that could jeopardize your recovery.

Common core exercises that may be beneficial include pelvic tilts, bridges, and modified planks. However, exercises that involve heavy lifting, twisting, or bending should be avoided until you have fully healed and received clearance from your healthcare provider.

2. Addressing Limitations in Mobility
It is common to experience some limitations in mobility after lumbar fusion surgery. Activities like bending down to tie your shoes or squatting may feel different or more challenging than before. This is often due to the surgical changes in your spine and the healing process. However, with time and appropriate rehabilitation, many patients find that their mobility improves.

To address these limitations, consider the following strategies:
- Use adaptive tools: For example, a long-handled shoehorn can help you put on shoes without bending excessively.

- Practice gentle stretching: Incorporating gentle stretches into your daily routine can help improve flexibility and reduce discomfort.

- Gradual progression: As you regain strength and mobility, gradually increase the complexity of your movements under the guidance of a professional.

3. Concerns About Metal Fatigue and Future Surgeries
Regarding your concern about the longevity of the hardware used in your fusion surgery, it is important to note that while metal fatigue can occur over time, modern surgical materials are designed to withstand significant stress. The likelihood of hardware failure is relatively low, especially if you adhere to post-operative guidelines and avoid high-impact activities.

As for the risk of needing additional surgeries due to degeneration, studies suggest that younger patients who undergo fusion surgery may have a higher risk of adjacent segment degeneration, which could lead to further surgical interventions. However, this risk varies widely among individuals based on factors such as age, activity level, and adherence to rehabilitation protocols.

Conclusion
In summary, post-surgery care after lumbar fusion involves a combination of proper rehabilitation, core strengthening, and gradual return to normal activities. It is crucial to work closely with healthcare professionals to develop a personalized recovery plan that addresses your specific needs and concerns. While some limitations may persist initially, many patients experience significant improvements over time. Lastly, while concerns about hardware longevity and the potential for future surgeries are valid, following your doctor's recommendations and maintaining a healthy lifestyle can help mitigate these risks. Always feel free to reach out to your healthcare provider with any questions or concerns as you navigate your recovery journey.

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