An operation on the spine does not end with the skin suture. What happens afterwards — how quickly you get up, how much load is applied, which exercises begin when, when you go back to work — helps to decide what the result looks like in six months’ time. This page describes the aftercare following the procedures that we perform: after a decompression, after a spinal fusion with screws or a cage, after a kyphoplasty and after an SI joint fusion.
The basic rule is: into movement early, into load slowly. Walking is almost always wanted and is the aim on the day of the operation or the day after. Heavy lifting, twisting under load and deep bending, by contrast, wait until the wound and the bone are ready for them.
Who this page applies to
To everyone who has been operated on at the spine or at the pelvis — regardless of whether the procedure was discussed with us or carried out elsewhere. Aftercare follows the same basic ideas everywhere, but differs in the detail: after a pure relief of the nerve, different rules apply than after a fusion, in which bone has to grow together. What is binding is always what is stated in your operation report and your discharge letter; this page explains the background to it.
There is no generally valid figure for “how long”. Wound healing, fusing as bone, previous illnesses, age, occupation and the course before the operation differ too much. Anyone who names you a fixed number of weeks without knowing you is guessing.
What happens exactly?
- The first few daysGetting up with support, usually on the day of the operation or the day after. Strength, sensation and reflexes are checked, the wound is looked at, painkillers are set so that movement is possible — not so that you stay lying down. Walking in short, frequent bouts is better than long distances. Sitting at first only briefly and frequently interrupted. Thrombosis prophylaxis is prescribed for the period of restricted movement. How long you stay in hospital depends on the procedure, on the course and on your situation at home.
- The first weeks at homeWalk regularly, a little more each day. Do everyday things yourself, but lift nothing heavy, do not twist under load, do not bend deeply. The wound stays dry until it is closed; showering is usually possible soon after the wound is closed, bathing and swimming wait until it has healed completely. Stitches or clips are removed as instructed. After a fusion, the agreed partial weight-bearing applies in addition, frequently with forearm crutches.
- Building up loadWhen the wound has healed, the actual training begins: strengthening of the trunk and the back, improvement of mobility and stamina, practising the movement patterns for lifting, bending and getting up. The build-up follows a plan and not the form of the day. Follow-up checks with us are part of it; after a fusion, fusing as bone is assessed with X-ray or CT images.
What applies after which procedure
- After a decompression — walking from the start, no heavy lifting and no twisting under load for a few weeks. The leg pain often eases quickly, while numbness recovers markedly more slowly, sometimes over months, and some of it can remain. Since the disc is not replaced, a further herniation at the same place is possible; training and back-friendly movement patterns lower the risk.
- After a spinal fusion — here bone is meant to grow together, and that takes months. The phase of restraint lasts correspondingly longer: no heavy loads, no twisting under load, no impact loads. Anyone who smokes should stop — smoking demonstrably makes fusing as bone more difficult. At the cervical spine, difficulty swallowing and hoarseness occur in the first few days and usually recede.
- After a kyphoplasty — getting up and walking are usually possible soon, because the vertebra is stabilised from the inside. What is decisive is what comes afterwards: the underlying osteoporosis has to be treated, otherwise the risk of further vertebral fractures remains. That includes calcium and vitamin D, a medical treatment according to the findings, fall prevention and strength training.
- After an SI joint fusion — partial weight-bearing of the operated leg for a few weeks as instructed, usually with forearm crutches, so that the implants can grow in. After that, building up load with physiotherapy, first the buttock and trunk muscles, later stamina. The fusion is checked over months.
What physiotherapy and rehabilitation achieve — and what they do not
The evidence is best investigated for the period after a disc operation. A Cochrane review of 22 studies with around 2,500 participants found: exercise programmes that begin four to six weeks after the operation relieve pain somewhat more strongly in the short term and improve function somewhat more than no treatment; more intensive programmes did somewhat better than less intensive ones. Supervised programmes and those carried out independently at home did not differ meaningfully. Important for safety: in none of the studies did exercising lead to more repeat operations. The overall certainty of the data is, however, low to very low, and in the long term the differences largely disappeared.
Put soberly: movement after the operation is safe and helps, but it is not a miracle cure, and the difference between an expensive and a simple programme is smaller than is often assumed. What counts most is that training takes place at all and lastingly. We are glad to write you a referral for physiotherapy.
Follow-up rehabilitation and the application for it
After an inpatient procedure, a follow-up rehabilitation comes into consideration — an outpatient or inpatient rehabilitation that follows on directly from the hospital stay. It is meant to begin promptly, as a rule within two weeks of discharge. The application is not made by you alone: the social services department of the treating hospital initiates it early during the stay with the responsible funding body — depending on your insurance, the Deutsche Rentenversicherung, the German statutory pension insurance, or the health insurance fund. So speak to the social services department early and not only on the day of discharge.
