spinal fusion surgery

The Ultimate Guide on Preparing for Spinal Fusion Surgery

Eight out of ten Americans will experience back pain during their lifetime. For many of these sufferers, at-home care can sometimes reduce symptoms. But what if an operation such as spinal fusion surgery is necessary to ease the pain?

Back surgery may sound like a stressful and scary experience. A little planning ahead of time and knowing what to expect, however, can calm your worries.

Here’s everything you need to know about preparing for spinal fusion surgery and how to make your recovery easier.

Prep Your Home

One of the most important tasks to do in the weeks leading up to surgery is to make your home as comfortable and recovery friendly as possible.

You won’t be able to bend over for a while, so remove anything off the floor that you think you may need such as footwear and clothing. Place them in a dresser drawer or another easily accessible area that’s off the ground. That goes for personal care items, reading material, and anything else you’ll want access to.

Kitchen items that are stored close to the ground such as pantry food products, pots, and pans should be moved to a higher location. Refrigerated food should be placed at a comfortable level.

Throw rugs can be a safety hazard as they’re easy to trip over. Roll them up and store them so they’re out of the way. Place non-slips mats in the shower and bathtub.

You may want to prepare or purchase meals that be easily defrosted and heated up if you don’t want to deal with cooking after surgery.

Keep your cordless or mobile phone next to your bed for easy access. If your home has more than one story, try to confine what you need on one floor if possible.

Enlist Help

Managing your needs after surgery will be easier if you have assistance. You won’t be able to drive yourself home when you’re discharged from the hospital, so make arrangements to have someone dependable drop you off and take you home.

You’ll require a helping hand to do cleaning, run errands, or take you to your post-op appointments until you’re fully mobile and able to drive. Arrange for a friend, family member, or professional care to visit and help you until recovery is complete.

Just Before the Spinal Fusion Surgery

Depending upon your particular medical condition, your doctor may advise that you be fitted with a cervical collar or lumbar brace to help with the recovery. This is usually done in the months or weeks leading up to the surgery.

Your home may need to be equipped with a toilet seat extender, walker, and long-handled reacher to make going about your daily routine a little easier.

You may be required to undergo a blood test, electrocardiogram (EKG), and chest X-ray prior to surgery.

If you’re physically active, you should keep up with the regular exercise or activity until you have the surgery. Maintaining a healthy weight and exercising regularly can keep circulation healthy which can even help prevent post-op risks such as blood clots.

Some patients experience constipation after back surgery. You can help prevent this by eating foods high in fiber a week before the procedure and drinking plenty of water.

Your surgeon will most likely advise you to stop taking ibuprofen, aspirin, and naproxen about a week before the procedure. These medicines are nonsteroidal anti-inflammatory drugs. They can thin your blood too much, leading to complications.

Disclose to your surgeon all pills you take including over-the-counter medication and any herbal supplements. You may be instructed to stop taking certain prescriptions such as blood thinners until after surgery. You should abstain from drinking alcohol a week before the surgery date, as it can also thin the blood.

If you smoke, you may be required to quit using all nicotine products a few months before surgery. Smoking can make healing longer and more difficult.

The Night Before Surgery

Expect a call from the hospital with final instructions the night before your operation. You won’t be able to eat or drink anything after midnight the evening before your surgery, even if it’s taking place later the following day. Even water is not permitted after midnight.

You’ll need to bathe with an anti-bacterial soap and you may be required to take an enema. Remove all jewelry including wedding bands and other rings the night before, as swelling in the morning may make them difficult to slip off.

The Day of Surgery

You’ll meet with a nurse who will ask questions about your medical background as well as the anesthesiologist who will walk you through the sedation process.

Remove all jewelry including wedding bands and other rings the night before. On the morning of your surgery, you’ll be asked to remove any jewelry, dentures, hairpieces, contact lenses, and artificial limbs.

Bring a supply of your own toiletries and clothing including slippers to the hospital with you to make your stay more comfortable.

Recovery and Coming Home

Most spinal fusion surgery patients stay in the hospital between two and five days. Hospital staff will assess you to make sure you can take care of your personal hygiene and walk the hallway without assistance before you are discharged. Light physical activity is often an important part of your at-home recovery from back surgery.

The hospital will give you careful instructions on how to care for your dressing and any warning signs to be aware of.

When someone takes you home, you should be reclining in the front seat or lying down in the back.

At home, follow these seven must-have tips for recovering from spinal fusion surgery.

