LUMBAR MICROSURGERY. Low Back Surgery to Reduce Your Pain

LUMBAR MICROSURGERY Low Back Surgery to Reduce Your Pain

Planning for Low Back Surgery Having a low back (lumbar) problem can be frustrating. You may have pain when you sit, stand, or walk. Even a simple action, such as bending forward, may cause pain to shoot down your leg. To help treat your problem, your doctor may recommend a procedure called lumbar microsurgery. This booklet will help you learn more about the surgery and whether it is right for you. When You Have Pain Over time, changes can occur in your spine. Wear and tear from constant use, such as repeated lifting and twisting movements, can also cause changes. Pain in the lower back and legs may result. If pain puts limits on your life and other treatments haven t helped, surgery may offer relief. Surgery Can Help Lumbar microsurgery is a way of doing low back surgery through a small incision. During this surgery, bone, disk, or both may be removed. This takes pressure off nerves. Surgery may not relieve all of your symptoms. But it is very good at reducing leg pain, numbness, and weakness. 2 Lumbar Microsurgery

How You Benefit Lumbar microsurgery uses a smaller incision than traditional lumbar surgery. This may help you heal faster. The goals of surgery include: Relieving leg pain from the hip down to the foot. Reducing leg numbness and weakness. Reducing back pain. Improving quality of life. Understand Your Role For best results, plan to take an active role in your treatment and recovery. Talk with your doctor about what you hope surgery will do for you. And, ask what range of outcomes you should be prepared to expect. Know the benefits and risks of having surgery or choosing another option. Also keep in mind: Recovery from surgery may take several weeks. This varies from person to person. After surgery, you may need to limit activities that put stress on your back for a few weeks or longer. A formal physical therapy program may be needed after surgery. Planning for Low Back Surgery 3

Learning About the Low Back When the low back is healthy, you can bend and stretch without pain. But if a nerve is pinched, you may have pain, tingling, or numbness all the way down your leg. Merely standing or sitting can cause symptoms. A Healthy Low Back Vertebrae are bones that stack with disks to form the spine. The lumbar spine contains the five bottom vertebrae in the back. Disks are soft pads of tissue that act as shock absorbers between vertebrae. The firm, fibrous outer layer is called the annulus. The softer center is called the nucleus. The spinal canal is a tunnel formed by the stacked vertebrae and disks. Nerves run through the spinal canal. These nerves carry signals between the brain and the rest of the body. A foramen is a small opening between the vertebrae where a nerve leaves the spinal canal. The lamina is the arched part of each vertebra that forms the back of the spinal canal. Ligaments are bands of tissue that connect the vertebrae. Nerves in spinal canal Lamina Nerves Top view of a vertebra and a disk Spinal canal Three vertebrae and a disk Vertebra Disk Foramen Nerve Lamina Foramen Disk 4 Lumbar Microsurgery

Pressure on a Nerve Your back and leg symptoms may be due to pressure on a nerve. Pressure may be caused by a damaged disk or by a bone growth (spur). In either case, you may feel pain, burning, tingling, or numbness. If there s pressure on a nerve that connects to the sciatic nerve, you may feel these symptoms down your leg. That s because the sciatic nerve runs all the way from your hip (pelvis) to your foot. From a Damaged Disk Constant wear and tear can weaken and damage a disk over time. The disk s soft center can begin to bulge. A bulging disk may pinch a nerve. If the outside of the disk tears, the soft center may squeeze through (herniate). This can also lead to a pinched nerve. Herniated disk pressing on nerves Vertebra Disk Sciatic nerve From Bone and Ligament Nerve With age, the disks in the spine may thin. This moves the vertebrae closer to each other. Also, bone spurs can form on the vertebrae. This may cause narrowing (stenosis) of the foramen or the spinal canal. Bone spurs can then press against a nerve. Ligaments may thicken as they age and press against a nerve as well. Bone spurs pressing on nerves Learning About the Low Back 5

Preparing for Surgery Once surgery is scheduled, plan ahead for both your procedure and recovery. Know the risks of surgery. And understand what the procedure can and cannot do for you. If you have questions, be sure to get them answered before the procedure. Planning Ahead The better prepared you are for surgery, the smoother your recovery is likely to be. Follow all instructions you are given. Stop smoking. Smoking slows healing. If you smoke, ask your surgeon for advice on stopping before surgery. Have any tests that are requested before surgery. These can include blood and urine tests, a chest x-ray, and an ECG (electrocardiogram). Talk with your surgeon about how long you will need to be away from work. This may depend on the type of work that you do. Driving and certain other daily activities may be restricted for a week or two after surgery. Ask family and friends to help you with errands and household chores during this time. Consider moving items you use often to between hip and shoulder level. This helps keep you from needing to lift or bend after surgery. 6 Lumbar Microsurgery