Whether a rehabilitation is sensible depends on the procedure, on the course, on the demands of your occupation and on your situation at home. Not everyone needs it; for some, physiotherapy close to home with subsequent training of their own is the better way. If you were not operated on as an inpatient, or if the follow-up rehabilitation does not come about, a rehabilitation can also be applied for later — then through the general practice or directly with the funding body.
Unfitness for work
How long you are unfit for work depends on the procedure, on the course and above all on your occupation. A predominantly sedentary occupation with the possibility of getting up and changing posture is possible again earlier than physical work with lifting, carrying, awkward postures or vibration. We deliberately do not name fixed numbers of weeks — they lead to false expectations in both directions.
A phased return to work, in which working hours are increased over weeks while unfitness for work continues for the time being, is often sensible. Raise this in good time at the general practice, with us and with the company doctor. If your occupation no longer suits you permanently, benefits for participation in working life are among the possibilities that the pension insurance body examines.
When you should get in touch
At once, and by way of the emergency number 112 or the nearest hospital: with a new numbness in the area of the buttocks and the perineum, with a new disturbance of passing water or of the bowels, and with a paralysis that increases within hours or days. Quickly, within a few days: with fever, with a wound that becomes red, warm, swollen or painful again, with weeping from the wound, with new weakness in the leg, the foot or the hand, with suddenly severe pain again after a period free of symptoms, with one-sided swelling and pain of the calf, and with shortness of breath.
Less urgent, but likewise a reason for an appointment: symptoms that do not get better after weeks, new pain elsewhere — for instance in the adjacent segment, in the sacroiliac joint or in the hip — and the feeling of not making progress with building up load. Everything on this is on the page Warning signs.
Avoiding relapses
- Train lastingly — not only until the symptoms are gone. Strengthening of the trunk and the back plus regular stamina work, even walks alone, is the most effective single factor against renewed back pain.
- Practise movement patterns — lift from the legs instead of from the back, carry loads close to the body, roll over your side when getting up from lying down. These patterns are learnt in physiotherapy and have to become a habit.
- Interrupt sitting — get up every half hour, change posture, walk briefly. The workplace may be adapted, and frequently the pension insurance body covers aids for this.
- Do not smoke — smoking burdens wound healing and makes fusing as bone after a fusion more difficult.
- Treat the underlying condition — an osteoporosis after a vertebral fracture, a high blood sugar, excess weight: whatever influences the bone and the healing should be treated as well.
Frequently asked questions
When may I drive again?
When you can turn freely, get in and out safely and brake firmly if needed — and when you are not taking any medication that limits your ability to react. That is not a fixed deadline, but a test that you should carry out honestly on yourself. Discuss it at the follow-up check.
Do I need a corset?
As a rule not. Support corsets are now used only in particular situations and then for a limited time, because wearing them for longer weakens the trunk muscles. Whether it makes sense in your case is stated in your discharge letter; ask for the reason and for the planned duration.
When can I do sport again?
Walking immediately, cycling on level ground and swimming after the wound has healed completely, followed by training on equipment. Sports with impacts, jumping, abrupt turns or heavy lifting come last, and only once the trunk and the back can take load again. After a fusion, the point in time additionally depends on fusing as bone.
The numbness is still there. Has the operation failed?
No. Sensation recovers more slowly than pain, often over months, and some of it can remain — especially if the numbness had already been present for a long time before the operation. A stable numbness that does not increase is unpleasant but not a cause for concern. Increasing numbness or new weakness are something different and should be examined promptly.
Do I have to go to rehabilitation if I do not want to?
No, a rehabilitation is an offer and not an obligation. What matters is that the building up of load takes place at all — whether in a rehabilitation facility, with physiotherapy close to home or in supervised training. What is practicable in your situation is something we discuss at the follow-up check.
Who looks after me after the procedure?
The follow-up checks with us are part of the treatment: the state of the wound, strength and sensation, in fusions the imaging check of the fusion, and with that the adjustment of load, medication and physiotherapy. The general practice accompanies the unfitness for work and the general medication. An appointment is open to you whenever something is not going as discussed.
If a further procedure has been recommended to you after an operation and you are unsure, you can obtain a second opinion from us. We look at your images and operation reports, examine you and tell you frankly whether we share the recommendation — and what happens if you wait for the time being and continue building up load. What you should bring is on the page Your first appointment.