Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone: 0800 183 0204 From a mobile or abroad: 0115 924 9924 ext 65412 or 62301 E-mail: pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR www.nuh.nhs.uk Lumbar Spine Decompression/Discectomy Information for patients Spinal Outpatients Department If you require a full list of references for this leaflet please email patientinformation@nuh.nhs.uk or phone 0115 924 9924 ext. 67184. The Trust endeavours to ensure that the information given here is accurate and impartial. This document can be provided in different languages and formats. For more information please contact: Spinal Outpatients Department Queens Medical Centre Derby Rd, Nottingham, NG7 2UH Tel: 0115 924 9924 Extension: 65377 Michelle Cantrill, Physiotherapy Department December 2018. All rights reserved. Nottingham University Hospitals NHS Trust. Review December 2020 Ref:1219/v4/1218/AS. NUH01961N
This booklet includes important information you need to know from the time it is agreed you require surgery until approximately six weeks after your operation. Please bring this booklet with you when you attend your preoperative assessment, at admission and at your first follow up appointment after surgery. Further information Back Care 0845 130 2704 www.backcare.org.uk Patient Name: Hospital No: Consultant Name: Notes: 2 19
Resuming sexual activity This is usually about three to four weeks after your operation and will depend on your pain and wound healing. Further information is available upon request from a member of staff. Returning to work If you have sedentary (sitting type) jobs it is expected that you would return at approximately four to six weeks after your operation. For manual jobs the absence from work will be longer and return to work should be discussed with your GP and employer. Travelling long distances Avoid long periods of sitting in the first couple of months after your operation and always ensure that you maintain good posture, sitting up as straight as possible. Flying is not advisable during this time. You should check with your consultant, your air carrier and travel insurance for specific details. Reducing the risk of blood clots after surgery This is a rare occurrence but can happen and some people are more prone than others. Wear elastic stockings if advised to do so for up to six weeks following your surgery particularly when you are inactive. Exercise your legs and twiddle your ankles. Drink plenty of fluids and avoid alcohol although small amounts are permitted. Avoid smoking. Do not take your self to bed or rest on the couch for long periods of time particularly in the first week after your surgery apart from normal sleep and bedtime. How do I contact a member of staff? If you have any questions or concerns about your planned surgery or your recovery please see the information below. Important telephone numbers listed below: Consultant secretary Name: Ward D8 Spinal OPD Spinal ward D8 Physiotherapist Neuro-Spinal day unit (NSDU) Your GP 0115 924 9924 ext 0115 924 9924 ext 62308 0115 924 9924 ext 65367 0115 924 9924 ext 62314 0115 924 9924 ext 61912 By phone Contact about dates for surgery After your have gone home. Appointments. Mobility and exercises physiotherapy out patients appointments. Pre-assessments. Wound care or problems, additional medication and fit notes. Transport to and from your hospital appointments and admission is your responsibility unless you meet the NHS criteria for support with transport. Please speak to a member of staff if you think you meet this criteria or contact the number below. Ambulance enquiries Tel: 0115 924 9924 ext. 63950 18 3
Can you explain the spine? The spinal column is made up of 33 bones called vertebrae with discs that act as shock absorbers in between. These bones are given a letter and a number depending on where they are located in the spinal column. The vertebrae have a small gap (called the foramen ) through which the spinal nerves run. The nerves leave the spinal column at the level where they need to be i.e. the nerves that go to your legs leave at the lower part of the spine (lumbar) and run all the way down your legs. The intervertebral discs (the structures between the vertebrae) are made up of a soft jelly like substance (the nucleus), which is held inside a tough, elastic and fibrous outer casing (the annulus). Please See figure 1. The spinal column is supported by many muscles, tendons and ligaments. These provide strength and stability to the chain of vertebrae and discs. The muscles are connected to your bones with tendons; when a muscle contracts the forces are passed on to the skeletal system via the tendons. Nerves pass on messages from your body to your brain resulting in body movement but also sends messages of pain. Figure 1 What can I expect in the first six weeks after my surgery? Pain, discomfort and activity Should you require any additional or new supplies of pain killers please see your GP. It is not uncommon to be more uncomfortable with increasing activity, however, this should settle with rest and pain killers. If you are concerned contact your GP. During this time it is important that you pace yourself, gradually increasing your level of activity on a daily basis. Remember everyone is different. If you experience any significant changes or new symptoms following your surgery or you start to feel unwell contact the spinal out-patients clinic during the working week and contact the ward after 5pm and at weekends and bank holidays. However, if you develop sudden loss of sensation around your buttocks area, numbness in your leg(s) or are unable to pass urine then please go straight to the emergency department of your local hospital. Your wound Your wound will normally be checked by your practice nurse (as per the ward s instructions) and should be left exposed three to four days after surgery. If you are worried about your wound or it becomes unusually sore or starts leaking please contact us as above. Driving The DVLA states that It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times and to be able to demonstrate that is so, if stopped by the police. Drivers should check their insurance policy before returning to drive after surgery. Professional licence holders (including lorry, bus and taxi drivers) usually require to take longer periods from driving and are bound by different regulations. 4 17
