Pre-Operative:

Patient issued a Thoraco-Lumbar-Sacral Orthosis(TLSO) for use after surgery. This brace should be brought to the hospital on the day of surgery.

Acute Phase: 1 day - 4 weeks

  • Hospital stay: 1-3 days
  • Physical therapy will provide training for safe transfers and bed mobility.
  • Dressing change will occur in the hospital and then every other day.
  • Post-op day 2 or 3 patient will be discharged either home or to a rehabilitation facility depending on level of safety and independence.
  • Sponge bathing (to keep incision dry) is to be performed until removal of staples (2 weeks post-op).
  • Incentive spirometry 4 times daily.
  • TLSO to be worn at all times except while in bed or recliner.
  • Begin Home exercise program attached.
  • TED stocking to be worn most of the time. Only removed 2-3 times per day for ½ hour to wash lower extremity (until 1st post-operative appointment).
  • Do ankle pumps on an hourly basis to promote circulation.
  • Continue to take prescribed pain medication and use ice as needed for pain control.
  • Bone stimulator may be used per M.D. discretion and will be fit and set up by representative (EBI/TERA).
  • Therapeutic exercises include: walking to tolerance.

Precautions:

Sitting (with good posture) no longer than 20 mins 3x/day, no bending, lifting, pulling, pushing more than 10 lbs. No climbing. May drive at 2 weeks post-op with the brace on.

Red Flags:

If you develop fever, chills, malaise, shortness of breath, excessive drainage, redness, or extreme pain and tenderness in calf region contact physician (315) 824-1250.

Subacute Phase: 4-8 weeks

  • Follow-up x-rays may be taken at 1 week and 6 weeks to demonstrate the beginning of bone healing at fusion site.
  • Lifting restrictions (10lbs).
  • No power tools.

Remodeling Phase: 8 weeks

  • Fusion may take 6 months to 1 year to fully heal.
  • Brace removed at approximately 8 weeks, if indicated will begin physical therapy.
  • Lumbar ROM is allowed to tolerance all planes after brace removal beginning in mid-range with progression to full available within pain limits.
  • Physical therapy will emphasize pelvic neutral, improving postural awareness (to avoid extra stress at level above and below surgical site), lower and upper extremity strengthening, flexibility, nerve root glides, and improving functional activities of daily living (walking, stair climbing, etc).
  • Return to prior level of function and work related activities (pending M.D. orders and release).
  • Return of full activities at 3 months post-operative.

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