Be Prepared For Your Spinal Fusion Surgery

Now that you know what to expect for your spinal fusion surgery, you can better prepare yourself and your home for the procedure.

At Executive Spine Surgery, we specialize in a full range of surgical procedures and treat many back conditions that include bone spurs, bulging discs, and arthritis of the spine. To learn if you’re a candidate for back surgery, book an appointment with us online.

5 Benefits of Minimally Invasive Spinal Fusion Surgery

1. Lateral Lumbar Interbody Fusion (LLIF), a minimally invasive technique for spinal fusion, does not damage or separate the muscles of the low back. This allows an easier time retraining weakened back muscles with physical therapy, as those suffering from chronic back conditions also have weak or atrophied muscles on top of their spinal condition.

2. Minimally invasive spinal fusion requires neither the cutting of bone nor the movement of blood vessels, which is required in traditional varieties of spinal fusion.

3. The LLIF method can be used to treat a wide range of conditions, including spondylolisthesis, nerve impingement, some tumors, herniations, as well as a host of issues caused by degenerative disc disease and degenerative scoliosis.

4. Patients undergoing LLIF and most other minimally invasive spine surgeries usually do not require an overnight hospital stay.

5. Patients treated with minimally invasive spinal fusion are up and about within a few hours of surgery and report minimal pain and a quick recovery.

6 Best Treatments for Back Pain

1. Physical therapy focusing on core strength and flexibility.

2. Weight loss.  Weight loss alleviates back pain by reducing stress and strain on your back and decreases damage to disks and joints.

3. Steroid injections may relieve back pain.  Steroids and local anesthetics work to decrease inflammation, washout chemicals that cause pain and directly reduce pain often breaking the destructive pain cycle.  Steroid injections are an effective treatment for conditions that cause back pain such as arthritis of the spine (called facet arthropathy) and disk disease.

4. Stem Cell Therapy.  Disk regeneration is a new therapy where stem cells taken from your hip are injected  into your damaged disk to regenerate the disk.  The stem cells make new disk cells increasing the fluid and size of the disk reducing back pain and suffering.

5. Endoscopic Laser Discectomy.  As the disk wears out, or degenerates, it turns black on MRI, collapses, bulges and may tear causing back pain.  Removal of the degenerated disk and treatment of the annular tear has been found to reduce back pain and suffering.   The discectomy and annuloplasty can be done with the spinal endoscope.  A scope the size of a pencil can be placed through an incision the size of your finger nail.  The disk is found and repaired under direct visualization.

6. Endoscopic Fusion. Painful degenerated disks, spinal instability, spondylolithesis may lead to severe back and/or leg pain.  This pain can be disabling.  Patients that have failed other treatments may be a candidate for fusion surgery.  Today fusion surgery can be done through a very small incision with the aid of an spinal endoscopic to reduce soft tissue and bone damage and quicken recovery.


Dr. Spivak is the President of Executive Spine Surgery and is a leader in Endoscopic Laser Spine Surgery.  He see patients in New York and New Jersey and teaches doctors his advanced surgical techniques throughout the United States.  For more information please call 908-452-5612 or click schedule-an-appointment.

Why do I have a pain in the butt?

Butt pain commonly arises from the sacroiliac joint (SI joint).  This pain is called sacroiliitis.   SI joint pain maybe felt under your jean pocket.    SI joint may cause back, buttock and leg pain. The pain is worse sitting especially on the butt cheek and with activity.

Causes of SI joint pain include arthritis (degenerative sacroiliitis), separation or weakness of the joint (SI joint disruption or laxity), abnormal joint from birth (sacral dysgenesis), inflammation and swelling (ankylosing spondylitis, Reiter’s syndrome or inflammatory bowel disease (IBD)), break or fracture, infection, bone disease and tumor.

The sacroiliac joint is the located between the spine (sacrum)  and the hips (ilium).  It is a large joint held together by strong muscles and ligaments.

SI joint pain can be difficult to diagnose and often is associated with spinal disease.  SI joint pain can be diagnosed by careful history, physical examination and diagnostic injections.  A needle is placed into the joint under x-ray or CT scan and steroid and pain medicine is injected.   Pain relief confirms the diagnosis of SI joint pain.

People may benefit from physical therapy, anti-inflammatory medicine and steroid injections. Patients who fail conservative treatment may consider fusion surgery.   Fusion surgery “fuses” the sacrum to the ilium to prevent pain.  This is done by surgically placed implants.  Many  people will have coexisting spinal disease requiring spinal surgery.


