This orthopedic surgery consists of making a small [approximately one-inch] midline incision in the lower back. Dr.Rao will dissect down to the bony covering of the spine, make a small window in the bone, protect the nerve, and trim the protruding disc. Once the nerve path is free and there is no more pressure on the nerve, I will check the disk space for any loose fragments. Any loose disc material will be removed. All healthy disc will be left alone so you will still have most of my disk intact. At the end the surgical incision will be sutured and staples will be used for closing the skin.
Immediately after orthopedic surgery your physical activities will be very limited. Usually a back brace and a walker are not needed but sometimes are useful to get around comfortably. The day of the surgery you will be instructed how to get around. You will be at the surgery center/hospital for a few hours till you are able to get up, maybe with some help, get to the bathroom, get in and out of bed, walk distances such as you would have to at home, use a walker as needed, tolerate eating and drinking something, and can manage on pain tablets. At that point you will be discharged home.
Your recuperation will take a few days till you can manage at home, a week or two till you can comfortably drive [automatic] short distances, and a few weeks-month or two till you can contemplate returning to modified non physical type of work. Initially you may have to attempt work for a few hours a day, a few days a week. It will be probably about 2-4 months till your spine surgery is considered healed.
What are the types of surgery?
“Lumbar laminectomy, lumbar diskectomy, diskectomy, microdiskectomy”
These are all different terms for the same type of surgery. A small one-inch incision is made in the middle of your lower back around the underwear line. That part of the disk, which is pressing the nerve, is then trimmed down so that the nerve passage is clear. It is anticipated that this will decrease the inflammation and pain caused by the nerve compression.
How you may benefit?
The surgery may benefit you by relieving the pain coming from the nerve compression. The pain in your thigh leg and foot may be better. The numbness and strength may be improved. Your lower back pain may also feel better though not as markedly as your leg pain. As your pain and nerve inflammation heal your ability to return to your personal, social and work activities may improve.
What are the things that can go wrong?
All orthopedic surgery has some potential risks. We should distinguish however between “potential and possible” complications and the “probable” outcome The “potential and possible” risks of surgery for lumbar herniated disc include blood loss, infection, recurrent herniation, lack of significant benefit, development of instability, nerve damage such as weakness in the foot, leakage of spinal fluid, anesthesia complications and reactions. Sometimes because of instability at the site of surgery back pain may become a problem in the future. Sometimes a local spinal fusion becomes necessary because of this persistent and intolerable back pain. The “probable” outcome for most patients suggests that about 80-85% of patients are happy that they had the procedure because otherwise their lives were at an impasse.
Preparing for Surgery
When you and Dr. Rao have decided that an orthopedic surgery for your back is your best option, there are a few things that remain to be done. Your surgery will be scheduled and coordinated with you by our office nurse. The surgery may be done at the Surgery Center or at the hospital. If at the hospital you may be required to visit their Same Day Admission Center. If at the Surgery Center the nurses will be calling you to discuss the procedure. About 7-10 days before the surgery please stop all anti-inflammatory medication such as aspirin, ibuprofen, Naprosyn etc. This will minimize your blood loss at the surgery. If you are a smoker please stop smoking as soon as you can so that your recovery will be free of complications from the lungs such as pneumonia. If you are planning to apply for disability please obtain the forms, fill them out in advance and bring them to the office at that time of your next appointment.
This is a big decision for you and we realize it. Sometimes it helps to talk to a real live person who has been through exactly the same procedure as you are contemplating. It may help answer some of your questions, to calm some of those natural anxieties and show you what the best decision for you is. We would be happy to give you the phone number of patients who have been through this surgery. Please ask Dr. Rao.
Tests and Examination
Dr. Rao will see you before the surgery and go over your general health and examination. You may find it beneficial if whoever is going to help you after surgery comes with you to this pre-surgical visit. Sometimes Dr.Rao may ask your personal physician to evaluate you for medical clearance for the anesthesia and surgery. If you have questions please make a list of them and discuss them at this time. Please notify the doctor about all the over the counter and prescription medication that you take. The doctor may order tests such as x-rays, MRI scan of your spine, CT scan of your spine, blood tests, urine tests and electrocardiogram.
Night Before Surgery
Do not eat or drink anything after midnight the night before surgery. Go over your questions, the checklist at the end of this form, verify your arrangements to and from the hospital. It will be a time of anxiety, but realize that you have done your homework, so anxiety is normal, worry is not necessary. Go to bed early! You will be better soon!
Day of Surgery
The morning of your surgery please do not eat or drink anything. You may brush your teeth but do not drink any water. If you are diabetic, please do not take your diabetes medication or insulin. If there is some medication, which you take daily, and you feel that you must take it, discuss it with your doctor and take the tablets with only a sip of water.
At the Surgery Center / Hospital
Our office staff will ask you to report to the surgery center/hospital a few hours before the surgery. Once you are there the nurses will ask you questions, examine you and get you ready for the surgery. You will probably be asked the same questions many times by different people so be prepared for a bit of harassment! You may feel less stressed if you make a list of your medication schedule, your allergies and any past medical problems. You can then just show this to people instead of having to remember it each time.
