Display Patient Information Leafelts

Your Back after Surgery

Date issued: December 2021 

For review: December 2023

Ref: C-53/AHP/JF/Your back after surgery v7

PDF: Your back after surgery [pdf] 1MB

Introduction

This booklet contains general advice to help you to help yourself (and your friends and relatives) during your recovery. If it raises any worries or concerns, please ask. When home, keep it handy for future reference.

Doctors, therapists and nursing staff are here to help you and your questions are welcomed and encouraged.

Remember, the most important member of the health care team looking after your back is YOU!

  • Your spine is the central support for the entire body and is involved in almost all your movements.
  • The vertebrae are the joints of the spine. They surround and support the spinal cord and the nerve fibers, which relay messages from and to the brain from all parts of the body.

Why am I being offered ‘Surgery’

There are several types of operations that can be performed on the spine, depending on the cause of the symptoms.

Surgery does not help treat degenerative back pain but it may help primarily with leg pain (sciatica) primarily; numbness and/or weakness may improve with time.

Your surgeon will explain your operation to you. The following descriptions are the most common operations performed.

Laminectomy

This operation involves the removal of the arches of bone at the back of the spine, usually over a number of spinal segments.                                                  By doing this the spinal canal gains more space.

Facetectomy

This operation involves the removal of part or whole of the facet joint of the spine, which will prevent the degeneration of the joint or inflammation compressing the spinal nerves.

Discectomy

This operation involves the removal of part of the intervertebral disc.  Sometimes other structures such as thickened ligaments and bony ridges may be removed.

Microdiscectomy

The above operation is performed using an operating microscope.

Your Operation ……………………………………………………........

After the surgery:

Immediately after the operation, you will be taken to ‘First Stage’ Recovery where the staff will look after you until they are happy that you are recovering from your general anaesthesia. If you need it, they will give you pain relief and medication to prevent nausea.

You will then move to the Recovery ward. Here you will be provided with any additional pain relief you require. A physiotherapist will then see you the following day to recap the advice and teach you exercises in this booklet to perform at home to help with your back recovery.

You will normally be expected to stay in hospital for 1-3 days depending on the type of operation you have had. You will be ready for discharge when the physiotherapists are happy that you can walk safely by yourself and when the senior nurses are happy that you are comfortable.

Importantly you must have passed urine easily prior to discharge. Also, if you notice any altered sensation around your genital area or any numbness, weakness or pain that is worse than before your operation, you should let the nurses or physiotherapists know.

Medication will be provided for you to return home with and will include painkillers and anti-sickness tablets. It is normal to feel some pain at the incision site or in the lower back and it is not unusual to experience some discomfort in the leg during the first few weeks or so. Pain is best controlled with pain-killers taken at regular intervals to keep blood levels constant. Remember that they should be taken to allow you to MOVE with minimum discomfort.

Importantly you must have passed urine easily prior to discharge. Also, if you notice any altered sensation around your genital area or any numbness, weakness or pain that is worse than before your operation, you should let the nurses or physiotherapists know.

Medication will be provided for you to return home with and will include pain-killers and anti-sickness tablets. It is normal to feel some pain at the incision site or in the lower back and it is not unusual to experience some discomfort in the leg during the first few weeks or so. Pain is best controlled with pain-killers taken at regular intervals to keep blood levels constant. Remember that they should be taken to allow you to move with minimal discomfort.

The risks of surgery:

There are some small risks associated with any surgery that it is important to understand. The results of surgery cannot be guaranteed.

Blood clots: Deep vein thrombosis is an uncommon problem. Special precautions will be taken to reduce this risk.

Bleeding: It is usually small in amount, but rarely it could be significant and may even require blood transfusion.

Leakage of fluid from the nerve covering: This may delay you getting out of bed and walking. If the leak persists it occasionally needs reoperation to close the leak. It may cause headache and may require bed rest for 24-48 hours.

Infection: Wound or occasionally disc space infection can occur requiring antibiotics.

Numbness or weakness: In the area supplied by the affected nerve (usually temporary). If it is pre-existing, then it may take up to 1-3 years to reach a plateau stage.

