Epidural injections of steroids have often been the treatment of choice for patients with a pinched nerve in the back whose symptoms did not respond to simple exercise, physical therapy, or other more conservative approaches. Steroid injections have also been offered to patients with spinal stenosis whose back pain was unrelieved by less invasive therapy. But the results of a new research study hint that injections of steroids for back pain may be less beneficial than believed. The study is small, but it still bears consideration, as the findings are statistically valid and underscore why healing is as much an art as a science.
The study of the efficacy of steroid injections for back pain examined more than 270 patients, aged 53 to 75 years old, culled from the ranks of a larger study of individuals with spinal health problems. The research subjects were followed for four years. Sixty-nine of these patients had epidural injections and 207 did not, but otherwise the patients’ symptoms were primarily the same in terms of severity, as measured by well-established scales used to measure pain in the leg and lower back. Using these scales, researchers found less improvement among those who had epidural injections than among patients who did not have injections.
Several caveats must be offered when considering the results of this research. First, as the authors readily acknowledge, factors that the researchers didn’t account for and couldn’t control may have affected or skewed the results. Nonetheless, we are seeing fresh thinking and new techniques improving outcomes for many spinal patients. For example, patients who elected to have spinal decompression surgery to relieve symptoms of pinched nerves typically opted for a spinal fusion back surgery in tandem, in order to stabilize the spine. Today, a growing number are opting for TOPSTM – the Total Posterior Solution – System, instead of spinal fusion. The TOPS system, unlike spinal fusion, preserves complete independent motion of the individual vertebrae. This is one more way that fresh thinking, and new technologies and procedures are transforming the care and treatment of back problems.
In our last blog we began addressing the topic of preparing for spinal fusion back surgery. We touched upon tests that may be performed, and the need to prepare physically through a conditioning regimen so your body is ready for the rigors of surgery. Here are additional points anyone considering spinal fusion should remember:
One potential complication of spinal fusion surgery is excessive bleeding. Several commonly used medications can increase bleeding, including aspirin, ibuprofen and other NSAIDs, as can anticoagulants such as warfarin. You will need to discontinue use of any such medications. Should your physician or surgeon be concerned about the risk of excessive blood loss during your spinal fusion operation, you may bank your own blood, called an autologous blood donation, before the surgery.
Be sure to discuss all the medications you are taking with your physicians, and they will advise you when (and if) you should stop taking them. Some medications could cause adverse affects in combination with the anesthetics or other medications used during the operation, and anti-inflammatory medication such as cortisone and chemotherapy can compromise the body’s ability to heal.
Failure of the bone graft to heal, called pseudarthrosis, is one of spinal fusion’s most problematic post-surgical complications. Smoking is associated with this complication, and nicotine has been shown to compromise the ability of bone cells to grow. It is imperative that smokers stop smoking prior to the surgery, and not smoke before their recovery is complete.
Before resigning yourself to spinal fusion surgery, remember that spinal problems often respond to more conservative treatments, such as physical therapy and healthy lifestyle changes. Alternative surgical procedures may also be available. For example, many candidates for spinal fusion can choose the TOPSTM(Total Posterior Solution) System instead. The TOPS System not only preserves all the natural flexion of individual vertebrae, unlike spinal fusion, but it has also been shown to have better outcomes in clinical trials around the world. Indeed, investigating alternative options is another productive way to prepare for a spinal fusion operation.
Spinal stenosis, an unnatural narrowing (or stenosis) of the spinal canal, is an all too common cause of back pain and restricted mobility, which results from pressure the narrowing column places on spinal nerves. For those who don’t respond to more conservative treatments, surgery may be recommended to correct spinal stenosis, and it’s important for such patients to prepare for the procedure properly. The preparations starts by ascertaining that back surgery is indeed called for.
Pain in your leg that is greater than the pain in your back caused by a pinched nerve (as measured by standard pain scales), is one indication that surgery is appropriate for a given case of spinal stenosis. Leg pain that does not decrease and interferes with your quality of life, and radiological scans confirming that the pain is likely due to nerve compression, are also indications that surgery may be beneficial.
Much of the advice on preparing for any back surgery applies to a spinal stenosis operation, as well. As in other back surgeries, you should stop smoking and, if overweight, shed excess pounds. Get your blood pressure down. Walk, or engage in other moderate activity that gets your muscles moving. This is important to speed your recovery process.
Check the medications you’re taking and discuss them with your physicians to ensure the medications will not interfere with your surgery or recovery. For example, blood thinners can interfere with blood clotting. Among women, birth control pills and hormone replacement therapy can also interfere with surgery.
Traditionally, spinal fusion back surgery has been performed in conjunction with spinal stenosis surgery to stabilize the spine at the site of the operation. A drawback of spinal fusion is that the procedure eliminates the independent motion of the fused vertebrae, and is also physically demanding. Now there is an alternative to spinal fusion following spinal stenosis surgery. The TOPSTM (Total Posterior Solution) System can be used instead of spinal fusion, and has better outcomes. Investigating whether this alternative procedure makes sense for you could be one of the best ways to prepare for your surgery for spinal stenosis.
We’ve addressed preparations for back surgery in recent blogs and specifically the surgery for spinal stenosis and fusion operations. Yet, the recovery process is just as necessary as the back surgery itself to your long-term health, so prepare well for postoperative routines and realities before the surgery is performed.
Among the first questions patients often ask about the spinal fusion back surgery recovery process is how soon they will get out of bed following the operation. Patients typically get out of bed the day after their surgery – with the help of attendants, who will assist you in sitting up, getting your legs over the side of the bed, standing up, and walking. You’ll be glad that you spent time getting in shape before your operation. The preparation pays off at times like this, as being in good health will help throughout your healing and recovery, as the body responds to the trauma of surgery and works to repair itself.
