Your Back after Surgery

Date issued: April 2020

For review: April 2022

Ref: C-53/AHP/JF/Your back after surgery v4

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.
  • Muscles attach to the bony edges of the vertebrae
  • The vertebrae are connected by the intervertebral discs, a pad of cartilage which acts as a shock absorber
  • The spine is not rigid, it can bend and rotate
  • The most mobile areas are the neck and lower back
  • It is this mobility that allows ease of walking, lifting and reaching

Why am I being offered ‘Day Surgery’ Micro-discectomy & Micro-decompression?

It is an operation to remove damaged ‘disc’ material from the spinal canal and the intervertebral disc. The disc has a complex structure. Its tough outer ring becomes weakened over time by wear and tear and the soft inner core ‘bulges’ out and compresses one of the nerve roots in the spinal canal (a ‘slipped’ disc). These nerves pass from your back to your leg and people get pain known as sciatica as a result. The nerves also supply sensation to the leg and bring about movements of the muscles so other symptoms can include numbness, tingling and weakness of part of the foot or leg.

 

Other than disc related problem, degeneration & overgrowth of the joints of spine (i.e. facet joints) could compress the nerves and result into sciatica pain.

 

Your surgeon has decided, based on your response to previous treatment and your MRI scan results that surgery may help you. They have also decided that you are fit to have this procedure as a ‘Day Surgery’ patient.

 

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.

The Operation:

The operation is completed under a general anaesthesia through a small (3-4cm) vertical incision of the lower back. It takes 60-90 minutes to perform. The ‘micro’ technique uses a microscope, which allows the incision to remain small and provides a good view of the nerve root. The surgeon gently exposes the affected nerve root and disc.  Material from inside the disc and any other tissue causing problems is then removed (Micro-discectomy).  Sometimes, decompression of the nerve root is carried out without need to remove the disc material instead part of facet joint is removed (known as Medial Facetectomy). Once the compression has been relieved, the muscles and soft tissues are put back in place and the skin is stitched together with dissolving stitches.

The following procedures are currently completed as ‘day case lumbar spinal surgery’:

  • 1 or 2 level Micro-discectomy
  • 1 or 2 level nerve root decompression or Medial Facetectomy
  • Revision nerve root decompression or Medial Facetectomy
  • Revision 1 level Micro-discectomy

Day Surgery:

You have been selected as a ‘Day Surgery’ patient meaning that you will have the operation and go home on the same day.  As you are fit and fulfill Day Surgery criteria, this is considered a safe option medically.

However, you must ensure that:

  • A responsible adult is at home with you for 24 hours after your procedure.
  • You have a functioning telephone and toilet.
  • You can access medical help within 1 hours drive.

Details of who to contact if you develop any problems are found at the end of this leaflet.

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 (Normally Postbridge Ward). Here you will be provided with any additional pain relief you require. You will be given sandwiches and drinks and you will need to get yourself dressed. A physiotherapist will then see you to recap the advice and teach you exercises in this booklet to perform at home to help with your back recovery. 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 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 minimum discomfort

The risks of surgery:

This is a commonly performed operation with a low incidence of complications. 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.

 

Going Home

Start off with the little things you can manage easily and plan to gradually increase your activity over the coming weeks.

Your GP can offer treatment, information and support on all medical matters following your discharge from hospital.

If you require further therapy on discharge, this will be discussed with you individually when reviewed by the physiotherapist.

 

Follow up:

Most patients recover quickly after surgery. Between 24 and 48 hours post-operatively, we will do a telephone call to assess your progress and provide further information or clarification on your post-operative care. You will either be seen in the outpatient clinic between 6 and 8 weeks post-operatively or you will have a telephone follow up arranged by your physiotherapist. (It depends on your consultant). You will be asked to complete PROMs (patient reported outcome measures) at pre-op, 6 weeks postop and 6 months post-operatively.

 

Posture

After your back surgery you may notice stiffness and some pain in your lower back that is not only from the wound area but also associated with weak muscles and poor posture linked with back pain.

Achieving good posture requires practice but can reduce your pain levels. You may choose to use supports or lumbar rolls to aide your posture however strengthening of your core abdominal muscles will lead to a long term improvement.

The muscles of your abdomen and back help maintain and support your spine, in all activities of daily living. The exercises in this booklet will help post-operatively to strengthen and improve your posture.

 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.

 

Sitting position

It is advisable to sit in a high, firm-backed chair with arms.

Make sure that your feet touch the floor when your bottom is pushed to the back of the chair.

Make sure that you are in a well-supported position and that you are not ‘holding’ yourself upright. Try to relax your buttocks and legs.

Avoid a slumped position, perhaps using a cushion or rolled up towel in the small of your back to help keep your spine’s natural shape.

Avoid crossing your legs.

 

Walking

Short walks will probably be your main source of exercise in the early days. Regular short walks are better than one long walk.

Gradually increase the number and length of your walks as able. After walking, if your back aches you may wish to have a lie down otherwise have a short rest in sitting.

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:

 

Sitting, by bringing your foot up to you (remember to maintain.  the natural curve of your back and bend your hips and knees)

Standing, by placing your foot on a chair or stool  Remember to maintain the natural curves of your back

As an alternative you can dress the lower half by lying on your back on the bed and

 

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

  • 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.
  • Before returning to driving you should be able to get in and out of the car comfortably. Normally people can return to driving after a couple of weeks.
  • 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. As a guide we suggest:

Those working at a desk may be able to return within 2-4 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 (being aware of back care) 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 whilst reducing load from your joints to make exercise more comfortable.

You may return to gentle swimming as soon as your wound is healed and dry and back more comfortable. This is usually around 4 weeks.

 

4.Sports

You will be able to return to most sports as is comfortable and in general, exercise is good for your back. However some sports (e.g. contact sports/weight lifting) may put an increased strain through your spine making a recurrence of injury more likely – particularly those involving heavy lifting/ straining/ twisting. Many patients decide to change their lifestyle after surgery to prevent future problems.

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

As a rough guide   

  • Cycling 1 month
  • Bowls 2 months
  • Running 2 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 on 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.

  1. 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.
  2. With knees together, slowly roll knees from side to side, keeping upper body still. 

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

2 weeks following your operation

  1. 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.
  2. In Standing.Bend sideways at the waist sliding hand towards your knee. Return to upright then repeat on other side.

  3. 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

  1. 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.
  2. 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.

Telephone: (01752) 202082

Bleep: 81483

 

Contacts/ What to do if:

If you develop any problems in the first 24-48 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

In office hours please ask to be put through to your consultant’s secretary or the duty neurosurgical registrar bleep via Switchboard

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

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