B
ack In Action lumbar laminectomy and lumbar discectomy
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A
bout this book
You and your doctor have decided that you should have lower back surgery to ease the pain in your legs or back. This book will tell you some facts about your back and what to expect at the hospital and when you go home. It includes tips and precautions for before and after your surgery.
This book is only to help you learn and should not be used to replace any of your doctor’s advice or treatment.
1
Contents Facts about your back
2–3
Why does your back hurt? 4–5 Types of surgery
6–7
Before surgery
8–9
The morning of surgery
10–12
“Back” in your room 13–15 “Back” at home
16–20
“Back” on track!
21
Cervical vertebrae
Thoracic vertebrae
Questions for your doctor 22–23 Resources
24
Lumbar vertebrae
Throughout this book, names of products for which a trademark has been claimed have been printed in initial capital letters (e.g., Bufferin).
2
F
acts about your back
Your spine supports your head and upper body. It also protects your spinal cord and nerves. The spine is often called the “backbone,� but it really is a stack of 33 bones called vertebrae. Your vertebrae get larger as they go down your back. The lumbar vertebrae in your lower back are the largest. This area of your spine is very flexible and supports most of your body weight. Nerves from the spinal cord run through openings between the lumbar vertebrae. These nerves travel to your legs and feet and control the way you move and feel sensations. The lamina is part of a vertebra. It is near the place where the spinal nerves exit. Between your vertebrae are intervertebral discs. These are like shock absorbers or cushions. They let you bend and twist your spine. A disc is made of a tough outer ring and a spongy center.
spinal nerves lamina intervertebral disc
3
W
hy does your back hurt?
Back and leg pain can be caused by a spinal nerve being pinched by: n n
a herniated (“slipped”) disc changes in the shape of vertebrae (osteoarthritis or spinal stenosis)
herniated disc This means the center of a disc has bulged or “slipped” through the disc’s outer layer and is pressing against a nerve. The pain from a slipped disc can be severe. It can spread to your buttocks and legs and keep you from working or doing things you enjoy. You can injure a disc by falling hard on your back or lifting heavy things without bending your knees. You can also develop a slipped disc without “doing” anything. Discs thin as you grow older, increasing the risk of an injured disc. The risk is greatest from the 30s through the mid 50s. Being overweight and smoking also increase your risk.
4
healthy disc
herniated disc pinched nerve
osteoarthritis Over time, bones may become rough and wear down. This is called osteoarthritis. It can change the size and shape of vertebrae.
pinched nerve
It may cause the openings for the spinal nerves to narrow (spinal stenosis). When these openings narrow, the nerve roots may be pinched. This can cause pain in the back, hips or legs.
Osteoarthritis
5
T
ypes of surgery
Types of surgery to ease back and leg pain are: n
laminotomy or laminectomy Your doctor removes bone from one or more lamina to make room for a spinal nerve. This surgery is most often done for people with osteoarthritis. • laminotomy - only part of lamina is removed • laminectomy - all of lamina is removed laminotomy
laminectomy
part of lamina removed
n
6
discectomy Your doctor removes the damaged part of a herniated disc to ease pressure on a spinal nerve. To reach the disc, your doctor may need to remove part of a lamina. This surgery is done for people with disc problems.
lamina removed
The surgery I will have is:
q laminotomy q laminectomy q discectomy Notes about my surgery:
Have your doctor show you what he plans to do on the art below:
back view
side view
7
B
efore surgery
tests Before your surgery, you will go to the hospital or your doctor’s office for tests. Your doctor will check your legs for strength, feeling and reflexes. You may have: n
an electrocardiogram (ECG or EKG)
n
a chest X-ray
n
blood tests
Your doctor will also talk with you about your surgery and order any other tests you need. The test results will be checked to make sure you are healthy and ready for surgery.
medicines If you have medicines you take every day, tell your doctor or nurse before your surgery. They will make sure you do not miss any medicine you need. Ask your doctor if you should bring your medicines to the hospital. Unless your doctor says it’s OK, for 7 to 10 days before surgery, do not take: n n
n
aspirin aspirin products like Bufferin, Alka-Seltzer, cold medicines, etc. anti-inflammatories like Aleve, Motrin, Advil, Orudis, ibuprofen, etc.
These medicines make it harder for you to stop bleeding during and after surgery.
