Discectomy. Information for patients Orthopaedics - Spinal Physiotherapy

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1 Discectomy Information for patients Orthopaedics - Spinal Physiotherapy

2 Introduction We have written this booklet to explain how you can prepare for your operation and to give you advice on your recovery and rehabilitation. We want you and your family/carer to understand as much as possible about the operation you are going to have. Please ask questions at your pre-operative assessment clinic appointment. There is space at the back of the booklet for you to write your questions down. What is a prolapsed disc? disc prolapse spinal cord disc vertebra nerve root A disc can become weakened with age. vertebra arch If a disc bulges backwards it may irritate the nerve root, producing pain in the leg, sometimes called sciatica. It can also cause numbness, pins and needles and/or weakness in the leg. Rarely, the disc bulges into the central spinal canal, pressing on the nerves to the bladder and bowel. These symptoms can include pain in both legs, numbness around the page 2 of 12

3 back passage, inability to control bladder and bowels, or difficulty passing urine. Any of these symptoms require urgent assessment by the GP or Accident and Emergency as urgent surgery (within 48 hours of the symptoms) may be required. What are the benefits of a discectomy? A discectomy is an operation to remove part of a disc. This is done to relieve pressure on the nerve, and relieve the leg pain. Some people can continue to have some pain and altered sensation after surgery but a discectomy can relieve a lot of the pain you previously had. The operation is successful in relieving or reducing leg pain in approximately 90% of cases. What are the risks of a discectomy? There are some complications that can occasionally occur to anybody having an operation. These include: Deep vein thrombosis (blood clots in the legs) Pulmonary embolus (blood clots in the lungs) Urinary infections Difficulty passing urine Chest infection Wound infection Complications that can occur rarely during or after a discectomy include: Damage to the nerve root(s). This can cause partial or complete paralysis of the muscles supplied by that nerve root as the nerve tissues are very close to the site of the operation. This usually page 3 of 12

4 causes a mild footdrop. Some patients may have some numbness afterwards but nerve damage may be temporary. Leakage of spinal fluid from around the nerves due to a tear of the lining. This would require an additional two days of flat bed rest. Infection of the disc space. Damage to a major blood vessel. Tissue scarring around the nerves can cause recurrent symptoms. Damage to the bowel. It is very rare for serious complications to occur. However, because a disc prolapse is part of a degenerative or ageing process in the spine, approximately 7% of patients experience a further disc prolapse within five years. This can either be at the same level in the spine, or at a different level. Before your operation we take every opportunity to ensure that you are as fit as possible. If we feel that you will benefit from some other medical treatment before your operation, then we will discuss this with you. Are there any alternatives to surgery? Before suggesting surgery your doctor may have suggested several alternatives: pain relief medication physiotherapy osteopathy or chiropractic treatment As these treatments no longer control your symptoms, your doctor has suggested surgery. page 4 of 12

5 Should I have a discectomy? Although your doctor may have suggested that you have this operation, the final decision is yours and must be made after you have weighed the benefits of the operation against the risks. You may wish to discuss the operation with your GP, family or carer. All your questions should be answered before you decide to have the operation and you should ask any questions you have in order to make your decision easier. If you have any concerns and wish to discuss these with a member of staff, please telephone the Pre-Admission Clinic on: What can I do to prepare for my operation? You need to complete and return the health screening questionnaire that you were given at your out-patient appointment. You should start to prepare for your operation as soon as your name is placed on the waiting list. It is important to try and keep as healthy and active as possible whilst you are waiting for your operation. There are a number of things that you should think about doing and these include: Diet/weight control Evidence shows that people who are carrying extra weight are at greater risk from surgery than those who are not. If you are in this group, it is important to the success of your operation that you try to lose some weight. If you would like help with this, you should contact your GP/Practice Nurse. Smoking We strongly advise you to stop smoking as this will reduce your risk of developing problems following your operation; for example, a chest infection. page 5 of 12

6 Exercise You should try to keep as mobile as possible and to continue with your normal everyday activities as this will aid your recovery. You should also continue any exercises you may have been shown by your physiotherapist. What will happen next? After you have returned your questionnaire, you will receive a letter asking you to telephone the hospital to make an appointment for the Pre-Operative Assessment Clinic. The purpose of this clinic attendance is to make sure that your symptoms have not changed and any problems with your general health can be noted and treated if necessary. This will reduce the risk of your operation being cancelled at short notice. At this clinic, the Pre-Operative Assessment Nurse will assess your state of health, discuss your stay in hospital and will organise all the necessary tests and care during the day. This may include blood tests, urine tests, an ECG (heart tracings) and x-rays. You will be given the opportunity to ask any questions you may have. When will I know the date of my admission? You will be telephoned and offered an appointment to see the consultant to sign the consent form for the operation, and have any further tests. You will also have the chance to ask any questions. You may or may not be given a date for your operation at this time. However, you will be sent a letter of confirmation. Though we always try to keep this date, occasionally planned operations have to be cancelled due to increased numbers of emergency patients or consultant staff needing to operate on urgent cases. Unfortunately, on these occasions, operations may need to be cancelled at short notice. page 6 of 12