Nerve injury: All spinal surgery carries a small risk of worsening weakness/numbness below the operation level including a very small risk to bladder, bowel & sex functions. Risk of paralysis is extremely rare.

Continued pain: 10-20% of people continue to have some symptoms even after a technically successful operation

Recurrence: Can occur in up to 15% of patients at the same place despite a successful operation

Back pain: 15% may feel that their back pain is more troublesome post-operatively.

Risks associated with a general anaesthesia: (See separate leaflet)

The operative surgeon will obtain an informed consent as well as consent to enroll in the BSR (British Spine Registry).

Wound Care

  • Your nurse will be able to provide you with accurate information regarding care of your wound.

  • You will have dissolvable stitches- in which case this will just dissolve of their own accord and do not require removal, or clips that your nurse will need to remove after 2 weeks.

  • You will need to keep the wound clean and dry whilst it is healing. You will be provided with waterproof dressings that can be used in the shower. Do not have a bath until wound is healed.

Contact your GP if any increased swelling, redness or wound leakage develops.

Pain

Immediately after surgery, you'll have some pain in and around the area where the operation was carried out. You'll be given pain relief to ensure you're comfortable and to help you move. The original leg pain you had before surgery usually improves immediately, but you should tell the nurses and your doctor if it doesn't.  A very small number of people have difficulty urinating after the operation. This is usually temporary, but in rare cases complications, such as nerve damage, may cause the legs or bladder to stop working properly. It's important to tell your doctor and nurses immediately if you have problems. It can take up to 6 weeks for the general pain and tiredness after your operation to disappear completely.

Going Home

You'll usually be able to go home 1-3 days after your operation.The physiotherapist will check you are able to complete normal tasks including getting out of bed, walking and be able to use the stairs safely.

When you get home, it's important to take things easy at first, gradually increasing your level of activity every day. Some help at home is usually needed for at least the first week after surgery.

Being active will speed up your recovery. Make sure you do the exercises recommended by your physiotherapist, and try not to sit or stand in the same position for more than 15-20 minutes at a time, because this can make you feel stiff and sore.

Follow up:

Most patients recover quickly after surgery. You may be contacted  via telephone call between 7-10 days after discharge from Hospital by a physiotherapist depending on your surgeon. Or you will be reviewed in 6-12 weeks in the outpatient clinic. This can be to assess your progress and/or provide further information or clarification on your post-operative care. You can also be referred to the physiotherapy outpatient clinic for further rehabilitation if required. This will be arranged by your phone call assessment.

Rehabilitation

Your medical team will want you to get up and moving about as soon as possible. This is because inactivity can increase your risk of developing a blood clot in the leg (DVT), and movement can speed up the recovery process.

After your operation, a physiotherapist will help you safely regain strength and movement. They'll teach you some simple exercises you can do at home to help your recovery.

As comfort allows, start to sit for short periods. There is no one ideal sitting or standing position, because no single posture can be comfortably maintained for a long period of time.  Instead we recommend regular changes in position, such as sitting, standing, lying and walking

Some suggestions for a comfortable position

Rolling and turning

Turn in ‘one piece’ trying not to twist your spine as you roll. Your shoulders and hips should move together and remain in line.

Getting out of bed

Roll onto your side, maintain a straight back, bend both knees and drop your feet over the side of the bed while pushing up into the sitting position.

Most people will be familiar and comfortable with this method.

Sitting

As comfort allows, start to sit for short periods in a supportive chair. There is no one ideal sitting or standing position, because no single posture can be comfortably maintained for a long period of time.  Instead we recommend regular changes in position, such as sitting, standing, lying and walking.

Walking

Walking will probably be your main source of exercise in the early days. Research shows that cardiovascular exercise can aid a faster recovery and help reduce your pain.

Gradually increase the number of steps of your walks over the following weeks preceding your surgery. You may find your back aches after walking this is quite normal, take some time to rest and stretch after prolonged activity.

Functional Activities of Daily Living

With thought and planning all your everyday activities are achievable post-surgery.  Indeed, it is considered the best form of exercise to aid your recovery.