Before Surgery Tell your doctor what over-the-counter and prescription medications you take. This includes aspirin, ibuprofen, and other NSAIDs. This also includes herbs and supplements. If you take medications to prevent blood clots, be sure to mention them. Ask if you should stop taking any of your medications before surgery. Arrange for an adult family member or friend to give you a ride to and from surgery. If you live alone, have someone prepared to stay with you for a night or two afterward. Stop eating or drinking before surgery as instructed. The Day of Surgery Arrive at the hospital on time. An intravenous line (IV) will be placed in your arm or hand. This delivers fluids and medications. You may be asked your name and what surgery you are having more than once. This is for your safety. Just before surgery, you will be given anesthesia (medication to prevent pain). You will likely receive general anesthesia. This puts you into a state like deep sleep during the surgery. Risks and Complications As with any procedure, lumbar microsurgery has certain risks. These can include: Bleeding Infection No relief of pain Injury of the same disk after surgery (recurrent disk herniation) Spinal instability Damage to nearby nerves or blood vessels Spinal fluid leak Paralysis Risks of anesthesia Preparing for Surgery 7

During Surgery During lumbar microsurgery, various techniques may be used to relieve pressure on a nerve (decompression). These may involve removing bone, disk, or both. You and your surgeon will discuss what will be done during your procedure. Reaching Your Spine To reach the spine, the surgeon makes a small incision in your low back. All of the surgery is done through this incision. During part of the surgery, the surgeon looks through a special microscope. This instrument provides an enlarged and detailed view of the problem part of your spine. Possible incision site Part of disk removed During surgery, bone and disk are removed with special instruments. 8 Lumbar Microsurgery

Removing Bone A small portion of the lamina may be removed. It is taken from the vertebrae above and below the pinched nerve. This is called a laminotomy. Some bone may also be removed to enlarge the foramen. This is called a foraminotomy. If present, bone spurs may be removed as well. If there is no disk problem, bone removal may be enough to relieve pressure on the nerve. Removing Disk If a disk is pressing on a nerve, part of it may be removed. This is called a microdiskectomy. In most cases, a laminotomy must first be done to expose the disk. The part of the disk outer wall and soft center that presses on the nerve can then be removed. Any disk matter that is loose or that may cause problems in the future is also taken out. There is usually enough disk remaining to cushion the vertebrae. Laminotomy Part of the lamina is removed from the vertebrae above and below the pinched nerve. A part of the disk is removed to take pressure off the nerve. Part of lamina removed Nerve no longer pinched Part of disk removed During Surgery 9

After Surgery After surgery, you will stay in the hospital until you have recovered enough to go home. Most people go home the same day as surgery. In some cases, an overnight stay is needed. Right After Surgery When you wake up, you will be in a recovery room. You may then be moved to a hospital room. The IV will remain in place for most of your hospital stay. You may have a tube in your low back to drain your incision. You may also have a small tube (catheter) in your bladder to drain urine. You may be wearing special boots or stockings. These help keep blood clots from forming in your legs. Controlling Pain You will be given pain medication by mouth, IV, or injection. In some cases, you may have a special pump (called a PCA pump) that lets you give yourself medication. Even with medication, you will most likely feel some pain. This is normal. If you are very uncomfortable, be sure to tell the nurse. Family and friends can often see you after you wake up from surgery. 10 Lumbar Microsurgery

Getting Up and Moving You can expect to walk within hours after surgery. This improves blood flow and helps with your recovery. At first, you may feel a little unsteady on your feet. But don t worry, a healthcare provider will help you. Before you go home, you may meet with a physical therapist (PT). He or she may teach you ways to strengthen and protect your back during recovery. You may also be given a program of exercises to do at home. Clearing Your Lungs Fluid can collect in the lungs after any surgery. To clear your lungs and help prevent pneumonia, breathe deeply and cough. You should do this often at least a few times each hour. A nurse or respiratory therapist may show you how to use an incentive spirometer. This device can help you breathe in and out the right way to help expand your lungs. You may be taught how to use an incentive spirometer to keep your lungs clear after surgery. After Surgery 11

Recovering at Home Once at home, be sure to care for yourself as directed. Also, see your surgeon for follow-up visits as recommended. As you recover, you can gradually return to your normal routine. Keep in mind that it may take a month or two for complete healing. Caring for Yourself at Home Take pain medications as directed. Also, ask your surgeon when it s okay to restart medications that were stopped before surgery. Keep your incision area clean and dry. Bathe or shower as directed. Also, change the dressing if you are told to. Avoid heavy lifting and other strenuous activities as instructed. Return to activity slowly. Take short, frequent walks each day. Ask your surgeon how long your walks should be and how often you should take them. You may be able to return to driving or a desk job within weeks after surgery. If you do more active work, you may need to wait longer before going back. As your back heals, you may feel ready to have sex. If you have questions about safe positions, talk with your surgeon. Follow-Up Visits with Your Surgeon Follow-up visits allow your surgeon to make sure your back is healing well. If needed, stitches or staples may be removed about 1 to 2 weeks after surgery. Once your back is healed, you may be prescribed physical therapy to help regain strength and movement. When to Call the Surgeon Call your surgeon right away if you have any of these: Fever of 100.4 F (38 C) or higher Increasing pain, redness, swelling, bleeding, or drainage at incision site Trouble swallowing or breathing New pain, numbness, or weakness in your legs 12 Lumbar Microsurgery

