Postoperative considerations for multilevel fusion include a longer recovery overall than for a one-level fusion, as would be expected due to the larger procedure. Depending on the surgical technique used, recovery still may be fairly quick, such as 6 to 8 weeks with the use of minimally invasive techniques. When multilevel fusion is done as a large reconstruction for spinal deformity (such as from scoliosis or Scheuermanns kyphosis) over 4 levels or more, it can easily take the patient 6 months or more for maximal recovery.
With multilevel fusion procedures, use of a postoperative external brace is common, providing added support and limiting excessive motion of the low back. Use of rigid internal fixation (rods and screws) and interbody fusion support may obviate the need for a postoperative brace, even in a multilevel fusion, especially if a patient's bone quality is strong.
Postoperative Restrictions
Activity restrictions following multilevel fusions are similar to single level fusions, and may vary based on surgeon preferences as well as the patient's bone quality and technical aspects of each individual surgical procedure.
- Typically, bending, twisting, and lifting activities are limited for the first 6 weeks, when therapeutic exercises are focused on activities of daily living and mild aerobic fitness activities such as walking or stationary bike riding.
- More aggressive abdominal and core strengthening exercises as well as aggressive range of motion exercises are usually not begun until after 6-8 weeks of initial healing.
However, each surgeon will individualize his or her patient's postoperative activities based on a variety of patient and surgical factors. Permanent activity restrictions (if any) following multilevel fusion surgery are also under the discretion of the operative surgeon
Full bony healing of a multilevel fusion is the same as a single-level fusion, as each level heals independently. Typically this process takes 6 to 9 months for full healing, but this is very dependent on the specific techniques and bone graft options chosen for any individual case.
For two-level fusions done for degenerative disc disease and low back pain, a full discussion between the patient and spine surgeon should include the reason for the need for multilevel surgery, the added risks, and the surgical technique options in order to minimize risk and maximize chances for relief of symptoms and complete recovery. A fusion of three or more levels of the spine for painful multilevel degenerative disc disease is rarely, if ever, advisable. Patients who may be considering this option should exercise extreme caution by proactively researching all their non-surgical options and seeking additional surgical and non-surgical opinions.
