Post op teaching for spinal fusion surgery

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    any OR nurses know any important patient teaching after a spinal fusion surgery? I heard patients are to avoid smoking for 6 months.

    all answers welcome..thanks!

  2. 4 Comments so far...

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    Watch for signs of infection, like fever, color or amount of discharge from incision, increased redness/swelling, or pain. Definately no heavy lifting or any type of hard core labor for up to 6 weeks or longer. Also no excessive bending or twisting, bend at the knees instead. Start with light exercise, may even have to consult physical therapist to learn correct form. I've heard about the smoking, it keeps bone from fusing like it normally should in a non-smoker.
    ken143 likes this.
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    Quote from ken143
    any or nurses know any important patient teaching after a spinal fusion surgery? i heard patients are to avoid smoking for 6 months.

    all answers welcome..thanks!

    i had a spinal fusion done 9 years ago, at 42, and the smoking issue is usually addressed by the surgeon preop, and the patient is instructed (or should be) to stop smoking all together before the surgery if at all possible. some surgeons won't do it if the patient insists on continuing to smoke, because it does seriously delay, and sometimes prevents, effective fusion of the bone. i don't smoke and never did, so it wasn't an issue for me, but it was mentioned up front. post-op, continuing not to smoke is of course paramount. the one biggest thing that i was instructed to do over the course of healing was to walk, walk, walk. and then walk some more. i was basically a "non-walker" as far as just doing it for the sake of doing it before the surgery, but within 8 weeks or so of having it done, my husband and i had built up to walking 3 1/2 miles every night after dinner.
    also, the use of anti-inflammatory meds is generally a no-no, because it inhibits the natural inflammatory process that is involved in the healing of the fusion. so, no ibuprofen, no naproxen, no nsaids of any kind postop. tylenol is acceptable, and is usually used in combination with something like hydrocodone at least immediately post op. lifting restrictions of course do apply, and are determined by the surgeon. this should be included in the patient's written post op instructions from the surgeon. if the patient was fused with an autologus graft (from their own hip bone) as opposed to donor bone, then they're going to have an accessory incision to the side of the main one, where the bone was removed. it was my experience, and that of everyone i talked to or heard about who had it done this way, that the graft incision was more painful, and hurt longer, than the main incision where the fusion work was done. it seems this is common, and should not be cause for particular concern, because it doesn't necessarily mean something is wrong if that's the case. in fact, 9 years later, i still get a twinge or two from time to time in that one.
    the doctor's offices generally have handbooks of some kind available to the patients when they are told that this is what's going to be done. maybe you could get hold of one or two of them, depending in which surgeon or surgeons do fusions where you work, and see what the patients are being told in those, to use as sort of a reinforcement? just a thought.........
    of course there are the usual things to check for in any incision, and neuro checks and so forth.....
    ken143 likes this.
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    discharge and post op instructions should be a facility/surgeon’s area of what is expected. it should include the typical instructions that all discharges have including wound care, activity restrictions, watching for ssi signs, med. dosages, follow up appointment, etc.

    for the smoking thing, i have had a couple of lumbar fusions too. i did smoke prior to the first and was instructed during the surgery consult to quit smoking because of the high non-fusion (non-union) rate. i was told that the failure rate ran somewhere between 40 and 60 percent for smokers. mine did fuse. then i needed a second fusion about 12 years later which i had picked up smoking again by about a year (never lost the craving). my old surgeon had moved so i went to a new one who gave about the same average and indicated that if he thought i was smoking before the surgery, he would not do it. his estimate was about 50 percent failure for smokers. he stated that it would be a waste of his time and the insurance’s money to do the surgery if one kept smoking. i quit about three months prior to the surgery (he wouldn’t schedule me sooner to give me time to quit). everything looks nice but there really isn’t a total bone fusion for that one (partially fused).

    i now work with a spine surgeon a couple days a week and this subject has come up. he thinks the failure is about 30 to 40 percent higher than non smokers but will only advise not to smoke and will still do the surgery because there is a good chance it will help and if it doesn’t the patient isn’t worse from the surgery.

    having said that, there is also a high rate of “failed back surgery syndrome.” this means that while the surgery was a success in changing the anatomic structures (removing disc, lamina, joint stabilization etc.) the patient may heal fine and look good on films but still have varying degrees of back pain. this for some reason seems to also be higher among smokers.

    i just goggled and glanced at this article—hope it helps http://www.spine-health.com/wellness/stop-smoking/quitting-smoking-a-spinal-fusion
    ken143 likes this.
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    I'm a pediatric home care nurse and my 14 year old client has CP with spastic quadriplegia that led to a 55 degree scoliotic curve. He also has asthma and a history of frequent bouts of pneumonia--4 times in the last 12 months. He had his spinal fusion surgery today, and although he'll be in the hospital for at least a week, I'm already worrying about caring for him at home once he's discharged. I know everything emphasizes how important it is to WALK WALK WALK after this surgery, but how can I best support this child who can't move independently at all? He's also unable to do deep-breathing exercises--the best I've been able to figure out is to try and get him to laugh during his nebulizer treatments so he at least gets a few deep breaths in. But after the surgery, I'm not sure he'll be in a laughing mood--either in pain or groggy from the meds. If anyone's got some good tactics or advice, I'd sure appreciate it!

    On a side note, his father's a Navy medic who doesn't know how to use the Hoyer lift they've got in their home and 2 weeks ago he decided he didn't like the Hoyer sling and literally hid it somewhere so I can't find it! He substituted it with a sling designed for a different kind of lift they had before, and this sling doesn't work well AT ALL with the Hoyer. It doesn't offer any kind of back or head support and spreads the child's legs so wide he cries because it hurts his hips, which don't have much ROM. Dad doesn't think the Hoyer sling is the right size, but my client's physical therapist measured him and it IS the right size. It's the same thing I use multiple times daily to transfer my client at the school he attends. Dad is flat-out refusing my requests to give me back the correct sling, and when my client comes out of the hospital, I absolutely do not feel comfortable using this floppy sling and am going to have to refuse to transfer my client at all if this is the only sling available to me. This isn't a fight I'm looking forward to having, because every time I've brought it up, I get the "well he's a medic so he knows what he's talking about" instant dismissal even though he himself admits he's never learned to use the Hoyer (not like it's hard!). ARGH! Any suggestions on how to deal with this?

    Sorry for rambling! Thanks for any help--

    Amy


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