8
pack your bags Take these items to the hospital with you: n
n
n
n
n
n
n
a pair of flat, comfortable shoes that won’t slip a knee-length robe for walking the hospital halls personal items like a toothbrush, deodorant and a razor glasses, hearing aids and other items you use every day a list of your allergies and how you react to them a list of all your medicines: how much, how often and why you take them a jogging suit or something comfortable to wear home
consent form You must sign a consent form before your surgery. This is a legal paper that says your doctor has told you about your surgery and any risks involved. When you sign this form, you agree to have the surgery and state that you know and understand the risks involved. Ask your doctor any questions you have before you sign the consent form.
9
T
he morning of surgery Most likely, you will not be allowed to eat or drink anything after midnight the night before your surgery. If your doctor has told you to take medicine, you may take it with a small sip of water. In the hospital, you will be given a gown to wear. You may also be given white, elastic stockings or stockings that massage your legs. These aid blood flow and help prevent blood clots. You will be asked to remove: n
glasses, contact lenses
n
dentures, hearing aids
n
nail polish, makeup
n
hairpins, wigs
n
jewelry
n
underwear
Have your family keep your things for you during surgery. Or ask your nurse to keep them in a safe place. You will be in surgery for 1 to 3 hours—it depends on the type of surgery you have. Your family will be shown where to wait so your doctor can find them.
n My surgery is scheduled for: date:________________________ time:___________________ place:_______________________________________________
10
for surgery An intravenous (IV) tube will be put in your vein. You will be given medicine (anesthesia) through this tube to put you to sleep for your surgery. It is also used to give you medicine and fluids during surgery and as you recover.
After you are asleep, a special tube may be placed in your throat to help you breathe. The tube will be gone before you wake up, but you may have a sore throat for a day or two after your surgery.
11
the recovery room After surgery, you will be taken to the recovery room. Your doctor will find your family and talk to them about your surgery. When you wake up, there may be a lot of machines around your bed. This is normal. The IV will still be in your arm, and you may have an oxygen mask over your face to help you breathe. The nurses in the recovery room will watch your blood pressure and heartbeat closely. You may spend about an hour in the recovery room.
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B
“
” ack in your room
pain and spasms Your legs and back may feel better right away. But the swelling from your surgery needs some time to go down. It may be a few days before you can feel a difference. Your incision may cause some pain, and you might need pain medicine for a few days. Your doctor may also prescribe pain medicine for you to take at home. You may have muscle spasms in your lower back, legs or buttocks. Medicines, walking or ice may ease these. Do not take any non-prescription medicines or use a heating pad on your back until you have talked to your doctor about it!
resting easy Your nurse can help you rest in bed the way that feels best for you. Pillows can help. n
n
When you lie on your back, keep pillows under your head and under both knees to relax your spine. When you lie on your side, keep pillows under your head and between your legs. You may also want to “hug” a pillow to your chest.
Your nurse or physical therapist will also teach you how to “logroll.” You roll from your back to your side keeping your knees, hips and shoulders in a straight line (like a log). This lets you move in bed without twisting your back.
13
up and about You may be able to get out of bed the day of your surgery. A nurse or physical therapist will show you how to get up without straining your back. n
n
When you get up from bed, roll to your side and use your arms to push your body to a sitting position. Let your legs drop over the side of the bed. When you get up from a chair, move your weight to the edge of the chair. Let your legs do the work, and don’t bend forward.
Practice walking in the halls. Try to do a little more each day. Exercise will ease your pain and help keep your lungs healthy. Be careful with your back. Do not:
14
n
lift heavy objects
n
twist at your waist
n
bend at your waist
breathing easy After surgery, you will be asked to cough and breathe deeply. This can help prevent pneumonia and other problems that can slow down your recovery and lengthen your hospital stay. You may also use an incentive spirometer. This is a device to help you practice deep breathing. Use your incentive spirometer, and cough at least 4 times every hour. Using the spirometer the right way can help keep your lungs clear. Keep the cylinder “floating� as you breathe in.
eating and drinking You may drink fluids a few hours after your surgery. Start with clear fluids such as tea, broth or apple juice. If you get sick to your stomach, your nurse can give you medicine to stop your nausea. When you can drink clear liquids with no stomach problems, you may start eating food.
15
B
“
” ack at home
You will most likely leave the hospital 1 to 3 days after your surgery. The IV tube and any other tubes will be removed before you leave.
call your doctor Your doctor needs to check your back as it heals. When you get home, call your doctor’s office to set up a follow-up visit. (This may be done before you leave the hospital.) Keep your follow-up visit with your doctor even if you feel fine.
