Spinal Team
C o n t a c t
D e t a i l s
Spinal Team
Nuffield Orthopaedic Centre
Windmill Road
Headington
Oxford
OX3 7LD
Phone:
Fax:
Web Site
01865 738051
01865 738027
www.noc.nhs.uk
Spinal discectomy/decompression patient information version 1
© 2007 Nuffield Orthopaedic Centre
Spinal Improvement Group Jan 2007
Review Jan 2008
Information and exercises
following back surgery
Decompression/
Discectomy
Welcome to the spinal team at the NOC. Together you and your
spinal surgeon have decided that you should have an operation called
a discectomy and/or decompression. This leaflet will explain what
you need to do after your operation to help yourself recover as
quickly as possible.
Structure of the back
Your spine is one of the strongest parts of your body. It is made of
solid bony blocks (vertebrae) joined by discs to give it strength and
flexibility. It is reinforced by strong ligaments and surrounded by
large and powerful muscles that protect it.
Having problems post operatively?
A small number of people have a problem once they go home. You
should contact your G.P if you have:
•
•
•
•
Any deterioration in your bladder or bowel function.
Any unusual leg pains or pins and needles.
Any redness, oozing or discharge from your wound.
Any increase in your temperature.
Post operative follow up
The spinal cord is the part of the nervous system which lies within
the spine and is protected by it. Nerves branch out from the cord and
carry messages to and from the brain. They allow us to feel
temperature, pressure and pain. If a nerve is pressed by a disc or by
bony changes then this can cause pain which may be felt in the back
or in the leg or both.
Benefits of having surgery
•
The main aim of surgery is to relieve the pressure on the nerve.
This will mean that there is a good chance that the pain in your
leg or arm will go or at least be much improved.
If you have had pressure on the nerve for a long time or the nerve
has become damaged by the pressure, you may not get a
complete recovery of the nerve function. This means that you
might always have some numbness in parts of the leg or arm, or
weakness of some of the muscles.
• Ssurgery does not always totally relieve the back pain, but often
improves it.
You will be reviewed by one of the orthopaedic doctors between 6
and 12 weeks post discharge.
Many people do not require physiotherapy post operatively,
however if you are particularly stiff or are having problems getting
back to normal activities or work then physiotherapy can be
arranged.
USEFUL TELEPHONE NUMBERS
NOC Main Switchboard
- 01865 741155
Physiotherapy
- 01865 738074
Occupational Therapy
- 01865 737551
Spinal Secretaries
- 01865 738051
Patient Advice & Liaison Service (PALS)
- 01865 738126
1
14
Risks of having surgery
If you have an exercise bike
♦ Start at a low resistance
♦ Build up gradually
♦ Standing with your arms by your
Unfortunately, as with all operations, although every effort is made
to avoid complications, surgery carries important risks. Some of
these are mentioned below:
•
However carefully we remove the disc there is always a risk of
recurrence. About 10 people out of 100, who have disc surgery,
will get another disc prolapse after an operation (or indeed after
an episode of pain without an operation).
•
Damage to a nerve happens in less than 1 person out of 100
having spinal surgery. This would mean that you might have
numbness or weakness in part of your leg or arm.
•
Damage to the lining of the nerves (Dura) causing leakage of
fluid occurs in less than 1 person out of 100. If this occurs
during the surgery we can repair it. Sometimes we are not
aware this has happened until after the operation and a second
operation would be necessary to try and seal off the leak.
Should this happen then you will have to stay in hospital for an
extra few days.
•
Infection is always a risk with an operation. We give you antibiotics during the operation to aim to prevent infection Despite
this it still happens in less than 1 out of 100 operations.
•
The nerves that supply your bladder, bowel and control your
sexual function and sensation can also be damaged, either
because of the disc prolapse or during surgery. This is a serious
but much less common risk occurring in around 1 out of 500
disc operations. This would cause you to be incontinent of the
bladder and/or bowel and to be unable to/or have difficulty with
sexual function.
side. Raise alternate arms above
your head.
Progression
Repeat above with weights/tins of
beans
♦
Brisk walking
Progression
Increase your speed or the distance
13
2
♦
♦
The operation
These are routine operations which take approximately 90 minutes.
They are often done through a microscope. This means that the cut is
smaller, which results in quicker healing. Once recovered the spine
remains strong and stable
Lie on your front.
If this is not comfortable, try
putting a pillow under your
tummy.
