Getting through major spine reconstruction or revision surgery

Which tests and clearances will I need before surgery?

Preparing well is part of a smoother recovery. Weak bones and poorly controlled medical conditions can slow recovery, so much of the work happens before surgery. Depending on your case, tests may include:

• full-length standing X-rays, front and side, including the hips
• a CT scan; after a previous fusion, it is the most accurate test of whether the fusion healed
• a CT myelogram, since metal can blur an MRI
• a bone density scan and nutrition blood tests
• medical or heart clearance

Our preoperative optimization office helps with weight loss, nutrition before surgery, and conditions such as diabetes.

Why does my bone health matter?

Screws and rods are only as strong as the bone holding them. Weak bone raises the risk of loose screws, fractures above the fusion, and a fusion that doesn’t heal. Testing bone strength beforehand lowers those risks.

• A DEXA scan is the standard test. Bone density can also be measured from a CT scan you may already have.
• A vitamin D blood level below 20 ng/mL is linked to more problems after surgery.
• If your bones are weak, a bone-building medicine is often started at least two months before surgery. For large, multilevel operations the window can extend to six months. Treatment should continue at least eight months after surgery.
• If you take denosumab, don’t stop it without a plan. Stopping it triggers rapid bone loss.

Our Bone Health Center provides DEXA scans, evaluation and counseling, and manages bone-building medicines.

Read more: Osteoporosis and spine surgery

Do I really have to stop nicotine?

Yes. Smoking is one of the common reasons a first spine surgery runs into trouble. Quitting nicotine and improving nutrition lower the risk of problems coming back. Daily walking and stopping nicotine both make recovery easier.

Which medicines should I review?

Keep one up-to-date medication list, including supplements, blood thinners and bone medications. Bring it to the pre-op visit. Keep any bone medication on schedule. The care team will tell you which medicines to pause before surgery, and when.

How should I plan for help at home?

Plan who will be home and when. Most people need someone with them full-time for at least the first several days, and family help matters most in the first two weeks at home. Come to the pre-op visit with your questions written down, and bring a family member or friend if you can. Use the checklist below to get the home ready before surgery.

For whoever is helping you: The Journey, family and caregiver edition →

How long is the operation?

In large multicenter studies, the average adult deformity operation takes about six hours. Operations that use both a front and a back approach take about eight hours on average. Some very large corrections are split into two stages on different days. The length depends on how many levels need correction, whether bone cuts (osteotomies) are needed, and whether this is a first surgery or a revision.

How long will I be in the hospital?

In large North American studies, the typical hospital stay was seven to eight days. With me, most patients stay 4 to 6 days. Most go home. Some go to acute rehabilitation first, usually in Newport (Vanderbilt), and spend one to two weeks rebuilding strength before going home.

What are the hospital days like?

Expect to get up and walk with therapists within the first day or two. Your pain plan moves from IV medicine to pills. The team decides with you whether you go home or to rehab first. Hard days are common and don’t mean things are going badly.

Surgery takes place at Brown University Health hospitals, including The Miriam Hospital.

Most patients need no brace; some need a neck brace or a brace that protects the top of the fusion. Showering is allowed from day 7. Blood-thinner injections usually continue for about 6 weeks.

What should I expect in the first six weeks at home?

• Walking is the main job: short walks several times a day, building up gradually.
• For 3 months: no bending, lifting or twisting, and nothing heavier than 10 lb.
• Stay ahead of pain and watch for constipation.
• Protect the wound and follow the steps you were given to prevent blood clots.
• Expect ups and downs: tiredness, low mood and poor sleep are common.

Many patients feel worse at six weeks than they did before surgery. That is normal. Disability scores often dip slightly at six weeks and then improve substantially by one year. Posture also keeps settling for about the first six months.

When can I drive and go back to work?

In a 2024 study of adults who had fusion to the pelvis, 97% returned to driving at an average of about four months, and 88% returned to work at an average of about five and a half months. Shorter or less invasive operations usually allow an earlier return. Don’t drive while taking opioid pain medicine.

Is recovery different after a revision?

Most people still improve. In a multicenter study, patients who needed a revision still improved by two years, somewhat less than those who didn’t, with similar satisfaction. Recovery after revisions for broken rods or failure above the fusion tends to be slower at first and usually levels out by five years.

When will I feel the full benefit?

Most improvement happens in the first year. Pain and function often keep improving into the second year. How you are doing at two years is a strong predictor of how you will be doing at five years.

Read more: Recovery after adult scoliosis surgery

When should I call?

For concerns, call the practice at (401) 443-4270. For a medical emergency, call 911 or go to the nearest emergency room.

What follow-up visits and X-rays will I have?

Your first visit with me is at about 3 weeks. After that, the care team will set your schedule. Full-length standing X-rays show your alignment and the rods and screws. If there is a question about whether the fusion has healed, a CT scan is the most accurate test. Keep copies of your operative report, implant record and images; any future spine doctor will need them.

I live out of state. How should I plan?

• Plan for the pre-operative visits, the hospital stay and the first follow-up at about 3 weeks.
• Arrange who will drive you home and stay with you.
• Ask at your visit how long you should stay near Providence before a long car ride, and which follow-up visits can happen closer to home.
• Ask your insurer whether surgery at a Rhode Island hospital is in network or needs a referral.
• Upload your X-rays, CT and MRI through the University Orthopedics imaging portal before you travel.

Read more: Traveling to Rhode Island for care

I live outside the United States. What should I ask?

Consultations can be held in English or Arabic. Start by writing to bdiebo@uoi.com, and don’t attach records: you’ll be told how to send your images securely. Before you travel, ask about:

• costs and how payment works for patients without U.S. insurance
• any letter or document you need for your travel
• how long to plan to stay, and who should come with you
• which follow-up can happen after you return home

Read more: International patients · Second opinion after spine surgery · Family and caregiver edition