7 What will happen on the day I come into hospital? You will usually be admitted to hospital on the day of your operation, depending upon your Consultant s wishes. Bring any tablets or inhalers with you. Once here, you will have a chance to speak to various members of the Orthopaedic Team and they will confirm the planned operation and answer any further questions you may have. What will happen on the day of my operation? As you will be having a general anaesthetic, you will not be allowed to have anything to eat for six hours before your operation and only be allowed to drink clear fluids until two hours before your operation. The nurse will tell you this at Pre-operative Assessment Clinic or on admission. The ward staff will help you to take a bath or shower and put on a surgical gown. You should also have: taken your usual tablets or medicines as advised by the staff in Pre-operative Assessment Clinic (you should also bring any tablets, medicines or inhalers into hospital with you). had a bath or shower. removed all make-up and nail varnish. removed all jewellery (except wedding rings), including body piercings. removed your glasses and dentures if you wear them. However, you can keep these on up until you go into the anaesthetic room. (For more information about the reasons for this, please ask to see the leaflet entitled You and your anaesthetic ). You will then be escorted to theatre by a nurse. page 7 of 12

8 Will I have an anaesthetic? Yes. You will have a general anaesthetic. The anaesthetist, who will care for you throughout the operation, will discuss this with you. How long will the operation be? A discectomy operation takes approximately one hour but you will also need to spend time in the anaesthetic and recovery room. What will happen immediately after my operation? After your operation, we will take you to the recovery room and monitor your condition closely. Whilst you are there we will check your blood pressure, pulse, breathing rate and temperature frequently. When we are happy that your condition is stable you will be taken back to your ward. When you are back on the ward, we will have placed a drip into a vein in your arm. This is to replace lost fluids, but we will remove it once you are eating and drinking normally. We may prescribe you oxygen after your operation so when you wake up you may have a mask on your face or oxygen tubes in your nose. You will also have a dressing on your back to protect your wound. The nursing staff will continue to monitor your condition and your blood pressure, pulse, breathing rate and temperature. Circulation and sensation of your legs will also be checked regularly. You will be given pain relief medication following your operation. Some patients may feel sick due to the anaesthetic, but we will give you medication to relieve this if necessary. As you are in bed, you may need help to use a bedpan or to move position, which staff on the ward will help you with. They will also encourage you to breathe deeply, cough and do leg exercises, as this helps your recovery. page 8 of 12

9 The physiotherapist will show you how to get out of bed and walk. When you are more comfortable you will be able to sit out of bed for short periods. When can I eat and drink again? You may be allowed to have a drink approximately one hour after your return to the ward and you may also be allowed to have food. This depends on your condition. Will my relatives be able to visit on the day of my operation? Yes, but please remember that after your operation, you will need a lot of rest, and it would be better for you if you only had one or two visitors at first. We would also be grateful if one member of your family could take responsibility for keeping other relatives informed of your progress so as to free up valuable nursing time, which can be spent with patients rather than answering the telephones. Will I need physiotherapy following my operation? Yes, a physiotherapist will come and see you and give you information about the exercises you should do after your operation. It is very important for you to do these exercises, as they will help you to get your back moving again. These exercises will: prevent scar tissue forming in the joints and nerves of your spine help to build up the strength in the muscles that support your spine so that it takes less stress page 9 of 12

10 What will happen during the rest of my stay in hospital? After your operation we will help you to get up and about and coping independently as soon as possible. During this time, you may have some discomfort whilst walking and exercising. This is to be expected and is nothing to worry about. If you are having difficulties with normal daily activities after your operation, then once you go home an occupational therapist can give you advice on how to cope at home. You will be able to have a shower two days after your operation and a bath after a week. How long will I need to stay in hospital? Most patients need to stay in hospital for 1 night. However, the length of your stay may vary depending on the speed of your recovery. What will happen on the day I go home? Before you go home we will give you the following: A 14-day supply of tablets if required; before any tablets we give you run out, you should ask you GP for some more. An out-patients appointment so we can assess your progress. Your appointment will usually be about 6 weeks after you go home. A letter for your GP telling him/her about any tablets you have been given to take home. A physiotherapy out-patient appointment if you need one. The ward contact number. A letter for your district or practice nurse. If you need a sick note, please ask the nurse before you go home. page 10 of 12

11 We will only allow you home if we are satisfied that you have: Suitable transport A relative or carer to accompany you home A responsible adult to stay with you for the first 24 hours. Please note that you will not be allowed to drive yourself until your doctor says it is safe to do so. Please talk to the nurse if you are unable to arrange your own transport home or to your out-patient appointment. What will I need to do when I get home? You should exercise generally and you will have a follow-up orthopaedic out-patient appointment 6-8 weeks after you go home. You should also carry on with your physiotherapy exercises. You will have an out-patient physiotherapy appointment 2 weeks after surgery. If necessary, the district or practice nurse will remove any stitches. We will have made arrangements for them to do so before you left hospital. When can I go back to work? You can return to work when you feel able to. As a guide, you can return to office type work between 3-6 weeks and manual physical work between 4-8 weeks. We wish you a safe and speedy recovery If after reading this booklet you have any questions, please speak to a member of the nursing staff who will be pleased to help you. Your healthcare is confidential to you. No information will be given to anyone, even close members of your family, without your permission. page 11 of 12

12 Should you have any concerns about your care whilst you were in hospital, please discuss these with the nurse looking after you or with the Senior Sister. If the Senior Sister is unavailable, please ask the nursing staff to contact the Matron. Alternatively, if you wish to discuss your concerns with the Patient Services Team, please ask a member of staff to contact them on your behalf. Please use this space to write any questions you may wish to ask: Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more Registered Charity No Alternative formats may be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD4053-PIL1366 v3 Issue Date: April Review Date: April 2018

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