Movement is indeed critical to proper healing, and since you’ll spend a good deal of time in bed in the first days after the spinal fusion operation, it’s essential to learn how to move correctly in bed. We’ll show you the best way to turn over, sit up, and move in ways that will promote proper healing, strengthen muscles and minimize pain.
All surgeries involve certain risks in one way or another, such as infection, bleeding, or nerve damage. E.g., if you suffer from osteochondrosis, problems with other discs may occur. In most cases, such complications are associated with the rigid spinal fusion structure, where the load on the vertebrae is unevenly distributed. Therefore, people may feel unable to do some movements. Joints perform a dual function that leads to degenerative changes.
On the other hand, a spinal stenosis surgery implant is a more effective treatment for certain spine diseases. But the healing process can take several months, especially if the patient is overweight or has poor muscle tone. At the stage of preparation for surgery, you’d change your lifestyle and take the following steps:
Getting out of bed after back surgery will go smoothly, and you’ll be able to get up and walk unaided in a few days and soon even go home to recover. Some elderly or debilitated patients may consider visiting a rehabilitation center for about a week. That will help strengthen a back and learn how to move safely.
The hospital regimen in the first days after the operation provides instructions on how to get around, as flexibility will be limited. Patients often receive pain relievers and wear a brace to maintain the correct spine position. By the way, prescription opioids shouldn’t be consumed with alcohol. You can also replace them with more traditional methods – e.g., cold or heat wraps for 15-20 minutes with a break of 2 hours between procedures. A separate topic is the resumption of a diet consisting of solid food. Also, general anesthesia requires fasting for at least 8 hours before the intervention. On the day of surgery, only a sip of water is allowed to take medicine.
When you’re in better physical condition before surgery, healing time can be shortened, e.g., doing all kinds of exercises recommended by doctors, physical therapy, undergoing a course of massages, etc. This is how you can strengthen your back muscles. Subsequently, they’ll better support the spine, and you won’t wonder how to get in and out of bed after back surgery. In any case, a sedentary lifestyle puts a greater risk of wear and tear on the vertebrae located above and below the immobilized part.
Anything that was inconvenient or seemed impossible before the operation became available. Postoperative care is directly related to the initial preparation phase, namely the layout of your home. Oddly enough, but it’s essential to have a spacious bathroom with a shower and a rug so as not to slip, a firm mattress so that the process of getting in and out of bed after back surgery is as painless and gentle as possible for the operated area. Consider placing a portable small refrigerator and cooler in the room, as well as blankets and other supplies so that you can easily access them. You can also utilize a grabber to lift items off the ground and shelves (find them in pharmacies or specialized stores). For elderly patients who have difficulty walking, sticks or walkers are recommended. A soft lounge chair, unlike a regular chair, can reduce the load on the lumbar region. In general, you need to take care of preventing falls: remove objects through which there is a possibility of tripping, install handrails as required (e.g., in the shower, on the stairs). This way, you can recover in a safe environment. Household chores after discharge are also best left to family members, a home care aide, or a caregiver.
Here are some tips on how to get out of bed after back surgery faster.
For recovery to take place as quickly as possible and for the load on the spine to be optimal, it’s necessary to take short walks every 30 minutes. For example, if you sit for most of the day, you’d learn the most ergonomic position. Use supports with a low back or unique chairs that allow you to maintain correct posture.
Please note that after surgery, you’d avoid long car trips.
Sitting with knees higher than hips has a negative effect on the spine. Therefore, try to get up slowly: move to the edge of the seat and utilize the armrests to push upward. Focus on your feet.
Bending, lifting, twisting, and driving – all these activities are prohibited in the early stages of recovery. For example, flexion at the knees and hips is perfectly acceptable, but not the spine. Remember: don’t lift anything that weighs more than a gallon of milk (about 8 pounds)! It’d also be borne in mind that due to drowsiness, impaired judgment, and poor coordination – side effects of prescription opioid pain relievers, driving is prohibited during the recovery period.
Sleep is critical to the body’s recovery – the immune system is involved in reducing inflammation. Of course, it can be difficult to fall asleep at times, especially since now you have to consider the new rules of rest.
So, utilize the log technique – keep your knees together and keep your back straight. Remember how geisha slept in ancient Japan? They rested their necks on wooden supports while the load was transferred to the upper spine and shoulders. You have to do something similar in everyday life: sleep with your head in the pillow, with a rolled-up blanket under your knees. So your legs will be slightly bent, so there will be no intense pressure on the operated area.
It would be best if you did manipulations to cleanse the wound daily. In addition, it’s worth checking it for infection. If you notice signs of suppuration, redness, swelling, or palpation of the wound that causes too painful sensations, you’d urgently consult your doctor. Occasionally, an infection may cause fever and chills. Don’t take a bath; take a shower instead and use a soft sponge only.
Today, many candidates for spinal fusion surgery can opt for the TOPS (Total Posterior Solution) System instead. The TOPS™ implant has been shown to have better clinical outcomes and fewer post-surgical complications than spinal fusion. And unlike spine fusion procedures, the TOPS™ device preserves the full range of each vertebra’s motion. Patients concerned about how soon they can get out of bed following spine fusion back surgery should make sure they’re familiar with all their surgical options, as the choices they make can also affect their recovery.
Your caregivers will have plenty of valuable tips for helping ensure a smooth, steady recovery from spinal fusion. For example, such simple tips will help you rehabilitate more quickly and with less discomfort:
But it’s essential to take care of your physical condition even before the operation since the timing of your recovery depends on it.