Departments of Nursing and Orthopedic Surgery
University of Iowa Stead Family Children’s Hospital
Peer Review Status: Internally Peer Reviewed
Last Revised: April 2014

Posterior spinal fusion illustration of before and afterThe Posterior Spinal Fusion Care Map outlines the plan of care before and after your surgery. Keep in mind, this is general information and your needs may vary. We hope this booklet will help you and your parents know what to expect during your stay in the hospital. Please feel free to ask questions at anytime

Day before surgery

Orthopedic Clinic

Lower Level, Elevator I, Main Hospital

  • X-rays
  • Urine and blood samples
  • Height, weight, and vital signs
  • “Before” pictures of your back
  • Meet with your nurses and doctors to talk about your surgery and what to expect after.

EEG (electroencephalogram)

Lower Level, Elevator D, Main Hospital

  • The EEG shows the nerve messages going through your spine before and during your surgery. This is done be putting special wires on your head and legs. This doesn’t hurt. The wires will be taken off after this test and put back the day of your surgery.

Anesthesia Presurgical Evaluation Clinic (PEC)

First Floor, Elevator F, Main Hospital

  • You will meet with the doctor who will be putting you to sleep before your surgery. You will talk about any medications you take on a daily basis and whether or not you should take them the morning of your surgery.

Day of surgery

Morning of surgery

  • It is okay to brush your teeth and rinse your mouth out. Do not swallow the water or chew gum.

Day of Surgery Admissions (DOSA)

Fourth Floor, Public Elevators, Children’s Hospital

  • This is where you will check in.
  • A nurse will take your vital signs (temperature, pulse, respiratory rate and blood pressure).
  • You'll get into a hospital gown and the nurses will help you onto a special bed.
  • You will go back to the EEG lab where they will put the special monitoring wires on your head. Sometimes they will put these wires on in the operating room.

Pediatric Surgery Family Lounge

Fourth Floor, Public Elevators, Children’s Hospital

  • Your family can wait here for you while you are in surgery.
  • The doctors will call out to them from time to time during your surgery to let them know how you’re doing. They will also talk with them after surgery.


  • A nurse will greet you as you arrive in the operating room. The room is sometimes cool and noisy. Please let the nurses know if you are not comfortable. Warm blankets are available.
  • The nurses will connect some monitors to you. This will not hurt. The monitors help the nurses and doctors keep track of how you are doing while you are asleep.
  • An IV will be placed in a vein in your arm or hand. The anesthesiologist will give you medicine in your IV to put you to sleep. A mask may be placed over your nose and mouth to help you breathe.
  • A tube is placed in the back of your mouth and throat to get air to your lungs while you are asleep. They will put the tube in after you are asleep. This tube is usually taken out before you wake up.
  • Once you are asleep, the doctors will begin the surgery. You will lie on your stomach on the operating bed. Your arms and legs will be supported with pads. Your back will be washed before starting the surgery.
  • The surgery usually takes about 4 hours, but you will be in the operating room a total of 4 to 5 hours.

Post Anesthesia Care Unit (PACU or Recovery Room)

  • When you wake up you will be in the recovery room. You will lay flat on your back for the first 6 hours and then be able to log roll to your side.
  • You will already be in your hospital bed. You may feel stiff from being in one position for a long time. A nurse will check you often and make you comfortable with warm blankets. You will have oxygen gently blowing in your nose. Your nurse will remind you to cough and deep breathe to exercise your lungs.
  • The nurse will ask you to rate your pain on a scale of 0 to 10. We will give you pain medicine to make you comfortable. It is not unusual to feel sick to your stomach after surgery. Please let your nurse know if you feel sick. We have medicine for that too.
  • You will have more x-rays of your back while you are in the recovery room.
  • You will be in the recovery room for 1-2 hours, or until your doctor and nurse feels you are awake enough to move to your hospital room on the pediatric unit. If you are 16 or younger, your parents or 2 adults can see you while you are in the recovery room.
  • Some patients will need to go to the Pediatric Intensive Care Unit (PICU) after surgery. This happens if the doctor thinks you should be watched more closely. Your parents can stay with you in the PICU as well. The doctors will decide when you are ready to go to your room on the pediatric unit

Day 1: After surgery


  • A sample of your blood will be drawn to check your blood counts.

