Lumbar Spine Surgery. Patient Information

Transcription

1 Lumbar Spine Surgery Patient Information 1

2 Welcome to The Walton Centre Admission to hospital can be a daunting experience for most people; our job is to make sure you experience a safe and fast recovery from your surgery. The information enclosed in this booklet is designed to help you understand what will happen to you during your time with us. It also contains your physiotherapy exercises for you to do following your surgery and some general advice following lumbar spinal surgery. This booklet does not contain information about a specific operation, but the advice, experience and recovery for most patients undergoing lumbar spine operations is very similar. There is an explanation of some terms that may be relevant to you and your surgery. These are on page If you have any questions before or after your surgery, then please contact us via the contact details on page 21. How is the spine constructed? The spine is constructed in two parts, the spinal column which consists of the bones, (your back bone) and the spinal cord which consists of the nerves of the spinal cord that pass messages through from your brain to your body and back again. Spinal column The spine is composed of small bones called vertebrae which all sit on top of each other to form your spinal column. The vertebrae get larger as they go down the spinal column, with the largest being in the lumbar (lower back) region. To stop these bones from rubbing on each other you have intervertebral discs. These are soft cushions of tissue, which sit in between each of the bones in your spinal column and act as shock absorbers, stopping the bones from rubbing on each other. The spinal column is very strong and flexible, it is held in place by many structures. The cervical (neck) and Lumbar (lower back) areas are more prone to problems as these are the areas that move the most to allow us to move our head and bend and stretch. 2

3 Spinal Cord The spinal cord consists of millions of nerve fibres which run through the middle of your spinal column. Your spinal cord, and the nerves it is composed of, act in a similar way to a telephone exchange passing information from your brain to your body and back again. At the level of each bone (vertebra) your spinal cord sends out one nerve on the right side and one on the left side. These nerves contain hundreds of nerve fibres that transmit messages between your body and brain. Spinal Cord Intervertebral Disc Spinal nerve The cervical vertebrae are in your neck, thoracic are in your trunk and the lumbar and sacral vertebrae are in your lower back. Any problems with your spinal column that causes pressure on your spinal cord or nerves can cause problems with feeling and/or movement. The nerves in the lower back are responsible for the feeling and/or movement from below your waist, and so any problems in the lower back may result in symptoms in this area. Why do we perform Spinal Surgery? Surgery for problems with the spinal column or spinal cord and/or nerves, can be performed for many reasons. In general you will have been offered surgery to :- 1. Give you relief from pain 2. Stop any further deterioration in the feeling and/or function from below your waist and more often in your legs. 3. Give you a chance of making some recovery from any symptoms. It is important that you understand, that spinal surgery is often performed in order to prevent any further deterioration in movement or sensation. If nerves and/or spinal cord have sustained damage, quite often over a long period of time; the damage already caused to the nerves or spinal cord may not be reversible, despite surgery to remove the problem. This is why surgery is often offered in order to prevent any further deterioration rather than to guarantee any improvement. 3

4 What are the risks? All the risks will be discussed with you prior to your surgery and although they are not common you should be aware that there is the potential for them to occur. 1. Risk from anaesthesia 2. Small risk of increased pain in back or leg 3. Risk of injury to the nerves causing weakness or numbness in the legs, and/or problems with the function of the bladder, bowel and sex organs. In the extreme this could mean paralysis from the waist down but this is exceptionally rare. 4. Leak of spinal fluid 5. Infection, which includes infection from the MRSA bacteria (infection with MRSA is very rare) Are there alternatives to Surgery? It is your decision if you wish to have surgery and surgery will only have been offered to you if your consultant feels that it may be of benefit to you. If you do not wish to have surgery then your neurosurgeon will discuss the individual implications this will have for you. Here are some alternatives that may be suggested to you:- 1. Wait to see if your condition remains unchanged without surgery. 2. Manage your pain with analgesia (pain killers) 3. Try conservative measures, for example physiotherapy and/or exercise such as pilates or Thai chi. Pre-operative Assessment Most people will be assessed in a special pre-operative assessment clinic. Most patients will be admitted the morning of their surgery. Some patients may be admitted the evening before their surgery, having been asked to fast from the night before, and will not go home over night. This will all be discussed with you in advance. 4