16
Call your doctor right away if you have: n
a fever over 100 degrees
n
pain not eased by medicine
n
weakness or numbness in your feet or legs
n
redness, drainage or swelling around your incision
Your incision may have staples or stitches after surgery. If these are not removed in the hospital, your doctor will remove them at a follow-up visit. Ask your doctor when your staples or stitches will be taken out.
safe at home If you can, prepare your home before you go to the hospital. Or ask a family member or friend to get things ready for your return. Watch out for anything that could cause you to fall: n
long cords that lie across the floor
n
loose rugs and carpets
n
wet spots on bare floors
n
ice or mildew on steps
Be careful if you have pets that could run across your path and trip you. When you use stairs, move slowly, use the handrail and watch your step.
17
incision care When you get home, check your incision every day. Use a mirror or have someone look at the incision for you. The area around your stitches may be a little red and swollen right after surgery. But, you should call your doctor or nurse if you have: n
warm skin around the incision
n
redness or drainage
n
fever over 100°
You may be able to wash your incision gently with soap and water, but ask your doctor first. Do not sit in a bath or hot tub until your doctor says it’s OK.
18
take it easy Be very careful when you go home. Protect your back while you heal. Until your doctor says it’s OK, do not: n
lift anything that weighs more than a gallon of milk
n
bend forward, backward or to either side
n
twist your back to either side
n
drive a car, boat, tractor or lawn mower
n
pilot an airplane
How soon you can return to work depends on your surgery, your recovery and the type of work you do. Ask your doctor when it will be safe to return to your job. Also, talk to your doctor about any limits on your sex life.
19
exercise Walking is the best exercise after back surgery. It can help you feel better and prevent muscle spasms and constipation. Slowly increase the distance you walk unless your pain gets worse. One month after surgery, most people can walk at an easy pace for 30 minutes or longer.
lifting After your doctor says you can begin using your back, you still must be careful. When you pick up items from the floor or a low drawer: 1. Place your feet as wide apart as your shoulders. 2. Bend your knees, using your leg muscles to squat. 3. Hold the item close to your body. 4. Keep your back straight. 5. Use your thigh muscles to stand. 6. Do not bend at your waist!
Remember the lifting rule: “Lift with your legs, not your back.�
20
B
“
” ack on track!
Laminectomies and discectomies have come a long way in the last ten years. Today, most people who have these surgeries are walking around and feeling better within a few days. But don’t try too much too soon. Your recovery will take some time, so be patient. Follow your doctor’s advice and use the tips in this book to help your back heal safely.
n My follow-up visit is scheduled for: date:________________________ time:___________________ doctor:______________________________________________
21
Q
uestions for your doctor
Be prepared to talk to your doctor about your surgery. Write down any questions you have so you don’t forget them. Here are a few to help you get started: n
n
How long will my family wait while I am in the operating room and recovery room?
n
How will I get my pain medicine after surgery?
n
Will I need to see a physical therapist?
n
22
Should I take my daily medicines the morning before surgery?
Can I try exercises other than walking? (Examples:)
n
How soon can I shower after surgery?
n
How soon can I drive a car?
n
How soon can I return to work?
n
How soon can I have sex?
n
What are the chances of this back problem happening again?
n
n
Call your insurance company to see how much of the costs they will cover.
23
R
esources For more information, you can call or write: Arthritis Foundation
1330 West Peachtree Street Atlanta, GA 30309 www.arthritis.org
(800) 283-7800
American Medical Association 515 North State Street Chicago, IL 60610 www.ama-assn.org
merican Academy of A Orthopaedic Surgeons 6300 North River Road Rosemont, IL 60018-4262 www.aaos.org
(312) 464-5000
(800) 346-AAOS (346-2267)
Administration on Aging (202) 619-0724 330 Independence Avenue, SW Washington, DC 20201 www.aoa.gov
National Institutes on Aging Information Center PO Box 8057 Gaithersburg, MD 20898-8057 www.nih.gov/nia
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(800) 222-2225
Author
We believe that you have the right
Blynnsa Call, RN, BSN, CCRN, CNRN, is a member of Sigma Theta Tau, the national honor society of nursing. She is a former neuroscience nurse clinician at Piedmont Hospital in Atlanta, GA.
to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.
Consultants Connie F. Whittington, RN, ONC Orthopaedic Nurse Clinician Piedmont Hospital Atlanta, GA Margaret M. Hickey, RN, MS Clinical Nurse Specialist Rush-Presbyterian-St. Luke’s Medical Center Chicago, IL Ann R. Potts, RN Patient Care Manager Sierra Regional Spine Institute Reno, NV
Pritchett & Hull Associates, Inc. ‚
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