Wondering what to expect after back fusion surgery? Common questions about recovery are:
How long will it be before I can go back to work?
What does the recovery process look like?
What, if anything, could go wrong at this stage?
Recovery time is an important consideration for many patients considering spinal fusion. The emergence of minimally invasive surgery has impacted all types of surgery—back fusion surgery included—for the better, lessening the incision pain in the hours that follow. Surgeons can perform procedures through smaller exposures. Computers are helping doctors to move surgical instruments more smoothly and accurately. Pain medication injections also contribute to reduced levels of post-operative pain.
However, even though the level of pain immediately following surgery has been somewhat reduced with these developments, the changes that occur in your back after spinal fusion make the overall recovery process more challenging than some other types of surgery. And if you’ve been doing your homework on spinal fusion, you probably know that the long-term results of this procedure are also less than ideal.1 That’s why it’s a good idea to investigate alternatives to fusion—and their associated recovery times—as well.
In this blog, we’ll answer questions as they pertain to spinal fusion, and compare them to the recovery time for BalancedBack Total Joint Replacement, an advanced motion-preservation procedure that works differently than fusion.
What is spinal fusion?
To set the stage for a discussion about recovery, you need to understand how spinal fusion works. Your spine is a stack of bony vertebrae all connected together. Discs provide movement between each vertebral body, and facet joints at each level of your spine control these movements. During fusion, your surgeon removes the disc material and all or part of the facet joints, packs the space with bone graft, and inserts spacers, screws, and rods into the bones to temporarily hold everything in place. Eventually, the bone graft fuses, the body heals, and what were once two separate vertebrae are now joined as one solid mass of bone.
What’s happening during the recovery process (and what could go wrong)?
During the recovery months, surgeons keep a close eye on the progression of bone growth—the bone needs to grow across the gap where the disc used to be to create that “one solid mass of bone.”
It sounds fairly straightforward, and, for most patients, it is. But there are sometimes cases where healing doesn’t go as planned. For example:
- For most patients, bone growth simply takes time. For others, however, the bone never heals completely adequately; it’s a condition we call pseudarthrosis, or nonfusion. Because the bone never fully welds together, motion may continue across the area, causing pain, loosening, and even breakage of the hardware. Normally, the time it takes for bones to fully fuse is approximately four to five months, but in some cases it can take up to a year. If it still hasn’t happened after eight months, the condition is referred to as a “delayed union” or “delayed healing”; it becomes pseudarthrosis if healing is still incomplete after one year. The treatment for pseudarthrosis is a second attempt at fusion by adding some additional bone grafting.
- Before the bone grows across the gap, the fusion hardware is not fully stable. Trying to do too much activity too soon after surgery could stress the fused segments and loosen the hardware; once it is loose it won’t retighten, which means repeating the procedure. Back fusion surgery recovery requires a delicate balance of steadily progressive mobility and the rest needed to heal, which could take about 8-12 weeks.
Would you rather avoid fusion? Download this free brochure about a new procedure, BalancedBack Total Joint Replacement, a motion alternative to spinal fusion.
As mentioned above, the changes that occur in your back after spinal fusion make the overall recovery process more challenging than other types of surgery.
For one, pedicle screws and spacers used during a fusion are often a source of pain during the recovery process. Pedicle screws are placed through the pedicle into the vertebral body. The screw heads protrude from the back of the implant, into the space occupied by postural muscles. When the muscles around the screw heads move, they rub causing irritation and pain. This is often the very area of the surgical incision, which can be extremely painful.
Additionally, most people are fused while lying on their stomach—essentially, they are fused in a standing position. But people don’t just stand. We sit, slump, lay on the couch, ride in a car, stand back up, push a shopping cart, etc. The curve of the spine is different in all these positions—for instance, you have more of a curve in your spine when you’re standing than when sitting. Because patients are fused in a standing position, they often have what we call a sitting intolerance. The spine tries to flatten out but the screws resist it. The dramatic difference in those two postures not only causes pain when patients try to move their body into that position; it also causes tremendous stress in the areas adjacent to the fusion that could lead to problems down the line.
A Spinal Fusion Recovery Timeline
Timetables vary by patient, especially as it pertains to when they can go back to work. It largely depends on what type of work they do, whether they have a primarily manual job or an office job. Surgeons like to see some form of bone growing across the gap before they allow patients to do activities without restrictions.
