INFORMATION FOR PATIENTS LUMBAR DISCECTOMY (for degenerative disc disease)

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1 INFORMATION FOR PATIENTS LUMBAR DISCECTOMY (for degenerative disc disease) FOR MR SHAD'S PATIENTS Information provided in this leaflet is intended to give you general information about your treatment. The specifics might vary to meet your individual medical needs, so it is important to always follow your consultant's advice. MR A SHAD FRCS (Ed) FRCS (SN) Consultant NEUROSURGEON 1

2 Lumbar Discectomy Definition Lumbar discectomy encompasses a number of terms, including discectomy, microdiscectomy and laminectomy/discectomy. The typical patient presents with pain in the leg, which may radiate from the buttock to below the knee. The usual pain is either to the back of the calf and to the sole of the foot, or to the outside of the shin and top of the foot. Back pain is not usually a feature, however it may initially occur. Lumbar disc problems are exceedingly common and it is important to realise that in the vast majority of cases non-operative management works very well. Most patients settle with 6-12 weeks after the onset of symptoms. If a patient has pain, but it is not too severe, then typically conservative management is initiated. It must be remembered that the vast proportion of patients will settle with time and as long as improvements are noted at 6 weeks, there is minimal or no weakness and the pain is not excruciating and is liveable with oral analgesia, then waiting and continuing with conservative therapy is a good option. Technique: Surgery is usually performed as a minimally invasive procedure. General anaesthesia is utilised and the surgery is performed through a small incision. Through gentle dissection under microscope the offending fragment is removed. Only a small portion of disc is removed. The whole disc is not removed. Risks: 1. Wound Infection 3% 2. Increased motor deficit 1% - 2% 3. Dural tear (CSF leak) 3% - 5% 4. Recurrence of disc herniation 5% 5. Clot 6. Discitis (disc space infection) <1% 2

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4 Expectations: 1. Leg Pain: In uncomplicated cases the likelihood of good/excellent relief of leg pain is 85% - 90%. 2. Numbness: Numbness is slow to recover and may persist 3. Weakness may take 6-12 weeks to return to normal 4. Pins and needles: usually start to improve immediately. 5. Back pain (may or may not get better- can increase mortality) Recovery: Patients who have a lumbar discectomy are typically in hospital for 2-5 nights. It is notable that bending, lifting and twisting may increase the recurrence rate in the first 6 weeks, so my patients do not do any other exercise other than walking for that time period. After 6 weeks a return to normal activities is initiated. It is important to remember that the back is not normal after disc surgery and that care needs to be taken in the future. Bending, lifting and twisting need to be avoided as these activities ultimately may have precipitated the initial event. Recovery from surgery does not guarantee a return to normal. Good back care is the rule for life. Wound care: There are typically dissolving sutures in the back and no removal is required. Any paper tapes on the wound will fall off in the shower. If there are any staples or sutures have these removed by your family doctor 10 days after surgery. Make sure you leave hospital with a staple remover. Keep the back dry Do not swim for at least 4 weeks Do not put any creams on the wound Do not get the wound wet. Do not take baths for 4 weeks. For the first week after surgery, after every shower pat the wound dry Change the dressing after each shower for the first week Exercises: The best exercise is walking. Small amounts frequently are best. Do not go jogging or swimming for at least 6 weeks after surgery. Posture: Try and keep the back straight Don't bend, lift or twist Avoid sitting for over an hour without taking a break Keep mobile - change positions frequently Driving: Do not drive for at least 2 weeks after surgery If you must be a passenger in the car, recline the seat and travel short distances only for the first month When driving take a 15 minute break for every 45 minutes of driving Return to work: You can return to a desk job 2-4 weeks after surgery. Don't sit for prolonged periods of 4

5 time. See Mr Shad at 6 weeks before returning to a physical occupation. 5

6 10 points to remember when you have a surgical wound: 1. It is very important to maintain a high level of personal hygiene while the wound is healing. This will reduce the risk of infection. 2. Keep your fingers away from the wound as constant touching can cause an infection. 3. The wound may look red and raised this is part of the healing process and will improve with time. 4. If the wound however, becomes very painful, red and swollen and/or starts to weep, contact the hospital for advice. The wound may need to be examined by a nurse or a doctor. 5. You may have some pain/discomfort in the area of the wound for several weeks following surgery. If the wound is not red or swollen and dry, then regular mild painkillers can help relive this pain/discomfort. If you feel you need stronger painkillers then please consult your GP who can prescribe these for you. 6. You may shower with an appropriate waterproof dressing covering the wound if required. Please DO NOT have a bath until the wound is completely healed or when clips and sutures have been removed. 7. An appointment or letter to the Practice Nurse to have clips or sutures removed will be given to you prior to your discharge from the hospital. 8. A good diet with plenty of proteins and iron rich food e.g. red meat, green vegetables, fish, chicken and dried fruit will help with the healing process of your wound. 9. If you smoke, you should try and give up. Smoking can cause chest infections and coughing will cause more pain at the operation site. Any concerns or questions once home, please feel free to contact us at: BMI The Meriden Hospital, Clifford Bridge Road, Coventry, CV2 2LQ. Tel:

7 Post-Op Discectomy / Lumbar Surgery DO NOT: Sit for more than 15 minutes (if possible avoid sitting) Bend Twist Stand on one leg Lift Struggle with socks / shoes ask for help DO: Stand for meals / tea / coffee Mobilise as directed by the Physio Get in and out of bed as shown Follow exercises as directed by the Physio Lie on alternative sides with a pillow between your knees and one at your back Lie on your stomach with or without a pillow under your hips 7

8 Home Advice Following Lumbar Surgery Avoid twisting for 4-6 weeks. Avoid heavy lifting of carrying anything heavier than a full kettle for 2-3 weeks then increase gradually after that. Avoid activities in flexion; bend from your knees not your spine. Allow yourself to bend enough to brush your teeth/wash your face but do not go in to pain. Do not drive for 4-6 weeks. Check with your Consultant and insurance company regarding driving sooner. Return to work around 6 weeks for sedentary jobs. Allow up to and beyond 8 weeks for heavy duty/manual jobs (depending on Consultant advice). Consider a staged return to work. Slowly increase the distance walked daily. Attempt 2-3 short walks per day. Do not sit for longer than 30 minutes at a time for 2 weeks, build up after that as pain allows. Long term, avoid sitting for long periods of time (i.e no longer than 1 hour without a change of position). Avoid heavy housework, e.g hoovering, scrubbing, mopping for 6 weeks. Ironing can be completed in short bursts of no longer than 15 minutes and within comfort after 4-6 weeks. Avoid putting things in the washing machine for 6 weeks. REMEMBER wet clothes are heavier than dry clothes. REMEMBER discomfort is normal post-op but don t push into pain. Return to sports: - Swimming: Backstroke from 6 weeks Breaststroke and Front Crawl 3 months - Gym work: Non impact e.g cross trainer/bike 6 weeks Running 9 months Golf 3 months 8