Laminectomy/Discectomy Post-operative Instructions


Note: Please Contact the Office if:

  • Increasing pain or drainage
  • Fevers, chills, sweats
  • Weakness

 

Office Phone:  954-530-4344

SouthFloridaBackSpineandScoliosis.com


Activity

 

  1. After your discharge from the hospital and until you have had your first post-operative appointment with Dr. Hepler, avoid all activity except walking.
  2. No lifting anything weighing more than a coffee cup.  This restriction will be in force until your first post-op visit (7-10 days after surgery) with Dr. Hepler.
  3. No bending or twisting of the back. Wear a lumbar corsette/abdominal binder as a reminder to avoid these activities.
  4. No heavy housework or yardwork.
  5. You may go up and down the stairs, taking one step at a time and always using the handrail.  
  6. The first week after your surgery your priority is to REST.  No exercising except WALKING.  You should start taking short, frequent walks daily, after the first week.  Staying in bed all the time is not good for you.  You may walk outdoors as soon as you feel ready.  You should begin to gradually increase your walking as you can comfortably do so.
  7. You may resume sexual relations whenever it is comfortable for you to do so.

 

Daily Activity Guidelines

 

The progress of your recovery and your activity guidelines are very individualized.  Every patient is different.  It is important that progress be gradual.  If you experience increased pain after or with walking, reduce the time and distance you are walking.

 

  1. Walking should be done at a comfortable, even pace.  You should never hurry or rush.  Be patient with yourself and remember that proper healing takes time.
  2. Frequent, short walks will rebuild your strength and endurance more rapidly than trying to walk long distances right away.  Start walking 2-3 times a day.  
  3. When you first arrive home, begin with five minute walks around the house every hour as tolerated.
  4. Walk on level surfaces: be cautious walking out of doors due to slippery or adverse weather conditions, especially during the winter months.
  5. Wear good walking shoes.
  6. Stairs are okay as long as you are careful of your footing.  Take one stair at a time and always hold onto the handrail.

 

Pain

  1. Do not become discouraged if some back and/or leg pain or numbness persists for a while after surgery.  The healing process occurs slowly and can take as long as a year for some nerve injuries.
  2. You may use an anti-inflammatory (Naproxen, ibuprofen, meloxicam, diclofenac, Celebrex) for pain if approved by your internist. You will be given a prescription for narcotic pain medication which can be used in addition to an anti-inflammatory. Remember to use it only as prescribed.  Narcotic pain medication may cause constipation.  Drink as much water as you can possibly tolerate, and an over the counter stool softner (Metamucil, dulcolax) may be helpful.
  3. Pain medication refills require paper prescription and only given in person in the office.  Do not wait until you run out before you return for a refill. Plan your follow up at least 3-5 days before you might run out. Don’t wait until the last minute or weekend, the pharmacy will not take a refill over the phone
  4. You may use an icepack over your incision to decrease swelling and discomfort 2-3 times per day for the first few days after surgery.

 

Incision Care

  1. Your incisions are closed with sutures which are absorbable and steri-strips which are placed over the incisions. The dressing should be changed daily at which time you can examine the incision. It is not uncommon to have some swelling, bruising, tenderness, or small amounts of drainage around the incision after surgery but these changes should improve with each passing day. If they do not improve or worsen contact Dr Hepler’s office and plan on coming to the office for a re-examination. Otherwise, you should have scheduled a follow visit 7-10 days after surgery.
  2. Please keep your incision clean and dry until your first post-operative visit with Dr. Hepler.  You may shower with a sealed dressing but protect the incision from any direct exposure to the shower or water.  Do not soak the wound (bathtubs/pool) for a minimum of 4-6 weeks after surgery.
  3. Please notify Dr. Hepler’s nurse if you notice any increasing pain, redness, abnormal drainage from the incision or a temperature greater than 101.5.

 

Icebag

Mix the below ingredients together.  Divide the mixture into the ziplock bags equally and freeze them until the mixture turns to slush.  Place a towel next to your skin, then apply ice to the area.  Use 4 times a day for 15 minutes.  You may re-use the ice-packs.  

  1. 3 cups of water
  2. 1 cup of rubbing alcohol
  3. 2 quart size zip-lock bags

 

Other Important Information

  1. The use of tobacco can impair or retard the healing process and increase infection rates. Smoking should be discontinued as long before surgery as possible.
  2. Contact the office if you develop a temperature of 101 degrees or greater, any change in your incision (such as inflammation, redness, swelling, or excessive drainage), pain that is not relieved by rest, ice packs and your pain medication, or if you have any questions or concerns.
  3. Contact the office if you develop headaches, new leg/arm pain, numbness, tingling or weakness.