Dr. Spivak is a neurosurgeon who is fellowship trained in minimally invasive spinal surgery (MISS).  He treats a variety of disorders of the neck, back and SI joints. For more information on spine or SI joint treatment please call 908-452-5612 or click schedule-an-appointment.

Where do you get the bone for spinal fusion?

People often ask 2 questions about spinal fusion:

1) Why do you need bone?

Bone is a key ingredient in spinal fusion.  Spinal fusion is done when the spine is weak and needs to be made stronger.  One vertebral body is connected to another vertebral body with metal screws and rods.  Bone is placed in-between the vertebrae so the vertebrae will grow together and form one solid bone.  If bone isn’t placed  and a solid spinal fusion is not obtained the screws and rods will eventually loosen and fall out or break.

2) Where do you get the bone from?

In the old days the bone was taken from your body.  Usually a piece of your hip would be cut out and then used as graft for the fusion.  Sometimes only the inside of the hip bone would be scraped out.  Today  donor bone or synthetic bone alternatives like hydroxyapatite are usually used.. Bone removed during the operation is rarely used.  This may still be done if the person last fusion surgery failed to fuse and now the surgery was been redone or if they are very high risk for the fusion failing such as smoker, sick or on chronic anti-inflammatory medications.

About Dr. Carl Spivak and Executive Spine Surgery

Dr Spivak is a neurosurgeon with expertise in minimally invasive spine surgery and is a pioneer in endoscopic spine surgery.  He routinely teaches workshops and courses for doctors throughout the United States for JOIMAX USA.  For more information on how Dr. Spivak can help you, please call 908-452-5612 or click schedule-an-appointment.

When can I have Sex after back surgery?

Patients often ask when they can safely have sex after back surgery.  This is a common concern for the patient and for their significant other.

Often their sex life has already been affected.  Back pain may interfere with intimacy, decrease sex drive (libido) and interfere with sexual enjoyment.  Patients with pelvic numbness or nerve dysfunction may feel less stimulation and pleasure or have difficulties developing or sustaining an erection or orgasm. Even worse, sex might aggravate the back injury, causing a great deal of pain and ultimately making sex unpleasant and unwanted.  Back pain can also lead to depression or be associated with depression, another factor that can affect your sex life.

No wonder people are concerned!

I am happy to tell you that sex is safe after back surgery.  For patients undergoing traditional back surgery, doctors commonly recommended waiting 6 to 12 weeks before resuming sexual activity. These operations involved a large midline incision, muscle retraction and bone resection, and patients suffered intense pain from muscle damage. These surgeries are very different from today’s advanced endoscopic spinal surgery. Endoscopic surgery is done through a tiny incision the size of your finger nail, using a little high definition video camera the size of a pen! There is minimal skin, muscle and bone damage.  Most people recover in a few weeks and the incision is small and less likely to be torn open.

The great advancements that have been made in minimally invasive back surgery means that patients treated endoscopically can start having sex again after only 2 weeks if their incision is healing well, their pain has resolved or significantly improved, and their sex drive has returned.  The healing time will increase for other more invasive surgeries or surgeries involving spinal instrumentation.  As with all activity, the patient should approach sex in a safe, gentle manner and take on a passive role. The patient should avoid heavy lifting, bending and twisting. They should stop if pain develops. As an old colleague of mine told his patients, “No shaking the trailer!”

They may benefit from small pillow under their low back, stacked pillows under their knees to bend the hips and support the legs, and taking a well-supported position.  They may also benefit from taking pain medication prior to sex. Their partner should avoid putting their full weight on them.  The patient may have less pain starting with missionary position, lying down on their side or standing and bending over a chair.

Since all patients and surgeries are different, you should discuss your return to sexual activity with your doctor. Though you might feel awkward bringing it up, don’t worry. It’s a very normal, healthy concern.


Can I do yoga after spinal fusion?

Spinal fusion is a surgery to connect one vertebrae to another vertebrae.  This is done by the placement of bone in between the vertebrae and connecting the vertebrae with rods and screws or other fixation devices.

The patient’s activity is restricted after spinal fusion.  Most patients are restricted from twisting, bending and lifting after spinal fusion.  Walking and light activity is encouraged.  Yoga is a series of postures and breathing exercises.  There are many benefits of yoga including improving flexibility, strength, posture and breathing.