Progression
Push up to rest on your elbows.
Discectomy
If a disc has bulged and part of it is pressing on a nerve then this piece
of the disc can be removed. It is not usually necessary to remove all
of the disc.
♦ Standing. Hold on to something if you
like.
♦ Raise one knee towards the opposite
elbow
Decompression
This is the process of making more space around a nerve by removing
a small amount of bone.
♦ Repeat with opposite leg.
♦
Use a step where there is a rail or
something for you to hold on to
♦
Step up onto the step with one leg and
then step back down with the same leg.
♦
Repeat with the other leg.
Often these two procedures are done during one operation.
After the operation
After the operation you will wake up in the recovery room. Because
of the anaesthetic it is necessary to monitor your blood pressure and
breathing for a few hours.
3
♦
Sit on a firm chair
♦
Stand up using your legs to push you up.
Then sit down again.
♦
If this is difficult then start with a higher
chair
12
Exercises
The following exercises are designed to improve your spinal
strength and mobility. Use the principles of pacing to judge where
to start, then build up gradually. It is better to do a few exercises
several times a day rather than all at once.
♦
Lying on your back with the
knee’s bent
♦
Pull you tummy in and hold.
Progression
lifting your head and shoulders
♦
Lying on your back
bend one leg and put your
hands behind the knee.
Your wound, just like any cut, may be a bit sore to begin with. But a
back operation does not weaken your spine. It is just a matter of the
wound healing and getting the moving parts and muscles working
again.
Pain relief
You will have pain relief immediately after the operation and for as
long as you need it afterwards. Pain control is important, particularly
in the first few days and weeks. This is partly to make you comfortable
but also to help you get going. You should not hesitate to use
painkillers if you need them. It is best to take them regularly rather
than letting the pain build up. You can safely mask the pain to get
active—you will not do any harm.
How soon can I get going?
♦
Use your arms to pull the knee
towards your chest.
♦
Repeat with opposite leg.
♦
♦
11
The wound
The operation takes away the cause of the pain. It is up to you to get
back into condition and return to normal daily activities.
Lying on your back
bend one leg and put your
hands behind the knee.
Slowly straighten your leg
until you feel tightness at the
back of your leg.
You may feel more tired than usual for a day or two as a result of the
anaesthetic but surprisingly, you will be able to do a lot, fairly soon
after the operation. People do vary in how long it takes them to get
active. Things that affect this include:
•
•
•
•
your age
how fit you were before your operation
how confident you are
how much pain you have
♦
Repeat with opposite leg.
You will need to start slowly and build up your stamina over a period
of months by pacing yourself.
♦
If you prefer you can do this
sitting
You may feel some pain when you begin to do things again but this is
normal and does not mean that you are doing any harm to your back.
4
Practical Tips
Lying in bed
Lie in what ever position you prefer, but any position for too long will
be uncomfortable. The best thing is to change position regularly.
Getting out of bed
Roll onto your side, bend your hips and knees, swing your legs over
the side push and up with your hands. It does help if the bed is higher
than normal. You can progress to getting up normally over time.
Washing
Initially you will have to wash at a basin, with a flannel. This is to
prevent the wound from getting infected. You may return to
showering after a few days. Baths are best left until the wound is dry.
Toileting
You might find it difficult to go to the toilet at first. Don’t panic sit
down, relax and take your time. It helps to take your painkillers about
20 minutes before. The sound of running water sometimes helps.
Constipation is quite common, but nothing to worry about. It may just
be the side effects of the painkillers. It helps to drink plenty of fluids.
If need be, take a mild laxative. It might surprise you, but just walking
helps.
Dressing
You may find it easier to get dressed while lying on the bed or whilst
perching on the edge of your bed or a chair. Lots of people wear slip
on shoes initially. Others put their shoes on by putting their foot on a
chair .
Bending forwards
It will be easier to use your knees rather than your back
Change position
It is best to move before you stiffen up. Regularly changing your
position and activity can help to reduce discomfort.
5
Return to Work Plan
• What does your job involve? (e.g. sitting/ lifting/pushing/pulling/
driving/ bending/ walking/ reaching)
__________________________________________________________________
• Which of these activities are not a problem?
__________________________________________________________________
• Which of these activities are or may be difficult?
__________________________________________________________________
• How can you make the activity easier?
__________________________________________________________________
• When do you aim to return?
__________________________________________________________________
• How many hours/days will you manage at first?