Here are some suggestions you may find useful:

Bathroom and Personal Care Activities

  • Showering is preferable to bathing for the first 3 weeks following surgery.
  • Consider sitting on a stool at the washbasin or if standing, bend at the knees rather than stooping forwards for prolonged periods, or alternatively, put one foot in front of the other and place one hand on the surface in front of you.
  • When using the toilet ensure you bend both knees and maintain a good posture whilst sitting.
  • If you feel you have or will have difficulties with the above at home please alert a therapist who will advise you further.

Dressing

  • Stick to comfortable, baggy clothing which is easier to get into and is not restrictive to movement or tight on your wound.
  • Footwear should be strong, supportive and lightweight.
  • Slip-on shoes are ideal for the first few weeks.
  • The following diagrams illustrate some methods for dressing your lower half:

Kitchen activities

  • Arrange your most frequently used items between waist and eye level to reduce the need for reaching and bending.

  • Kneel to reach into lower cupboards, washing machines, dishwashers or oven.
  • Sit down for lengthy jobs such as preparing vegetables or ironing to prevent neck strain and poor posture.
  • Alternate between sitting or standing when preparing meals.
  • If your sink is low, consider raising the height of the bowl by using the draining board or by upturning another bowl to rest on.

Household Chores

Cleaning

You may carry out light housework as your comfort allows.

  • Avoid Vacuuming for the first 4 weeks.
  • Never perform repetitive movements by bending at the waist.
  • Use, where possible, long handled brushes.
  • Get help to carry heavy buckets or hoovers.
  • Always kneel to clean the bath.

Making the bed

  • Always kneel to make the bed, maintaining good posture.

  • Avoid overstretching.
  • Use quilts/duvets to avoid heavy blankets or bedspreads.
  • Enlist help wherever you can.

Laundry

  • When hanging out washing, avoid repeated bending by placing basket on chair.
  • Make several light trips from machine to basket to line, ensuring good posture throughout.
  • Do not carry a full basket of laundry.
  • Iron in short sessions, not all at once.
  • Where possible sit to iron.
  • Enlist help.

You can avoid bending when hanging out washing

Shopping

  • Carry a small bag in each hand, not one large one.

  • Shop more frequently for small amounts.
  • Use the trolley right to the car to avoid carrying heavy, awkward bags.
  • Enlist help.

Carrying Children

  • Do not carry them around.
  • Do not lift them unless necessary and  without too much strain.
  • Stand them on a bed/chair to wash/dress them, avoiding repetitive bending.
  • Wash and change baby on a high table with everything to hand.
  • Kneel when bathing children and keep toddlers on reins when shopping.

Sexual Activity

Can be resumed when you feel comfortable enough, for most people this is from 3 weeks post-surgery, but can be earlier.

Driving

  • Normally people can return to driving after as soon as they feel able. You must be off pain-killers that have a strong sedative effect and have good control over the muscles in your legs.
  • Ensure seat is in a comfortable position.
  • You must be able to look behind you and safely complete an emergency stop. If you are experiencing significant weakness in your foot (foot- drop) you will not have the power to perform an emergency stop.
  • You may be considered unsafe to continue driving until this resolves. You will need to contact the DVLA.
  • You must be able to look behind you and safely complete an emergency stop. If you are experiencing significant weakness in your foot (foot- drop) you will not have the power to perform an emergency stop. You may be considered unsafe to continue driving until this resolves. You will need to contact the DVLA.
  • Do not drive for any longer than you can comfortably sit.

Employment and Finance

Time taken to return to work varies. It will essentially be when you feel you can comfortably return to the role you were in.

Those working at a desk may be able to return within a few weeks weeks. Light manual workers may return at about 4-6 weeks. Long distance driving based occupations may take 4-6 weeks. Heavy manual workers may need up to 12 weeks. A graded return to work may be beneficial.

Key Points to Remember

1.      Lifting

  • You should avoid any heavy lifting for the first 12 weeks. A full kettle is probably as much as you should lift within the first 4 weeks. From then, aim to gradually increase to slightly heavier objects.
  • Assess whether the lifting task is necessary.
  • Do not twist whilst lifting.
  • Avoid lifting above shoulder level.
  • Hold object close to your body.
  • Do not lift if it causes discomfort in your back.
  • If the lifting increases your pain then STOP.