Flexibility is improved by slow gradual stretches decreasing stiffness in muscles, ligaments and joints.  Strength in legs, back and arms are improved by holding specific postures.  Yoga is important for core strengthening.  This is especially important in people with back problems.  Posture is improved through core strengthening.  Some yoga can be aerobic but  breathing is controlled to promote relaxation.

Yoga may be helpful after spinal fusion.  Treatment should be direct by an yoga teacher experience in spinal fusion treatment.  Extreme bending and twisting movements should be avoided until your back is fused to prevent screws and rods from breaking.

For more information on spinal fusion please see Spinal Fusion and Options.

Click schedule-an-appointment to set up a consultation.

Do I need rehab after spinal fusion?

Spinal fusion surgery is the joining one spinal vertebrae to another.  This is usually done by placing bone in between the vertebrae and then connecting the vertebrae together with screws and rods, hooks, wires or clamps.

Even though spinal fusion surgery can be painful and initially limit activity, the main reason for rehabilitation after surgery is general weakness and reconditioning.  Severe back pain may lead to decreased level of functioning and de-conditioning.   Rehab also helps people to manage with activities of daily living (eating, preparing food, bathing, dressing, cleaning, etc), proper usage of assistive devices such as canes, walkers, wheelchairs and usage of spinal braces.  Sometimes back braces can be tricky to take off and put on, especially for people who have weakness or arthritis in there hands.  Rehab is also more common with big surgeries.

The amount of rehab depends on general health, functional ability, severity of the disease, the type of surgery done and the number levels fused. Rehab can vary from none to inpatient. People who need rehab usual need outpatient physical therapy 2 to 3 times per week. Elderly patients may require in patient for many days to weeks depending on their physical condition and the level of support they have at home.

Please see Spinal Fusion and Options for more information.

To set up a consultation please call 908-452-5612 or schedule-an-appointment online.

Should I hire a nurse after spinal fusion?

Spinal fusion surgery is the joining of one backbone to another backbone (bony vertebrae to another bony vertebrae).  This is usually done for instability, that is when the spine is weak and falling apart.  Spinal fusions can be large, painful and debilitating procedures, but hiring a nurse is not usually not necessarily required after lumbar fusion surgery.   That said each person, spinal disease and surgery is different.  If you are very concerned you could set up just in case.

Minimally Invasive Spine Surgery (MISS) tends to be less painful and debilitating then open surgeries. Multilevel surgery is more painful then single level surgery.  Minimally invasive surgery is less painful then open traditional surgery because there is less tissue destruction.  In traditional surgery there is a large skin incision, signifiant retraction of the back muscles and a lot of bone removal resulting in severe pain.

Tissue damage is minimized with minimally invasive surgery.  The skin incision is small instead of large.  The muscles are dilated (pushed apart) rather than retracted.  Muscle retraction damages muscles producing scar tissue and weakness resulting in pain.  Little if any bone needs to be removed during minimally invasive fusion (this is especially true for endoscopic lumbar interbody fusion (ELIF).  These benefits results in less pain then with traditional fusion surgery.

For more information on spinal fusion click Spinal Fusion and Options

For more information on how Executive Spine Surgery can help you please call 908-452-5612 or inquire at schedule-an-appointment.

Does the body ever reject the materials used in spinal fusion?

Spinal fusion is the connecting of one vertebrae to another vertebrae to strengthen the spine and decrease pain.  This is usually done with screws and rod or sometimes a metal clamp.  Bone is placed between the vertebrae to cause the vertebrae to grow together to make a solid continuous bone.  This is the fusion part of spinal fusion.

It is uncommon for the body to reject spinal fusion materials. Spinal fusion is usually done with bone, plastic (PEEK) or titanium cages and titanium screws and rods.   Spinal clamps are becoming more popular and  sometimes are used as an alternative to pedicle screws.   Bone or bone alternatives are packed into the disk space, facet joints or beside the spine for fusion to happen.  It is very rare to have a reaction to bone, PEEK or titanium.     Very rarely patients develop an allergic reaction to donor bone. If they use your own bone your body should not react to it.   Bone alternatives like calcium phosphate may cause reaction but again this is unlikely.

Rest assured most people go through a spinal fusion without rejection to the fusion materials.  To learn more information on spinal fusions please click Spinal Fusion and Options.

To book an appointment please contact Executive Spine Surgery at  908-452-5612 or click schedule-an-appointment.

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