 

Incision Healing

The incision from microdiscectomy and laminectomy usually heal within 3-6 weeks. You should have a scheduled follow-up at this time to confirm healing and schedule physical therapy to begin a rehabilitative exercise regimen involving range of motion and strengthening exercises. You can also use the exercise of the spine and cervical exercise handouts and the exercise video to assist in you post operative exercise regimen.

 

Back Rehabilitation

Most disc herniations require 8-12 weeks to heal and excessive activities during this time frame risk causing recurrent injury and pain. In addition the pain and disability associated with disc herniations result in significant core and aerobic deconditioning. Most patients therefore require 3-6 weeks of range of motion and strengthening exercises after healing  before resuming normal activity without restrictions. Patients with more activity demands such as manual laborers and workers compensation patients may require more extensive rehabilitative efforts. View other resources.

 

GLOSSARY OF TERMS

 

What your doctor means when he says…

 

ALLOGRAFT BONE:Sterile bone derived from another person, which is used for grafting procedures.
ANTERIOR:The front part of the body.  It is often used to indicate the position of one structure relative to another.
ARTHRODESIS:The fusion of bones across a joint space, thereby limiting or eliminating movement.  It may occur spontaneously or as a result of a surgical procedure, such as a fusion of the spine.
AUTOGRAFT BONE:Bone transplanted from one part of the body to another in the same individual.
CADAVER:A term generally applied to a dead human body preserved for anatomical study.
CAGES:A type of spinal instrumentation used in fusions.  The bone graft is situated within the cage.
CERVICAL:The neck region of the spine containing the first seven vertebrae.
COCCYX:The region of the spine below the sacrum.  It is also known as the tailbone.
DISC:The tough, elastic structure that is between the bodies of spinal vertebrae.  The disc consists of an outer annulus fibrous enclosing an inner nucleus pulposus.
DISC DEGENERATION:The loss of the structural and functional integrity of the disc.
DISCECTOMY:Surgical removal of part or all of an intervertebral disc.
EPIDURAL:Situated outside the thin, tough dural membrane that surrounds the brain and spinal cord.
FACET:A posterior structure of a vertebra that articulated with a facet of an adjacent vertebra to form a facet joint that allows motion in the spinal column.  Each vertebra has two superior and two inferior facets.
FORAMEN:A natural opening or passage in bone.
FRACTURE:A disruption in the normal continuity of bone.
FUSION:Union of healing bone.
HERNIATED DISC:When the inner part of the disc material extrudes or “seeps” through the outer part of the disc.  This can cause inflammation and consequently pain, especially if the extruded material presses against a nerve root.
ILIAC BONE CREST:The large, prominent portion of the pelvic bone at the belt line of the body.  This site is frequently used for bone grafts.
INFERIOR:Situated below or directed downward.
INSTRUMENTATION:The “metallic” (usually titanium) instruments or “hardware” used in spine fusions to secure the spine while the graft and existing bone fuse.
LAMINA:An anatomical portion of vertebra.  For each vertebrae, two lamina connect the pedicles to the spinous process as part of the neural arch.
LAMINECTOMY:An operation for removal of part (called a Laminotomy) or all (called a Laminectomy) of the lamina of a vertebra commonly performed in order to be able to remove a disc protrusion or to decompress a nerve root.
LUMBAR:The lower part of the spine between the thoracic region and the sacrum.  The lumbar spine consists of five vertebrae.
NERVE ROOT:The portion of a spinal nerve in close proximity to its orgin from the spinal cord.
OSSIFICATION:The process of forming bone in the body.
OSTEOPOROSIS:A disorder in which bone is abnormally brittle, less dense, and is result of a number of different diseases and abnormalities.
PEDICLE:The part of each side of the neural arch of a vertebra.  It connects the lamina with the vertebral body.
PHYSICAL THERAPY:The treatment consisting of exercising specific parts of the body in effort to strengthen, regain range of motion, relearn movement and/or rehabilitate the system to improve function.
POSTERIOR:Located behind a structure, such as relating to the backside of the body.
PSUEDOARTHROSIS:A form of non-union in which there is the formation of a false joint with some cartilage covering the ends of the bones and a cavity containing fluid that resembles a normal joint.
SCIATICA:A lay term indication pain along the course of a sciatic nerve, especially noted in the back of the thigh and below the knee.
SCOLIOSIS:Lateral (sideways) curvature of the spine.
SPINAL FUSION:A surgical procedure to permanently join bone by interconnecting two or more vertebrae in order to prevent motion.
SPONDYLOLISTHESIS:A defect in the construct of the bone between the superior and inferior facets with varying degrees of displacement so the vertebra with the defect, and the spine above that vertebra are displaced forward in relationship to the vertebra below.  It is usually due to a development defect of the result of a fracture.
SPONDYLOLSIS:Displacement of one vertebra over another with fracture of a posterior portion of the vertebra.
THORACIC:The chest level region of the spine that is located between the cervical and lumbar vertebrae.  It consists of 12 vertebrae, which serve as attachment points for the ribs.