2.   Hobbies

Research evidence suggests that best results are achieved from returning to your normal activities at the earliest opportunity, as you feel able.

Gardening - Aim to return to light gardening around 4 weeks post- operation. Try to minimise any prolonged bending and be careful when lifting and twisting.

Walking the dog - It is good to go out for a walk. However, walking with a dog that pulls on the lead, as any sharp jerks may hurt your back. It should be ok after 4-6 weeks.

3.   Swimming

Swimming is a fantastic exercise to return to following surgery as it strengthens large groups of muscles that support the spine.

You may return to gentle swimming as soon as your wound is healed. This is usually around 2-3 weeks.

4.   Sports

You will be able to return to most sports as comfort allows. Exercise is good for your back, it can speed up your recovery, reduce you stiffness and soreness of your lower back.

Specific advice individual to you can be discussed with your medical team or ward therapist.

As a rough guide of time frame of return to activities:

Sedentary Work          3 - 6 weeks

Heavy Lifting              7-12 weeks

Manual work               7-12 weeks

Cycling                       1 months

Running                     3 months

Golf                            3 months

Surfing                       3 months

Weights                     3 months

Contact sports 6 months

Back Exercises

These exercises are designed to help you recover after your back surgery.

Doing these exercises should help to -

  • Increase the movement in your spine.
  • Increase the strength of your back muscles.
  • Help with general fitness and flexibility.
  • Help you get back to a normal level of activity.

Remember

If your pain increases then try doing the exercises more gently with fewer repetitions. However, if your pain does not resolve and continues to worsen stop that particular exercise and try again a week later.

Only do those exercises that have been ticked

All the exercises where you lie on your back should be done on a bed with a pillow supporting your head. Where the exercise involves your legs, the number of repetitions should be done on both the left and the right leg.

These exercises need to be done 3 times a day.

If you need more information or have any concerns about these exercises please contact the ward physiotherapist.

Your Physiotherapist is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The contact number is 0845 155 8155, Bleep 81483

Day 1 following operation

The number of repetitions should be comfortable, start with 5 and increase to 10 over the first week.

Hold your thigh with both hands and slowly bring your hip to 90 degrees. Flex your foot and ankle towards you and begin to straighten your knee. When you have taken it to the point

You can feel a strong stretch on the back of your leg.

Hold for the count of 5, then lower and repeat 5-10 times. Repeat with the opposite leg. Do not push into pain.

With knees together, slowly roll knees from side to side, keeping upper body still.

Tighten stomach muscles and press small of back against bed, letting bottom rise and curl towards you.

2 weeks following your operation

Sit on a stool and practice good posture.

First let your back slump and get rounded, then use your back muscles to straighten your back and arch it gently. Hold approx. 1-2min.

In Standing.

Bend sideways at the waist sliding hand towards your knee. Return to upright then repeat on other side.

Lying on your back with knees bent and feet on the bed.

Lift your pelvis and lower back, curling from your tailbone to you midback. Hold the position then lower down, slowly returning to starting position.

4 weeks following your operation

 

Lying on your back.

Hug one knee towards your

chest as far as is comfortable. Hold approx. 5-10 sec - relax. Repeat on both legs.

Lying on your back.

Using your arms pull your knees

up towards your chest. Reach with your forehead towards your knees. Hold approx. 5-10 secs,  relax.

For further advice if you are worried about your exercises, do not hesitate to contact your Physiotherapist on the Neurosurgical Unit.

Contacts/ What to do if:

If you develop any new problems in the first 48 hours, especially: difficulty passing urine, altered perineal sensation, leg weakness, numbness or pain that is worse than prior to the operation, or you need advice please contact the hospital switchboard.

Hospital Switchboard: (01752) 202082

Out of office hours: please ask to be put through to Erme ward and the ward sister.

In office hours (08:00-17:00): please ask to be put through to your consultant’s secretary.

They will organise for you to come in and be assessed via Emergency department or on the Neurosurgery Unit.

In an emergency (for example: you become very breathless, you collapse or your legs become very weak), please ring for an ambulance immediately.

After 48 hours, if you are worried or concerned that all is not well, please contact your GP.

For exercise advice please contact the physiotherapist as above.

 

 

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