5 Admission to Hospital When you arrive you will be seen in an admission area and then informed which ward you will go to after your surgery. Patient name Unit number Date of birth Planned admission date Planned date of surgery No oral food from No drinks from Can drink clear water only until Medication instructions Additional comments The day of surgery You will be kept fasted (nothing to eat or drink) and you will be given a theatre gown to wear following your morning shower or bath. You will be collected for theatre and taken to the theatre reception area where the nurse will check your details again, this can appear repetitive but it is all done to ensure your safety. You will then be taken to the anaesthetic room, here the anaesthetist will give you your anaesthetic medication through a needle in your hand and once you are asleep you will be taken into theatre. Your surgery will be performed and what this involves varies depending upon your individual requirements. This will have been explained to you when you discussed it with your doctor and signed your consent form. Surgery is performed by either the consultant, or one of his/her team under the supervision of the consultant Recovery Room and Return to the Ward After surgery you will be taken into the recovery room where you will be monitored whilst you wake up from your anaesthetic. Your individual operation will determine your management, however, in most cases, the day following surgery your drip will be removed and your wound will be checked. You will be encouraged to get out of bed and move around the ward. If you have any problems the physiotherapist will see you to explain correct posture and the exercises that you will need to do. A copy of these exercises is enclosed in this booklet. You will need to bring this booklet into hospital with you so that you can start your exercises the day after your surgery. 5

6 Going Home The medical staff will see you and check that you are recovering well, following this most patients will normally be able to go home in the afternoon. For many spinal operations it is quite normal practice to go home the day after your operation. Your stitches will need to be removed, in most cases 7 days after your operation. Most patients can go to their local GP Practice Nurse or drop in centre to have this done. If you do not have access to this then the nursing staff will be able to arrange a district Nurse to come to your house. Please make sure that if you are not going home to your usual address, you inform the nursing staff. The nursing staff will inform you of the date your stitches need to be removed, and this can be documented in your discharge information. Some patients will have dissolvable stitches that do not need to be removed but will dissolve within a few weeks of surgery. Should you have any problems with your wound after your surgery, even if your GP or District Nurse are managing this, it is very important that we are also informed as we may need to monitor you more closely. Please phone either :- Spinal nurses on Tissue viability team on If you need transport home it is advisable to let the staff know when you are admitted, so this can be arranged in advance. If you are travelling home by car, sit in the front passenger seat and recline the seat back to make you more comfortable whilst travelling. When do you see us again? You will be sent an outpatient appointment by post, to return for a check-up about 2-3 months after your discharge from hospital. Here you will be seen by either a doctor or a Nurse Specialist, so we can check you are making good progress and discuss any concerns you may have. How much can You Do? It is not unusual to feel some pain in your legs or back, and altered sensations can happen as nerves try to recover. It can take many months for any recovery to occur, if there is going to be any, and this cannot be predicted. It is important that you are up and moving and do not go home and spend too long lying in bed, as this can cause its own problems. Remember that you have had an operation and it is usual to feel tired after this. Pace yourself and gradually build up your level of activity. Doing small things often, rather than all in one go is more sensible. You should progressively return to your normal daily routine as quickly as possible. You can undertake all the usual activities of daily life as you feel comfortable this includes walking, shopping, driving and sexual activity. You can return to work as soon as you feel you can cope even if your back is still uncomfortable. Heavy lifting should only be performed in the correct way and should be avoided for the first three months. The physiotherapy section starting on page 12 gives you advice on what you should be doing when you go home. If you are concerned for any reason please contact us via the contact details on page 21. 6

7 Questions to ask my doctor or nurse 7

8 Physiotherapy Following Lumbar Spine Surgery This information has been designed for post-operative back care. It is intended to answer the most commonly asked questions. Any further enquiries should be directed to your physiotherapist. The physiotherapist may visit you during the day after your operation. You will be shown the most appropriate exercises to be started immediately. In most cases you will be expected on your first day post-op to: 1) Be up and walking around. 2) Begin your exercises with your physiotherapist; even though your back may still be uncomfortable, this is normal. Your back is designed for movement. The sooner you get back to normal activity the sooner your back will feel better. 3) You may experience some hip and back pain; this is due to the position you were in, in theatre. This will resolve in a few days post-surgery. General advice on posture Good posture is important because it puts minimum strain on the joints and ligaments in the spine and therefore will reduce the recurrence of back pain. Lying Posture Use a firm mattress (not hard) which allows absorption of your hip and shoulder. Lie horizontally in any position you find comfortable. Sitting posture Recommendations for good sitting posture: For the first few days sit for only minutes at a time Gradually increase your sitting time as you feel able Use an upright chair Get up and stretch every minutes Standing Posture Think about: Standing tall Stomach in Maintaining an upright posture Lifting You must avoid heavy lifting immediately following your surgery. You may resume lifting when you feel able to do so. When you do resume lifting ensure you use the correct technique. Ask your physiotherapist to demonstrate if you are unsure of this. Use this method even if picking up light objects. Lifting technique You can return to work as soon as you feel you can cope, even if your back is still uncomfortable. Hurt does not mean harm. Returning to work and normal activities 8

