“What?? You’re sending me home?!
When my grandma had a spinal fusion she was in the hospital for a whole month!”
That’s right, she was. Back in the very early days of spine surgery, patients were on complete bed rest for 1 month or more. To provide a way to change position, they were in special beds that could be flipped over with the patient between two mattresses (scary for the patient) or in beds that rotated on a circular frame. Can you imagine that? AND when your grandma was finally allowed to get up out of bed, she probably was allowed very limited activity and wore a body cast for 3-6 months and then a brace for several months after that. Today, patients get up within a day of surgery and go home without a brace within a few days of surgery so as the saying goes, “We’ve come a long way, baby!”
Patients commonly refer to their surgery as a ‘spinal fusion’, (which is perfectly fine), rather than the longer name ‘spinal fusion with instrumentation’. To clarify terminology, the spinal fusion is the bone graft ‘healing’ to the bones of your spine. Once this healing takes place, which usually takes about a year (up to 2 years for complete fusion), the spine and the bone graft are like one solid piece of bone. The instrumentation (rods, screws, hooks, etc.) is like an ‘internal brace’ holding the spine in a corrected position while the bone heals.
The first spinal fusions for scoliosis were done in the early 1900s with bone graft alone and no attempt at correction of the deformity. Hospital stays were much longer as patients were on bed rest and in casts to support the spine and avoid motion while the fusion was healing because there was no ‘internal brace’ providing this support. As you can imagine, there was a pretty high rate of fusions that did not heal. Instrumentation came on the scene in the late 1950s but consisted of only 1 or 2 rods with hooks at the ends which attached to the spine at the top and bottom of the curve. This was an improvement over using no instrumentation and allowed some deformity correction but only attaching to the spine in two locations still required the patient to limit their mobility and wear a cast or brace for months postoperatively. Over the next several decades, huge improvements in the instrumentation systems were made but some patients were kept flat in bed for the first few days after surgery and still braced for a few months.
Fast forward to the present and the use of instrumentation that is very secure as it is attached to the spine at several locations. Most common is the use of 2 rods and multiple screws inserted during a posterior spinal fusion. These implants are so secure that it is rare for a patient to be braced postoperatively unless he/she has other conditions that warrant some external support. Most doctors tell patients that they can resume normal activities when they feel like it, using good judgment and letting their bodies be their guide. (This usually doesn’t include extreme sports.) All patients are different and surgeons have their own preferences so you should follow your surgeon’s recommendations and postoperative protocols.
In the mid to late 1990s and early 2000s, the average length of stay in the hospital for a spinal fusion for idiopathic scoliosis was 7-10 days. This decreased to 6-7 days, then 5-6 days, and time kept getting whittled away to the current practice of 3-4 days with some patients being discharged at 1-2 days after surgery. The above information explains the main reason that patients are up and moving and out of the hospital more quickly than in the early days of spinal fusions. What a difference from when your Grandma had surgery!
“But why not keep patients in the hospital and let them rest for longer after surgery?”
You may think that patients do better if in the hospital for a longer stay but there have been studies done that evaluate how patients are doing postoperatively and the opposite is true. Getting them out of the hospital and back at home promotes a faster recovery. Once patients are home after surgery, they tend to relax, feel better and get back to their regular activities sooner. Hospitals are full of sick people and germs and the risk of developing a complication like a wound infection is greater while in there versus being at home.
For example, there was a presentation given in September at the SRS’ Annual Meeting entitled “Impact of an Accelerated Discharge Pathway on Early Outcomes and Recovery Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Prospective Comparative Study”. Two high volume spine centers signed patients up to participate in a study that tracked how long they were in the hospital and how they were doing after surgery. One center used a traditional postoperative protocol or pathway that guides what patients should be accomplishing on each day after surgery leading up to discharge and the other center used an accelerated pathway. When both centers had a pre-determined number of patients in the study that followed the postoperative protocol for an established amount of time, the study was concluded and they collected the results. Their hypothesis, (what they thought the study would show), was that the patients on the accelerated pathway would be discharged sooner without an increase in postoperative pain or complications and would return to school in a similar time frame.
When there are 2 groups of patients in a study, they are ‘matched’ as closely as possible to each other based on curve size, age, number of levels fused and blood loss so they are comparing ‘apples to apples’. Patients at the center using the accelerated pathway were discharged an average of 2.7 days sooner with lower pain scores than those on the traditional pathway. Questionnaires filled out by the patients at 6 weeks follow-up showed similar scores for their quality of recovery and when they returned to school.
So there you have it – those patients that agreed to be followed for the study were simply recovering from surgery. By agreeing to have their data collected and analyzed, they helped change the length of hospitalization for those having future spine surgery since the comparison showed that there was no increased danger in having patients “Get up and get out earlier than in the past!”