If you are considering spinal fusion surgery, you may be wondering if you will need a back brace after surgery. The good news is that most patients do not benefit from a back brace after spinal fusion surgery.
In this blog post, I will explain risk factors and spinal fusion surgery scenarios that could warrant the use of a back brace post surgery. I will also cover common questions about spine fusion recovery that I have heard during my extensive experience performing minimally invasive spinal fusion surgery.
Will I need a back brace after spinal fusion surgery?
Most patients will not need a back brace after spinal fusion surgery. Like with any procedure, my recommendations vary based on the patient, the location of their fusion, how many levels of the spine are being fused, and their risk factors.
For lumbar spinal fusion surgery, which is involves joining together two or more vertebrae in the lower back (L1-L5), I follow the guidelines from the Journal of Neurosurgery, which find that bracing for lumbar fusion provides no noticeable benefits compared to not bracing. Back braces can be cumbersome, and according to research and my anecdotal experience as a neurosurgeon, do not increase the rate of fusion or minimize pain in the long-term. If I perform a complex fusion of three or more vertebrae, I may recommend a back brace to aid in the patient’s comfort. When this is the case, the patient will likely wear the brace for 4-6 weeks.
Will I need a neck collar after cervical fusion surgery?
For patients who undergo a cervical spinal fusion, which is the joining of two or more vertebrae in the upper region of the spine (C1-C7), I only recommend a neck collar if three or more levels of the cervical spine are fused. If patients have risk factors, such as smoking, obesity, or poor bone quality, or are taking certain medications that may affect the fusion, I may recommend a neck collar. Typically, a patient who requires a neck collar will be advised to use it for 8 weeks or more.
Will smoking impact my spinal fusion?
Yes, smoking and nicotine usage can negatively impact any surgical outcomes. Numerous studies show the rates of cervical and lumbar fusion significantly decrease for patients who are smokers. The same research shows that the risk of infection and post-surgical complications are much higher in smokers than non-smokers.
I recommend that any patient who smokes quit prior to surgery. Because of the poor spinal fusion outcomes for patients who are smokers, I rarely perform surgery on active smokers except if there is an emergency or neurologic deficit, such as weakness.
For patients with poor bone quality and conditions like osteoporosis or osteopenia, I recommend they work with our Bone Health and Spine Fracture Clinic prior to surgery to ensure the best possible outcomes of spine fusion surgery.
How much pain will I be in after spine fusion surgery?
As an expert in minimally invasive spine surgery, I take every measure possible to ensure my patients have the best outcomes with the quickest recovery times. Using a minimally invasive spine fusion approach whenever possible means my patients have smaller incisions and less trauma to their surgical site, which reduces pain, minimizes blood loss, and improves recovery.
The majority of my lumbar spinal fusion patients have well-controlled pain with a combination of oral narcotics, muscle relaxers, and acetaminophen during the first week after surgery. Most are then able to transition to pain medications on an as-needed basis the weeks following surgery.
For most of my anterior cervical fusion patients, their pain is minimal and they may experience a sore throat and minor difficulty swallowing but do not need regular pain medication for more than a week or so post-surgery. Patients who undergo a posterior cervical fusion may experience more pain and will often need a combination of oral narcotics, muscle relaxers, and acetaminophen for a few weeks or longer after surgery.
Neurosurgery One’s Enhanced Recovery After Surgery (ERAS) has been proven to help patients experience less pain and minimize their use of opioid medication following spine surgery. Patient education pre- and post-surgery is a key component of our ERAS program as our team equips patients with tools and resources to manage pain effectively.
Will I need more spine surgeries after a spinal fusion?
There is a common misconception that once you have one spinal fusion, you will need future surgeries. The vast majority of patients do not need any additional back or neck surgery. Our ability to diagnose patients and pinpoint the source of their pain has greatly improved over the past few decades, which has reduced the need for additional surgeries.
Am I too old for spinal fusion surgery?
While every patient is unique, in general, your chronological age is not a determinant of whether or not you are a good candidate for spine fusion surgery. Rather, we assess your bone health, overall health, how active you are, and your goals for surgery. Most patients who are in overall good health and active are eligible for spine fusion surgery.
What questions should I be asking before considering spine fusion surgery?
I tell all my patients that it is important that you feel informed about your options and realistic about the goals you hope to achieve with surgery. Many times, back and neck surgery are done to alleviate pain or immobility in the leg or arms. Back pain relief can be more unpredictable to pinpoint (not impossible), which is why I take time with all of my patients to help them understand expectations. In essence, I want patients to create their definition of what “better” means post-surgery, and I work closely with them to ensure their treatment options, whether surgical or not, can help them realize their goals. For instance, if you have never run a marathon before but think spine fusion surgery is going to help you do so, I don’t believe that’s realistic. But if you used to be able to walk to the park but persistent leg pain is now making that impossible, getting back to that activity may be possible, depending on your diagnosis and recommended spine surgery.
If you are considering spine fusion surgery, I encourage you to ask any and all questions prior to surgery. And you should seek a second opinion if you are feeling uneasy or uncertain about your options. My goal as a neurosurgeon is to treat patients holistically and help you get back to what you love doing.