In general, the recovery timetable looks like this:
Day of/Day after surgery—patients get out of bed, start moving around, and sitting up.
Four to six weeks—only walking and sitting. No major exercises.
Six weeks to five months—walking, driving, possibly returning to work in an office setting.
Five to six months—Manual workers return to work.
A Spinal Fusion Alternative: BalancedBack Total Joint Replacement
If you’re hesitant about fusion and looking for another option, consider BalancedBack Total Joint Replacement.
After removing the disc and facets, instead of fusing two vertebrae together, a BalancedBack surgeon implants a motion device that replaces the function of the entire joint. The surgery addresses the same root causes of pain as fusion, but rather than doing so at the expense of a joint, BalancedBack gives you a new one.
Because the device is intended to act as a joint, BalancedBack patients almost always recover faster. Why? It’s likely due to a few reasons:
- While your soft tissues have to recover from the incision made during surgery, there’s no need to wait for bone to span a gap. Instead, your bone simply heals into the implant. The device is designed to be stable as soon as it’s put in, which means you can start resuming your regular activities sooner than you could with fusion.
- After removing the disc and facets, surgeons insert the BalancedBack device entirely inside the disc space and axis of the pedicle. BalancedBack is what we call a “zero profile” device, meaning there is no material protruding into the muscles—a factor that dramatically helps reduce postoperative pain, particularly near the surgical incision.
- Fusion devices are intended to create something rigid; trying to move a rigid structure hurts. In fact, too much movement early on weakens the screws and stresses the growing bone. In contrast, the BalancedBack device carries the mechanical load of your movements in the same way your original disc and facet joints did, which means your movements automatically put less stress on the construct, and the construct puts less stress on the bones. Your body won’t sense the implant like a fusion, and you will most likely heal much faster with less pain.
Take a look at the BalancedBack recovery timetable below. Again, it varies somewhat from patient to patient, but it does represent a typical progression.
BalancedBack Recovery Timeline
Day of Surgery—Patients begin ambulating as soon as possible. We typically have people walk up and down the hallways at the hospital 2-3 hours after surgery. Early mobility is encouraged. In most cases, patients are discharged home the same day to begin their full recovery in a positive, comfortable, non-hospital environment.
Day 3/Day 4—Patients begin a walking program. Walking is the best type of exercise after motion surgery because it puts a low amount of stress on the back while aiding the healing process and building muscle strength and balance.
Two weeks after surgery—Patients can get in a swimming pool, do aerobic activities, use light hand weights, or do a stationary bike. At this point, most patients can also do a small amount of stretching (about 25 to 30 degrees)—enough to bend forward slightly as needed, take a shower, etc. The majority of patients can also drive short distances at this point.
Six weeks after surgery—In this stage, patients are usually able to bend further—45 to 50 degrees—as needed, and can continue to do the activities listed above. Many people return to work at this point.
Three months after surgery—On average, most patients have no further restrictions on their activities three months after their procedure.
In contrast, approximately 40% of patients undergoing lumbar fusion surgery rate themselves as symptomatically unchanged or worse following surgery.2
Motivation Is Key To Recovery
Typically, BalancedBack patients have several things in common, one of which is that they are highly motivated to recover. (Take a look at our patient stories and you’ll see what we mean.) Patients who live an active lifestyle no matter their age are anxious to get back to whatever they enjoy doing the most. That means they’re motivated to follow post-surgical instructions to a T and follow through with physical therapy as prescribed.
Would you like to learn more about BalancedBack?
If you’re in search of an alternative that not only helps you avoid a lengthy spinal fusion recovery time but also keeps you moving more naturally after surgery, we invite you to speak with a member of our clinical team. We’ll answer your questions about total joint replacement and help you determine if it might be a good fit for you.
1Mannion, A. F., Brox, J. I., & Fairbank, J. C. (2016). Consensus at last! Long-term results of all randomized controlled trials show that fusion is no better than non-operative care in improving pain and disability in chronic low back pain. The Spine Journal, 16(5), 588-590.
2Stromqvist B., Fritzell P., Hagg O., Jonsson, B. One-year report from the Swedish National Spine Register. Swedish Society of Spinal Surgeons. Acta Orthop Suppl. 2005; 76:1-24.