9 will help your recovery. Simple changes can make your job easier, talk to your foreman, boss or occupational health adviser. Stand close to the object you are lifting. Face in the direction you will be moving the object never lift and twist. Bend the knees; keep the back straight, standing up by straightening the hips and knees. Initially your legs may be weak but will strengthen with practice. Never twist or rotate when you are lifting. When shopping/travelling use two lighter bags rather than one heavy one better still use a trolley. You can return to work as soon as you feel you can cope, even if your back is still uncomfortable. Hurt does not mean harm. Returning to work and normal activities will help your recovery. Simple changes can make your job easier, talk to your foreman, boss or occupational health advisor. General advice When travelling home in the car recline the front passenger seat. Try to avoid sitting too long, if possible stop and have a walk around every 30 to 40 minutes. Avoid bending at the waist; instead bend at the hips and knees. Do not drive until you can sit comfortably and drive safely. Avoid stooping at low work surfaces. It is safe to continue with all household activities such as cooking, cleaning and shopping. You may continue to have some back/leg pain or changes in sensation especially for the first 6 weeks, do not allow this to prevent you from progressing to a normal lifestyle. Remember hurt does not mean harm. If your pain is significantly worse than the original pain, and you are concerned see your GP or Chartered Physiotherapist. If you suddenly develop any of the following symptoms you should see a Doctor straight away: Difficulty passing or controlling urine Numbness around your back passage or genitals Numbness, pins and needles or weakness in both legs 9

10 Unsteadiness on your feet Exercise Following periods of back pain or back surgery you may find you are not moving your back so well. This leads to your back becoming stiff and your muscles wasting due to lack of use. Your back and spine are designed for movement. Normal activity and movement will help to make your back feel better. The exercises shown below aim to restore mobility, improve muscle tone and strengthen your back, abdominal (stomach) and gluteal (bottom) muscles. You may experience some discomfort initially; this is normal and will settle with time. The secret of these exercises are to do them little but often, so increasing their effectiveness with minimum discomfort. To maintain strength and mobility in your back long term, continue with the exercises 1 to 2 times per day. Regular exercise gives you stronger bones, develops fit and active muscles, keeps you supple and fit, makes you feel good and releases natural chemicals that reduce pain. Staying active will help you get better faster and prevent more back trouble. Lifelong regular activity is not only good for your back but also for your general health. These are examples of exercise and activities you may enjoy: Walking Swimming Jogging Cycling Aerobics Gym activities Yoga Pilates Tia chi Aqua aerobics Exercise Programme Exercises to be completed in sets of 10, 1-2 times each day. These exercises can be complemented by activities such as swimming, yoga, pilates and any other activity which you normally enjoy. START POSITION: Lying on your back with both legs bent and your knees together. ACTION: Slowly roll your knees from side to side keeping your upper trunk still. START POSITION: Lying on your back with knees bent feet on firm surface (bed/floor). ACTION: Pull pelvic floor muscles in and lift your bottom off the bed. Hold for 10 seconds then relax. Repeat exercise 10 times. 10

11 START POSITION: Lying on your back. ACTION: Bend the leg to be stretched forward towards your chest and hold with both arms. Hug both knees to chest. You should feel the stretching on the back of your thighs and buttock. Hold 10 seconds, repeat 10 times. START POSITION: Lie on the back with both legs straight. Bend one hip to 90 degrees and hold the thigh. ACTION: Hold 10 seconds then relax. Repeat 10 times. Holding the thigh in position, slowly straighten the knee until a stretch is felt at the back of the thigh. Hold 10 seconds then relax. Repeat 10 times. START POSITION: On hands and knees with the knees under the hips and the back relaxed in a neutral position. (Feet relaxed). ACTION: Suck in your tummy muscles and keeping the back flat slowly rock backwards moving at the hips. Do not let the back bend or arch. Move back towards the heels until you feel the pelvis start to give. ONLY move backwards as far as the controlled flat back allows. Move slowly and do not stretch. This exercise may not be suitable for people with existing hip or knee problems. START POSITION: Sit upright with your legs side by side. ACTION: Alternately straighten your legs and then bend each leg allowing them to swing. Do not do so much as to make it painful. 11

12 START POSITION Sit on a chair with your legs apart. ACTION Bend your head down and trunk down between your knees rounding your upper body as far as feels comfortable, bend forwards, you may experience some back stiffness. Return to upright sitting. Repeat 10 times. START POSITION Sit on a chair and cross your arms over your chest clasping the opposite shoulder. ACTION Bend your upper trunk forward while at the same time rotating and side bending to the same side. Let your eyes follow the movement. Breathe out during the exercise. These exercises have been taken from Kinetic Control UK, with the kind permission of Mark Comerford MCSP, B.Phty., MAPA. Preventing recurrences It s your back! Maintain your good posture in sitting and standing. 12