Learning to Move Safely Good body mechanics (how you move) help keep your back safe during recovery. They also lower your risk of future back problems. You may work with a PT to learn the best ways to move to protect your back. Be sure to use these techniques daily. What Are Good Body Mechanics? Each time you bend, twist, reach, or move in any way, pressure is put on a part of your spine. Disks may be squeezed, bones rotated, and muscles tightened. Good body mechanics put the least amount of pressure on your spine. If you maintain good posture when you sit, stand, sleep, and move, you can help keep your back healthy. Keep your ears, shoulders, and hips in line with each other. This helps take pressure off your vertebrae and disks and keeps them healthy. Don t slump or slouch. Pressure can squeeze disks, strain ligaments, and twist vertebrae. Over time, this can lead to damage and pain. Keys to Good Body Mechanics To move your body safely, follow a few simple rules: Always try to keep your ears, shoulders, and hips in line with each other. When you move, tighten the muscles in your stomach to support your spine. When you bend, bend at your hips and knees, not at your waist. When you turn, don t twist your shoulders or waist. Instead, turn your whole body. Recovering at Home/Learning to Move Safely 13

Protecting Your Back These pages give you more tips on good body mechanics and moving safely. Follow these guidelines until the movements become natural to you. Also, improve your strength and motion by exercising as directed. Lifting Safely Get close to the object. Lower your body by bending at the hips and knees. Keep your ears, shoulders, and hips in line with each other. Hold the object close to your body. Press down with your feet. Allow your legs to lift your body and the object. Sitting and Standing Up To sit, back up until the front of the chair touches the back of your legs. Tighten your stomach muscles. Bend forward slightly from the hips (not from the waist). Using your leg muscles, lower your body onto the chair. Then, scoot back into the chair. To stand up, scoot to the edge of the chair. Place one foot a little behind the other. Use your leg muscles to raise your body from the chair. Standing and Turning Stand with one foot slightly in front of the other. Keep your knees relaxed and your stomach muscles tight. To turn your body, move your feet. Step around. Do not twist your body at the waist or shoulders. 14 Lumbar Microsurgery

Getting Into and Out of Bed Getting into and out of bed can strain your back. Learn how to do it right. Follow these steps to get into bed. Reverse them to get out of bed. 1. Back up until the back of your legs touch the bed. Tighten your stomach muscles. Bend forward slightly at the hips. Use your leg muscles to lower your body and sit on the bed. Safe Sleeping Positions 2. Using your arm for support, lower your body onto its side. Lie on your back with a pillow under your knees. Lie on your side with your knees slightly bent. Keep a pillow between your knees. 3. As your upper body moves down, lift your feet onto the bed. Roll onto your back without twisting at the waist. Improving Strength and Motion Take walks regularly. Walking helps keep your back muscles and the rest of your body strong and flexible. Your surgeon or PT may also assign certain exercises. These exercises can help stretch and strengthen your muscles. Do all exercises exactly as instructed. And always tell your surgeon or PT if exercise causes new or lasting pain. Protecting Your Back 15

Work with Your Doctor Lumbar microsurgery offers many benefits. Before making the decision to have surgery, talk with your doctor about all of your options. Be clear what results to expect. Also, know what you need to do to prepare for surgery and recover from it. By being informed, you can help your doctor ensure that your needs are met. Your Surgical Checklist Use the checklist below as a reminder for what to do before and after your surgery. Follow any other instructions you re given. Before Surgery Have any tests or exams as instructed. Do not smoke. Arrange for an adult family member or friend to give you a ride to and from surgery. Stop taking any medications as instructed. Stop eating and drinking as directed before surgery. Depending on the time of your surgery, this may mean nothing to eat or drink after midnight the night before surgery. Also available in Spanish TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit www.kramesurvey.com to provide your feedback on this booklet. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 2014 The StayWell Company, LLC. www.kramesstore.com 800.333.3032 All rights reserved. Made in the USA. After Surgery Care for your incision as directed. Ask how long you should keep from getting your incision wet. Avoid bending, twisting, or lifting as directed after surgery. Make and keep all follow-up visits with your surgeon. Ask when you can begin driving again. Also ask about returning to work and sex. Practice good body mechanics. And do your exercises or physical therapy as instructed. 12038 1411