If you’re considering lumbar spinal fusion, you probably would like to know what to expect six months after your spine surgery. Why six months? I have found that six months seems to be the time period most patients expect to have spine surgery firmly behind them.
Expecting a full recovery 6 months after spinal fusion in the lower back is a reasonable expectation for most people. But notice that I used the word “most,” not all. There are several things we need to look at when determining what spinal fusion recovery will look like for you. There isn’t a checklist we can hand you that shows you what will happen two weeks, two months and six months after surgery because your recovery may vary based on many factors. However, in this article, I hope to provide you with a framework of the recovery process so that you can speak with your Denver spine surgeon about reasonable expectations in your particular case.
Spine fusion surgery can be life changing. It is a very effective procedure used to help reduce pain caused by spinal conditions such as degenerative disc disease, spinal stenosis, or herniated discs. But it’s major surgery — even if it’s performed in a minimally invasive manner — that requires time and commitment to heal properly.
Below I’ve outlined in general what you can expect six months after spinal fusion if you’ve had a one- or two-level fusion. (Levels refer to the space between the bones, so a one-level surgery means we are fusing two vertebrae together.) Any surgery beyond two levels gets a bit more complicated and takes longer to fully heal. For patients in reasonable health who don’t smoke, don’t have uncontrolled diabetes and are not obese, on average, you should add about a month of healing for every additional level.
Pain Management
During the first six months after lumbar fusion, it’s common to experience varying levels of pain as your body heals from surgery. You can expect to experience moderate to severe pain in the first two weeks following surgery that we will help you control with pain medication. Gradually, your pain will lessen and by the six-month mark, you should be in a much better place. You may still feel pain due to the condition being treated but it should be significantly less.
At Neurosurgery One, we use a special approach called Enhanced Recovery After Surgery (ERAS). This program uses a pain management plan that controls your pain at a manageable level while also reducing opioid use compared to traditional spinal fusion recovery.
The amount of pain you experience and the length of time varies from person to person. Most patients feel much better and a lot less pain within two weeks, while others take longer to recover.
Some of the factors that will impact your pain after spinal fusion include:
- how many levels you are having fused
- how much pain medication you are currently taking. Patients taking high doses of pain medication experience post-operative pain differently because all of their pain receptors are already saturated by their pain medication.
- your personal pain tolerance and whether you have been using pain medication prior to surgery
- how well you follow your post-surgery physical therapy plan – overdoing it can be just as harmful as underdoing it
- how much pain you experienced prior to surgery and how long you’ve been in pain — while we never want to do surgery sooner than needed, it’s also helpful to not wait until your pain has impacted your mobility and overall health in a significant way that will make it harder to recover
Be sure to let us know about any severe pain you’re experiencing beyond two weeks so we can guide you on adjusting your pain management plan accordingly. Taking your pain medication as recommended, gentle movement such as walking, and massage can help alleviate pain and improve your overall comfort level.
Healing and Fusion
During spinal fusion surgery, we typically remove the disc between the vertebrae being fused and insert a spacer. Then, we apply bone graft to encourage the vertebrae to grow together, or fuse, which eliminates the movement between the bones that was creating pain. The fusion process takes anywhere between 18 months and three years. However, most of my patients feel pretty well healed by about the three-month mark and really start upping their activity level. For most people, you can expect that six months after spinal fusion, you’ll be back to full activity. I have many patients who are playing golf and other sports with a spinal fusion 3-6 months after surgery.
With a skilled neurosurgeon, spinal fusion is generally successful — meaning the bone graft “takes” and the vertebrae grow together as one. There is a small chance that the fusion will fail; however, that generally won’t happen in the first two or three years. The risk of failed fusion is much greater in patients who smoke. That’s why it’s imperative to quit smoking before your surgery. Even quitting a few weeks before surgery helps. People who have uncontrolled diabetes also are at increased risk for failed fusion. Be sure to discuss these risk factors with us prior to having surgery so we can work to create a plan to ensure your spinal fusion has the highest chances of success. Some patients who are at risk of failed fusion may qualify for a bone growth stimulator, which is an external device that sends energy to the bones to help heal.
Mobility and Rehabilitation
Lumbar fusion is done to improve your quality of life and allow you to engage in activities that were previously limited by pain. Six months after spinal fusion surgery, you can expect to see significant improvement in your ability to perform daily tasks, and you should be able to engage in low-impact exercises.
Outpatient physical therapy plays a crucial role in your recovery. It aids in strengthening the muscles around the spine and enhancing overall function. I work with several skilled physical therapists who I trust completely to design rehabilitation plans for patients. Stick to your recommended exercise plan and work with your physical therapist to gradually incorporate more challenging activities over time.
Your physical therapist will advise you as to what types of exercise are best for you, but in general, most bodyweight exercises — squats, leg lifts, planks — are safe. While occasional bending, lifting and twisting are fine, I recommend avoiding repetitive bending of the back, such as with sit-ups, to minimize pressure on the spine levels above and below your fusion. These levels have more stress on them due to the fusion and have a higher tendency to breakdown over time, typically 10-15 years. The key to protecting those adjacent segments is to maintain good core strength.
By the six-month mark, I want to see most patients getting back to their normal lives and enjoying fun activities. After all, that’s the whole reason you had spinal surgery in the first place.
Potential Complications
While spine fusion surgery is generally safe and effective, there are potential complications that can arise. These complications are rare. Immediately after surgery, complications can include blood clots, nerve damage and infection. Infection risk lasts as long as six months after surgery. Issues related to the surgical hardware can occur after the three-month mark. It’s important to be aware of these possibilities, but it’s equally important to remember that the likelihood of experiencing such complications is quite low as long as you choose a highly skilled neurosurgeon with plenty of experience performing spinal fusion surgery.
Regularly attending all follow-up appointments and adhering to all post-operative guidelines can minimize your risk of complications. Should any concerns arise, don’t hesitate to get in touch with your spine surgeon.
What You Can Expect Six Months After Spinal Fusion
When it comes to what to expect six months after spinal fusion, results vary by individual. The overwhelming majority of my patients can expect to see significant improvement in their pain, mobility, and overall quality of life six months after spinal fusion surgery. By adhering to your physical therapist’s recommended rehabilitation program and gradually increasing your activity levels, you can enhance your recovery process and reclaim activities that were once hindered by pain.
Remember, every person’s journey is unique, so it’s important to work with your surgeon to set realistic expectations.
The author, Dr. Josh Beckman, is a board-certified neurosurgeon who specializes in spine surgery. Dr. Beckman joined the Neurosurgery One Lakewood clinic in 2021 after serving as the director of spine surgery at San Antonio Military Medical Center, the nation’s largest military hospital and Level I trauma center where he developed special expertise in treating severe spinal injuries.