13 It s your back! Immobility leads to pain, to more immobility, to more pain; hurt does not mean harm, so continue with your exercises. Live life as normally as possible, keep up daily activities, and try to stay fit. Be patient. It is normal to get aches or twinges for a time. The information contained in this booklet is a guide to help you understand what to expect. It may be that in order to address individual needs your experience is slightly different from that described. If you have any queries, before or after, your surgery please feel free to contact us :- Spinal Nurses Physiotherapy team Secretary to your consultant via hospital switchboard on If you require this information in other formats or languages, please speak to a member of staff for details. The references used in compiling this information are available on the Walton Centre website or on request. The Glossary of Terms MRI Scan This is a scan that uses the magnetic fields of the cells in the body. It can provide very detailed images of both head and spinal structures. It requires the person having the scan to lie still in the scan tube for approximately 30mins. CT Scan This type of scan is useful for giving accurate pictures of the structures within the spine, especially detail of the bony structure. It uses x rays in a particular way to form the pictures. Spondylosis Degenerative changes in the joints of the spinal column, usually as a result of osteoarthritis. Stenosis Spinal stenosis is when the spinal canal is too narrow and the spinal cord /nerves become too tight in the narrowed space. This can be due to congenital narrowing or degenerative changes. A laminectomy (see next page) is often performed to give the spinal cord/nerves more space. 13

14 Scoliosis Abnormal curvature of the spine. 14

15 Spondylolisthesis This is a forward slip of one of the bones of the spinal column on another. This can occur due to degenerative changes or trauma. It can cause narrowing of the canal in which the spinal cord / nerves run and as a result can put pressure on the spinal cord or nerves. Radiculopathy This is the name given to problems, for example pain or weakness, that occur as a result of pressure on a particular individual spinal nerve root (rather than multiple different nerve roots). Cyst A fluid filled cavity Syringomyelia This is the development of a fluid filled cavity within the spinal cord. This can be associated with other conditions or the result of trauma. The spinal cord around the cavity can become compressed as the cavity expands. 15

16 Osteophyte This is a bone spur. These bones projections form along joints and occur naturally in the spine as a person ages. They often only cause a problem if they cause any pressure on the spinal cord and/or nerves. Surgical Procedures Laminectomy This is a surgical procedure to remove the lamina and spinous process. Both of these are parts of the bone that encircles the spinal cord/nerves and they are at the back of the bony spinal column. This is done in order to provide access to the spinal cord and nerves for surgery or to release pressure on the spinal cord and/or nerves. Laminoplasty This is a procedure where one side of the spinal column is scored creating a hinge affect, and the other side is opened slightly to form a space. The space is held open by wedging the gap and this creates more space within the spinal column without 16

17 removing large sections of bone. This expansion of the spinal canal gives the spinal cord/nerves more space. Decompression This is when the cause of any pressure to the spinal cord and/or nerve roots is surgically removed. They are decompressed. Facetectomy This is the name given to the surgical procedure to remove part of the facet joint of the vertebral column. The facet joints are on each side of the vertebrae just by where the nerve root comes out from the spine. Sometimes these joints can become too big (especially as we get older) and cause pressure on the nerves lying next to them. Fusion This is an operation to join two or more vertebrae of the spine together. This is often performed to stop/reduce abnormal movement of the bones (vertebra) that can cause pain, or problems with the function of the nerves. It sometimes needs to be performed to stabilise any bones that have become unstable as an unavoidable result of a surgical procedure. The bones are fused together using your own bone, donor bone with or without metallic screws, rods and plates. Rods Bone graft Screws 17

18 Foraminotomy This is a surgical procedure when overlying bone is drilled away from the nerves that are underneath to release any pressure from the bone on those nerve roots. Foramen Widened Vertebraplasty Injection of a form of cement into a particular bone or bones of the spinal column to make them more stable. Kyphoplasty This is the same as vertebraplasy with the addition that the bones of the spinal column, at the particular level are manoeuvred into a better position by a small balloon, before the cement is injected. 18

19 Notes 19

20 Appointment Record Date Day Clinic Comments 20

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22 The Walton Centre NHS Foundation Trust Lower Lane, Fazakerley Liverpool, L9 7LJ Tel: Fax: Visit alternatively, log on to: or call for advice and information for people with neurological conditions and their carers. The Walton Centre for Neurology and Neurosurgery NHS Trust. All rights reserved. No reproduction by or for commercial organisations is allowed without the express written permission of the Walton Centre. Produced by: Spinal nurses Reviewed: Oct 2017 Review Date: Oct