__________________________________________________________________
• Who do you need to talk to, to arrange things?
10
Lifting
The structure of the spine is strong enough to lift after the operation,
the issue is whether you are fit enough. Most people will find they
need to practice lifting to improve what they can mange.
What is considered to be light or heavy varies from
person to person and depends on:
♦ How fit they are
♦ What they are used to lifting
♦ How confident they are
You can begin lifting light weights 1 week after the operation. It takes
practice and time to get back to normal. Use pacing to gradually
increase the amount you lift. As a guide, we would expect that you
could lift heavier things by 6 weeks.
Rest
It’s alright to rest for short periods if you need to but try to alternate
rest with gentle exercise and increasingly normal activity.
Sitting
You will find it easier to sit on something high like a stool initially.
You will find it helpful to only sit for short periods initially. It is
useful to have a walk each time you get up from sitting. You can sit in
normal chairs once you are comfortable to do so, but this often takes a
few weeks.
Getting out of a chair
To begin with you will find it easier to get out of a higher chair. It
helps to move your bottom to the front of the chair, and use your hands
to push up.
Concerns regarding managing at home
Lifting recommendations for heavier objects
♦
♦
♦
Think about your capability before you lift.
Keep the load close to your waist.
Ensure a good hold on the load.
Work
You need to get fit for returning to work as soon as possible. You do
not need to wait until you are painfree. How long you are off work
depends on your job. The following is a rough guide:
•
•
•
Desk jobs - 2 weeks
Light lifting - 4 weeks
Heavy lifting - 8 weeks (confirm this with your surgeon)
There may be ways to make adjustments to your job that will let you
get back earlier.
It helps to make a plan for when and how you are going to return
firstly to work and, secondly to your normal duties.
9
During your stay in hospital if you have any concerns about managing
at home, please ask your nurse or physiotherapist to refer you to the
occupational therapist.
Housework (have a look at the activity chart)
You can return to normal household activities as you feel able to do so.
However, you may be more comfortable if:
•
You use pacing techniques to do tasks such as hoovering.
•
You sit on a high stool when ironing or preparing meals.
Shopping
Initially shopping may be more comfortable if:
•
You use 2 smaller bags or a backpack.
•
You use a shallow trolley rather than a deep one.
Also
•
Some supermarkets have a “carry to car” facility to help with
your shopping.
•
Try internet shopping.
6
Pacing activity
Getting back to normal
After the operation everyone builds up how much they do at different
rates. The activity chart will give you a general feel for what is normal.
It will take a few weeks for you to get back to most basic activities.
Begin by getting out and about, exercising regularly, shopping, or
meeting friends. Doing this will increase your confidence in your
back. It will be a month or two before you can begin strenuous sports,
and even then you must train and build up gradually.
As a general rule, do things slowly at first and a little bit at a time.
Establish a routine of activity that builds up gradually, step by step and
day by day.
Build up gradually
The first thing to do is find out what you can manage at the moment. It
helps to keep a record.
and so on
20 min
15 min
I can
11 min
8 min
Sit for ——————minutes at present
6 min
Walk for———————minutes at present.
Lift ———————- kg/ llb from one table to another
5 min
Sitting/ standing/ driving/cycling/ walking/ swimming/ running etc
Stand for ————- minutes
Once you know what you can do then you can work to improve it. To
do this you need to do a bit less than you can manage (say 80%) but
practice frequently and then build it up gradually by doing a bit more
every few days.
Good and bad days are normal
You will find that you will have days when the pain is better or worse.
This is normal. On a good day it is tempting to do more, but this is not a
good idea, as it can lead to a flare up of your pain. It is best to keep to
your activity plan even on bad days.
Within two months you should be doing most everyday things fairly
normally. Heavy physical activities come more slowly. You do not
need to avoid lifting all together, just be sensible and leave the heavy
stuff for a while.
7
Driving
You may drive from 2 weeks after your operation as long as you are
able to control the pedals and perform an emergency stop. It is best to
inform your insurance company that you have had an operation.
You can get into the car normally, but if this is difficult then you can
try sitting down first and then putting your legs in. Similar to other
activities you need to build up the length of the journey gradually.
Stopping regularly and having a stretch or a walk will help.
Sexual activity
You back is not fragile, so the decision about when to have intercourse
is really governed by when you feel comfortable to do so. This is
likely to vary from person to person. The activity chart will give you a
guide.
8