Recovery times depend on whether your surgeon performs open spine surgery or minimally invasive spine surgery.
Open surgery involves making a large, long cut along the spine to get access to the operating area and is considered a largely outdated approach to spine surgery. Many spine surgeons who have not kept their surgical skills up-to-date still perform open spine surgery.
Minimally invasive spine surgery, also known as ‘keyhole’ surgery, involves making only a small number of small cuts to gain access to the spinal pathology and leaves the patient with much smaller cosmetic scars and many other post-surgical benefits.
Open spine surgery – What to expect
With open spine surgery, hospital time can be several days, and recovery after leaving the hospital can take between 3–6 months. In some cases, this may last as long as one year. The most difficult period is the first few weeks after surgery.
Pain, mobility, activity
Pain will likely limit the patient’s mobility. Furthermore, the patient will spend much of their time managing this pain by limiting activity and taking medication, including highly addictive opioids. The early period will also involve time spent caring for wounds from the surgery. Patients will have to avoid activities such as long drives, standing for long periods, and lifting objects. All of this will of course limit or inhibit the patient’s ability to do things such as chores and even work.
Physical therapy and exercise
Physical therapy and exercise will play a large part in patient recovery. In many cases, weekly physical therapy sessions may start the first week after surgery and last the entire recovery period. After a few months, it is usually recommended that the patient start light exercises to strengthen the back. Although there is a need to start slowly and to take it easy, exercise has been shown to speed recovery. After 3–4 months of physical therapy and exercise, most patients can engage in more activity and do things such as lifting objects.
Getting back to work
A major part of the recovery process is the timing for when the patient can return to work. Of course, this depends on the severity of the patient’s condition, what type of job the patient has, and the success of the patient’s therapy and exercise regimen. Patients recovering from conditions such as a herniated disc may go back to work after 4–6 weeks. Certain conditions such as spinal stenosis may require longer recovery time. Also, patients with jobs requiring physical labour may need to give themselves more time before returning to work.
Recovery time depends on the procedure
Recovery time depends not only on whether the patient has had open vs minimally invasive spine surgery but also on the procedure. With a discectomy, removal of all or part of a disc, recovery is usually fast with patients getting better in a few weeks.
Recovery time for more intensive procedures such as laminectomy or removal of the lamina and spinal fusion is much longer. After surgery, the bones need to heal, and this can take 3 to 4 months and up to a year in some cases. During this time, the activity of the patient will be quite limited.
Minimally invasive spine surgery – What to expect
As to be expected, recovery from minimally invasive spine surgery (MIS) is faster than from more invasive types of spine surgery. Nonetheless, any kind of spine surgery is a serious procedure and patients can expect a period of less activity and some degree of discomfort. The usual recovery time until a patient can return to normal activities is about six weeks. During this time, patients will have to restrict their activities. How much restriction is required will be determined by a patient’s doctor, based on the procedure undergone and the patient’s overall health.
Why minimally invasive spinal surgery recovery is easier and faster
There are three main reasons the recovery time for minimally invasive spine surgery is shorter than for traditional open spine surgery. First, as its name implies, minimally invasive spinal surgery is less invasive. What this means is that the incision made during the procedure is much smaller than in open spine surgery. MIS uses the latest technologies and techniques to do what usually takes traditional surgery incisions of 5–6 inches in length with incisions that may be as small as one centimetre. It makes sense that the smaller the incision, the shorter the healing time.
One of the most invasive measures taken during open spine surgery is that of disconnecting the muscles from the bone to access the spine and proceed with the surgery. Removing muscle attachments from the bone causes a lot of trauma, making recovery longer and more difficult. With MIS, the muscles do not have to be disconnected and can merely be pushed out of the way to access the spine.
The third reason recovery is faster with MIS is that both the larger incision and muscle disconnecting required in open spine surgery cause the patient a lot more postoperative pain. With its smaller incisions and other less invasive techniques, MIS affects the muscles and other soft tissues less than open spine surgery. Less severe pain after surgery means the patient can start their physical therapy sooner and recover faster, relying on less pain medication too.
Tips for recovery
Some of these tips are common sense but are nonetheless important for a speedy and healthy recovery after spinal surgery, regardless of whether or not it is open spine or MIS.
Although a patient may be in noticeable pain after surgery, it is important to go for short walks, gradually increasing the distance each day. However, patients should avoid activities that involve bending, twisting, pushing or pulling, and lifting anything over a couple of kilograms. Sitting too long should also be avoided.
Patients should take their pain medicines as prescribed. However, it is important that you do not take more medication than instructed. Pain medications are often highly addictive and can also cause constipation. Other treatments to relieve pain include light exercise, massage, taking frequent short breaks, and not remaining in any one position for too long.
Caring for wounds
For the first few days, patients should keep the incision and area around it clean and dry. They should avoid full baths until the incision has healed and the doctor gives the ok. Bandages should remain on the wound for about a week but may eventually be removed. Patients should check their wounds for redness, swelling, and extra fluid.
Calling the doctor
A patient should contact their doctor immediately if they have a fever, chills, or constant fluid from the incision. The doctor should also be contacted if pain worsens or there is a sudden loss of bladder or bowel function.
Choosing a spine surgeon
Choosing a surgeon that has specific sub-specialised fellowship training in minimally invasive spine surgery is crucial. Many spine surgeons have not updated their core skills since starting their careers a significant time ago.
It is also beneficial to select a spine surgeon that has built up a high-volume practice, indicating credibility with their peers. High-volume surgeons have the benefit of treating both common and rare surgical presentations, giving you the greatest chance of having a successful surgical outcome.
Dr Richard Parkinson in Darlinghurst, Sydney is a neurosurgeon specialising in spine surgery. He has undertaken sub-specialised minimally invasive spinal surgery training in Australia and the USA. He is a high-volume spine surgeon operating at Sydney’s leading private hospitals. Visit his website here: ispine.com.au
Tommy Williamson did his degree in psychology at the University of Edinburgh. He has an ongoing interest in mental health and well-being.