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This post was co-authored by Grace McClure and Dr. Trevor North, M.D., OS

Everyone knows back surgery is scary but what doesn’t get as much airtime is how anxiety-filled recovery can be. It’s tough to know what to expect after back surgery and whether the symptoms you’re experiencing are just part of plain ol’ recovery or cause for concern.

As your body heals from surgery, you will experience pain, swelling, and inflammation along with other symptoms like insomnia and emotional healing/ depression. So how can you differentiate between normal recovery symptoms and post-op symptoms that indicate an infection or a potential complication?

The more you know about what normal recovery after a discectomy, spinal fusion, laminectomy or other decompression looks like, the better you can steer your recovery into safety. By understanding early warning signs, you nip complications or infections in the bud.

According to the American Association of Neurological Surgeons, infections occur in approximately 1-4% of spine surgical cases. Most infections, when caught early enough, can be cured with oral or IV antibiotics.

Read on as we share the red flags to watch out for as you recover from back surgery.

“WORST”: 5 Red Flags to Watch Out For After Back Surgery

With a wide range of physical and emotional post-op symptoms, uncovering real warning signs that your recovery may be taking a turn is a challenge. To help, here’s our handy acronym of post-op warning signs you need to watch out for: WORST.

  • Worsening, discolored or foul smelling discharge from your wound/ excessive bleeding.
  • Out of breath, chest pain or difficulty breathing.
  • Red streaking around incision.
  • Sharp pain.
  • Temperature of 100.5 degrees fahrenheit or greater.

1. Worsening, Discolored Discharge/ Bleeding

Your care team (and you) can tell a lot about your recovery from your wound/ incision mark. During your time in the hospital or ambulatory center, your surgical incision will be checked regularly. You will be taught how to change your wound dressing and how to clean and protect your incision as it heals.

Your wound has a lot to say. If you know what to look for, your wound can tell you how your healing and show early signs of infection.

After surgery, your incision will feel warm and normal. However, you should not have drainage from your incision for more than 5 days after your surgery. If your incision drainage has an odour or is discoloured, this is not normal. Always contact your medical team if your wound smells, is bleeding excessively, or is not draining clear.

2. Shortness of Breath/ Coughing

After back/spine surgery, your movements may be limited but it’s important to keep moving as recommended by your care team. Whether you’ve had general or local anesthetic, you will need to move around. In the case of general anesthetic, there may be fluid in your lungs that needs to clear (moving around helps with this).

In any case, if you’ve noticed difficulty breathing in the days or weeks following surgery, reach out to your care team immediately. Shallow breathing or coughing after surgery is a red flag that you may have an infection or a blood clot.  If you are having trouble breathing, are experiencing chest pain, or have a cough, contact your doctor or surgeon ASAP.

3. Excessive Redness & Streaking

After surgery around your spine, you will have redness, tenderness and heat around your incision. This is normal. In fact, you may notice that your incision area is warm to touch for weeks after surgery. Your pan medication, icing, and movement will help with some of the redness and inflammation.

What you’ve got to look out for in recovery is red blotches or streaking down your back. Red streaks down your back around the incision can signal an issue. If redness looks streaky or is spreading across your back, buttocks, hip or leg, contact your care team.

4. Sharp, Persistent Pain

After surgery, pain is normal. You will feel pain in the surgical area and some overall discomfort. There will be pain and swelling around your incision/ wound and some nerve pain as the area will be swollen. However, pain should feel fairly consistent with a trend of gradually feeling better (there are some exceptions, like when you taper off pain medication or increase physical therapy). After the 6 week more, pain should be noticeably better.

Pain that feels like it’s “shooting” or “spiking” is not normal pain. If you’re experiencing sharp, persistent or worsening pain, contact your care team immediately.

5. Temperature of 100.5°F+

Your regular body temperature should be between 97-99°F (36.1 – 37.2°C). Anything above 99°F is technically considered a fever, but a fever isn’t significant until it’s above 100.5°F.  If your temperature is clocking in above normal, it could mean you have a fever. Fevers are signs that you may have an infection (like a wound infection or urinary tract infection), or another complications (like pneumonia).

Hot Tip: In early recovery, keep a thermometer on stand-by. You will want to check your temperature frequently to make sure

Who Has the Most Risk of Infection & Complication After Surgery?

Quite a few factors contribute to your risk level for infection or complication after spine surgery. Some have to do with the procedure itself, while others have to do with lifestyle factors, family history etc.

Here are some factors that contribute to your post-op risk of complication:

  • Type of procedure being performed (the level of invasiveness, the duration of the surgery, the type of surgery, type of implant being used etc.)
  • Site of surgery (e.g. dorsal surgery is higher risk for infection than cervical or lumbar)
  • If the surgery is a revision, it will be higher risk.
  • Traditional open approach may have a slightly higher risk than minimally invasive surgery
  • Site of surgery (dorsal surgeries with highest infection risk compared to cervical and lumbar locations)
  • Age (older patients have higher risk)
  • A history of IV drug abuse/ taking prescription opioids for extended time before surgery
  • If you have secondary disease/ comorbidity (like diabetes, cancer etc.)
  • Weight (being overweight or underweight)

How You Can Lower Your Spine Surgery Risk

Lower Spine Surgery Risk

The good news is, no matter where you’re at with your back surgery, there are things you can do to lower your risk for complications and infection. If you’ve already had surgery, this means keeping up with physical therapy, eating nutritious foods that boost healing, staying away from cigarettes and alcohol, icing, getting enough rest, and working through the emotional side of healing.

For those preparing for back or spine surgery, you’ve got a golden opportunity to steer your outcome in a positive direction! For anyone dealing with back pain (with the possibility of a corrective surgery) or anyone with a surgery on the books, one word for you: PreHab. A daily PreHab program helps you get the most prepared possible for surgery and gives you a jumpstart on recovery.

Before a laminectomy, discectomy, spinal fusion or other back surgery a daily PreHab program, like PeerWell will help you:

  • Lose extra weight that is putting you at a greater risk of infection and blood clots
  • Control pain with opioid-free pain management education that’ll help you stay in a better headspace and stay on top of post-op pain.
  • Physically prep your body with exercises that will improve your sciatica, nerve damage, herniated discs, lower back pain, spondylosis, scoliosis, and other debilitating back conditions. Muscle strengthening will help you with post-op movement, flexibility, extension etc.
  • Manage anxiety/ stress to mentally prep for surgery, cope with stress, and deal with the mental components of pain.
  • Recover quicker when you’ve built a strong foundation and get back to your new normal.

Are you experiencing back pain? Join PeerWell now, and be first in for to get helpful articles straight to your inbox. While you’re at it, join our supportive Facebook group for back pain! Our Facebook group holds live Q&As with back pain experts; is a helpful community for peer support; and shares the best articles on pain management and pain relieving procedures.

Dr. Trevor North, M.D., OS is a board-certified orthopedic surgeon at Henry Ford Hospital systems in Detroit Michigan and surrounding area. Dr. North completed medical school at the University of Sydney, receiving the highest distinction for academic and clinical performance. He finished his residency at Henry Ford Hospital where he was chief resident. Dr. North did his Adult Reconstructive Orthopedic Surgery fellowship at the renowned Cleveland Clinic. He currently specializes in complex hip and knee replacement surgery. Dr. North is well-published in Pub Med journals, won research resident of the year at Henry Ford and also won the Henry Ford research symposium.

In pain? Preparing for surgery? PeerWell Health helps you fast forward to better with 1:1 doctor visits, physical therapy, and a custom at-home program for your condition. 

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