Nursing care

  • The nurses will teach you to cough and deep breathe and use a breathing device (incentive spirometer). This helps prevent infection in your lungs.
  • Leg and ankle exercises every hour while you are awake. This helps the blood circulation in your legs


  • If your stomach is waking up, you can drink clear liquids.
  • You may want chapstick on your lips.
  • Chewing gum 5x/day for 20 minutes.


  • Slowly decrease IV pain medicine and start taking pill or liquid pain medicine if you are able to drink.
  • IV antibiotics
  • If you are low on red blood cells, you may need a blood transfusion.


  • Out of bed to a chair and/or walk 3 times. A Physical Therapist will be there to help you the first time.
  • A Child Life Specialist will meet with you and help find activities you can enjoy while in the hospital.

Tubes and bandages

  • Hemovac drain in your back.
  • Catheter in your bladder can be removed once you walk.
  • IVs from surgery
  • Bandage on your back.

Day 2: After surgery


  • Blood sample in the morning.

Nursing Care

  • Cough and deep breathe
  • Incentive spirometer
  • Leg and ankle exercises


  • If you are drinking okay, you can slowly begin eating again.
  • Chewing gum 5x/day for 20 minutes.


  • Liquid or pill pain medication.
  • IV antibiotics will be stopped after your catheter is removed.
  • If you are low on red blood cells, you may need a blood transfusion.


  • Walk 3 times. A Physical Therapist will be there to help you the first time.
  • A Music Therapist will meet with you and teach you ways to use music for relaxation. (Monday-Friday)
  • Child Life Specialist (Monday-Friday)

Tubes and bandage

  • Hemovac drain in your back will be removed by your doctors today.
  • Bandage on your back.

Day 3: After surgery


  • Blood sample in the morning.
  • X-rays of you standing up before you go home.

Nursing care

  • Cough and deep breathe
  • Incentive spirometer
  • Leg and ankle exercises


  • Normal diet


  • Liquid or pill pain medication.
  • If you are low on red blood cells, you may need a blood transfusion.
  • Iron pills


  • Work on stairs with Physical Therapy.
  • Work on getting in/out of bed independently.
  • Child Life Specialist

Tubes and bandage

  • Bandage on your back.

Going home


  • Keep your incision clean and dry.
  • Remove back dressing according to the separate instruction sheet provided.
  • You can take a shower 2 weeks after surgery if your back incision is well healed and has no drainage.
  • Do not stand and let the water spray right onto your back incision. Let the water hit your front and shoulders then trickle down your back
  • Your back incision may be numb for several months.


  • Eat a well balanced diet to promote healing, especially foods with Vitamin C and protein.
  • Drink 8 to 10 glasses of fluids a day and include a variety of fruits and vegetables to prevent constipation.


  • You may return to school in 2-4 weeks depending on how you feel.
  • You should ask your school to provide you with an extra set of your school books to have at home. You will not be able to lift/carry a book bag.


  • Walk for exercise as tolerated, gradually increasing the pace and distance.
  • Continue leg and ankle exercises.


  • Your first return appointment will be about 6 weeks after your discharge from the hospital, then 4 months, 6 months, and one year after surgery. Then yearly visits after that.
  • It is important that you return for your scheduled appointments.

Activity restrictions

For the first 6 weeks after surgery:

  • No driving. Make sure to wear your seatbelt.
  • Surgery may cause irregular menstrual cycles.
  • Take pain medication as prescribed. Your need for pain medication will gradually lessen. No non-steroidal anti-inflammatory medications (ibuprofen, Advil, Aleve) for six months. You may use Tylenol (acetaminophen) once you are done taking your prescription pain medications.

For the first 6 months after surgery:

  • No sports or PE.
  • No lifting greater than 5-10 pounds. A gallon of milk weighs about 5 pounds.
  • No lying on your stomach.
  • No bending, stooping, or twisting.
  • No dental work.

Contacting your doctor

If any of the following problems occur after surgery, please notify your doctor:

  • Fever or chills
  • Redness, warmth, or foul smelling drainage at the surgical site
  • Increase in pain
  • Numbness, tingling, or weakness in your arms or legs
  • Change in bowel or bladder control

Your doctor

Orthopedic clinic nurses

Orthopedic scheduling

Nights, weekends, and holidays

Medical Services