The anesthesia specialist will usually talk to you either at the time of your preoperative visit at the surgery center/hospital or the night before the surgery. Sometimes Dr. Rao will ask you to see the anesthesiologist for a consultation before the surgery. This is to make sure that there are no last-minute questions about your medical condition! Usually you will be asleep under “general anesthesia” for the surgery.
Once you are asleep you will be turned onto your stomach on the operating table. The incision is usually about one inch long in the midline in your lower back. The surgery will be performed through the operating microscope and or magnifying lenses. The anesthesia may take about 30 minutes; the actual operation may take about one hour. When the surgery is finished the incision will be sutured closed and the skin edges stapled. You will have a small dressing on your lower back.
The operation essentially is to remove the pressure on the nerve in your lower back. To do this a small opening is made in the covering bone, the nerve is protected and the underlying disk that is pressing the nerve is trimmed down. This should relieve your leg pain.
You will wake up in the recovery room. You may notice some back pain. You may even feel that your leg pain is better already. If you have pain and would like some medication please ask your nurse for some. If you have trouble urinating your nurse may temporarily insert a small catheter into your bladder. Don’t worry, this is quite painless! When you feel up to it, she will help you get up, walk around a little and have something light to eat and drink. When you feel that you can manage you may go home.
You should be able to go home in a few hours. Please have someone drive you home. You may wish to have a few extra pillows in the car and recline the front seat. If you have frozen (vegetables such as peas/corn etc. are softer than ice) packets against your back dressing your drive may be more comfortable.
If your recovery is late in the day or if your nurse and doctor feel that you will be unable to manage, you may be asked to stay overnight for specialized orthopedic care. You should be able to go home by the next morning.
After your surgery you will be given pain tablets or even injections if the pain is severe. Please ask your nurse for the medicine and she will administer it appropriately. You will also be given a prescription for pain medication at home.
You should be able to get up and walk around slightly within a few hours of the surgery. You will feel slightly unsteady initially, but don’t worry! This should get better each time you try. The easiest and least painful way is to roll over onto your sides, use your hands to push your body off the mattress and slide your legs over the side at the same time. Pause for a few seconds after you change your position to avoid getting dizzy when you stand up!
Breathing and Circulation Exercises
For a few days after the surgery you will probably not be moving around much. It is important to avoid lung complications and infection, and blood clots in the legs that could be dangerous. The best way to do this is to take deep breaths a few times an hour on a regular basis. Also to exercise the muscles of your ankles, knees and hips, bending them up and down and stretching the muscles on a regular basis.
Bathing and Incision Care
With the day of surgery being counted as day 0, you may shower on day #3. After the shower have someone take the dressing off until the skin staples are visible. Have them clean the surrounding area with some rubbing alcohol. After that they may put on a small dressing or Band-Aid to cover the entire incision which is usually only one inch long.
The most frequent adverse effect is a flare up of your pain. With the best of intentions you may forget to be careful when bending or reaching. Walk slowly, be careful not to trip, don’t do anything that you think I might disapprove of, do not strain at stools but use a laxative. Try to avoid sleeping on your stomach unless you have two or three pillows under it.
Please make an appointment to see Dr. Rao in the office about 7-8 days after the surgery. You will have your skin staples removed at that time.
Usually you will start a physical therapy program about 10-14 days after the surgery. You may count on physical therapy for approximately 3-6 weeks. When you are able to resume your usual job activities then therapy may be slowly discontinued. About a week after the surgery you may start a walking program on your own. Once or twice a day try going for a small walk, staying well within your tolerance limits, and gradually building up your strength once again. Also at about this time, if you have a stationary bicycle, you may start using this to gradually increase your endurance. To be careful, keep the speed, resistance and time limits quite low initially and gradually build up the time of exercise before you increase the speed or resistance.
Avoid this for a few days right after the surgery so that your back pain does not flare up. Unfortunately the pain may not become noticeable until one or two days afterward. If you are a man it will be easier if you are on your back with your knees slightly bent. Women will find that bending the knees too much may hurt the back. Women may find that rear entry positions are more comfortable and less demanding. Both men and women will find that sexual desire, physical capacity and performance may be much subdued for a few months. Your partner and you should discuss this in advance in order to eliminate embarrassment and to minimize any possible stress in your relationship after the surgery.
Before the surgery:
- See your doctor as scheduled before the surgery.
- Make a list of your questions so you will have less anxiety about the “unknown”.
- Complete your paperwork and have it ready to take it with you to the surgery center/hospital.
- Make arrangements for time off from work, childcare, household care, pay bills off in advance, rearrange things in your kitchen, bathroom and personal areas so you will not have to reach or bend as much.
- Stop taking anti-inflammatory medication about 10 days before the surgery.
- Do not eat or drink anything after midnight the night before the surgery.
- On the morning of the surgery take only the medications which have been permitted by the doctor.
After the surgery:
- Make an appointment for follow-up about 7-8 days after the surgery.
- Schedule your first physical therapy appointment.
- Make a follow-up visit with your family medical doctor at his/her request.