Clinical Orthopaedics and Related Research®

, Volume 470, Issue 6, pp 1658–1667

Prolonged Bed Rest as Adjuvant Therapy After Complex Reconstructive Spine Surgery

  • Rex A. W. Marco
  • Ryan M. Stuckey
  • Stephanie P. Holloway
Symposium: Complications of Spine Surgery

DOI: 10.1007/s11999-012-2318-3

Cite this article as:
Marco, R.A.W., Stuckey, R.M. & Holloway, S.P. Clin Orthop Relat Res (2012) 470: 1658. doi:10.1007/s11999-012-2318-3



The benefits of postoperative mobilization include decreased incidence of pulmonary complications, pressure ulcers, and progression of deep vein thrombosis. However, the complexity of certain spinal reconstructions and the patient’s physiologic condition may preclude the possibility of early mobilization. Prolonged bed rest after spine surgery is controversial.


We evaluated the efficacy of prolonged bed rest after complex spine surgery to determine (1) patient characteristics that led to prescribing bed rest, (2) clinical and radiographic outcomes, (3) complications, and (4) estimated direct costs.


We retrospectively reviewed all 11 patients (median age, 50 years) who underwent complex spine surgery followed by prolonged bed rest between 2005 and 2010. All patients were deemed at high risk for developing pseudarthrosis or instrumentation failure without postoperative bed rest. One patient died of complications related to pulmonary tuberculosis at 4 months. The patients averaged 3 months of bed rest. Minimum followup was 24 months (median, 30 months; range, 4–52 months).


All patients had (1) tenuous or limited fixation after correction of severe deformity, (2) previously failed spine reconstruction after early mobilization, or (3) limited treatment options if failure occurred again. No patient experienced pseudarthrosis, failure of instrumentation, thromboembolic disease, pressure ulcers, or pneumonia. One patient had a delayed union and one developed late urosepsis. The median cost of skilled nursing facilities during the period of bed rest was $16,702, while the median cost of home health nursing was $5712.


For patients with contraindications to early postoperative mobilization, prolonged bed rest may be useful to minimize the risk of complications that can occur with mobilization.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Rex A. W. Marco
    • 1
    • 2
  • Ryan M. Stuckey
    • 1
  • Stephanie P. Holloway
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Texas Medical School at HoustonBellaireUSA
  2. 2.Department of Neurosurgery and Spine Surgery and Musculoskeletal OncologyUniversity of Texas Medical School at HoustonHoustonUSA