Going home The ward team will organise your discharge home, this will depend on the following: Being able to walk safely and independently. Safe to use the stairs, if you have stairs at home. Being independent with all of your self-care or have somebody available to help assist you if required at home. Checking your wound area or dressing is satisfactory. A clean dressing maybe applied if necessary. Your pain being under control with appropriate painkillers. The nurses and doctors are sure that you are medically fit. Why have I got back/leg pain? Back pain is a common disorder, as we get older our body undergoes wear and tear (degeneration) in the vertebral bones, discs and surrounding structures. Over time this can cause back and leg pain as well as changes in muscle strength and feeling in the area of the nerve supply. Common reasons for back/leg pain include: Muscle sprain: sometimes you can pull a muscle in your back, which can result in a small tear or sprain in your muscles. A physiotherapy out patient appointment will be arranged for your nearest physiotherapy services. Your follow up will be explained to you, this may be by a phone call or a clinic appointment approximately six to eight weeks after your operation. You will be given a letter to take to your GP or practice nurse explaining what operation you have had and any medication you have been given to take home and also how to check your wound or dressing. Please ensure that all your contact details are up to date before you leave hospital. Disc protrusion (bulge): The discs between the vertebrae become weaker and bulge out. This can cause low back pain and sometimes leg pain. Prolapsed disc ( slipped disc or herniated disc). The disc bulges further out and puts pressure on the spinal nerves. You may feel this as pain in your legs known as sciatica. Spinal stenosis: The spinal column runs through a narrow gap in your vertebrae called the spinal canal. If this opening becomes too narrow the nerves may become trapped and cause pain. Figure 2 16 5
What surgery may help me? Decompression: This is a procedure whereby the bony areas in the spinal column and/or overgrown ligaments surround the spine. These cause compression and are fully or partially removed. Discectomy: This is a procedure whereby any disc material that has been pressing onto a nerve root is removed. Microdiscectomy: This is a procedure whereby any disc material that has been pressing onto a nerve root is removed. This surgery is done using smaller instruments resulting in a smaller wound. This surgery may be undertaken as a day case procedure. The above procedures will be discussed with you by your consultant or nurse to decide which one is most appropriate for you. What happens after surgery? A physiotherapist will see you the day after your surgery. He/she will do the following: Check the sensation and muscle strength in your lower limbs. Advise you on the best ways to move to help avoid pain when moving i.e. getting in and out of bed and walking. Encourage you to be up and about as often as possible. Before you go home: The physiotherapists will encourage you to increase your walking with or without a walking aid as required. You will undertake a stair assessment where required. An advice and exercise booklet will be discussed and offered to you to help you improve after your surgery. If you have any queries or questions about your discharge or your home environment please speak to any member of staff. What does my surgery involve? The surgery is performed under general anaesthetic. An incision is made in the back at the appropriate level of the spine. The tissues and the nerve are then carefully held out of the way whilst the procedure is carried out. The wound is then closed with dissolvable stitches under the skin so there are usually no stitches to be removed later. Sometimes sticky paper strips called steristrips are applied over the wound. These peel off on their own accord usually in about 7-10 days. What are the benefits of surgery? Pain relief is the most likely improvement. This should lead to improved activity levels. 6 15
What happens when I am in hospital? Your anaesthetic You will normally meet your anaesthetist on the day of surgery to discuss your anaesthetic. Most patients have a general anaesthetic. Further information is available should you require it. On the day of your surgery The nursing team will make final checks with you prior to your surgery. A porter will come and take you down to theatre. You will be taken to the anaesthetic room where you will be connected to monitors to observe your blood pressure and pulse during surgery. During your stay staff will ask you questions such as who you are, your date of birth and any allergies you have. It may seem like people are asking you the same questions several times, but this is in the interest of your safety while you are in hospital. After surgery you will go to our recovery area, where staff will observe you and monitor your condition. Once you are fully awake from the anaesthetic you will be taken back to the ward. Will I be in pain after my surgery? You will feel uncomfortable but will receive regular pain medication after your surgery. What happens after my surgery? The dressing covering your wound is a special dressing that will be left on for the duration of your stay in hospital but will normally be changed before you go home. You may be given surgical support stockings and injections into your tummy to reduce the risk of getting blood clots. 14 What are the risks from surgery? Some risks include: Developing a blood clot in your leg (deep vein thrombosis) (2 in 100 patients). A small part of this clot may break off causing a clot in your lungs (pulmonary embolus) (2 in 100 patients). Infection (1 in 200 patients). Damage to the nerves leading to weakness, numbness or pain in the leg (1 in 100 patients). Dural Tear (this is a tear of the covering of the spine resulting in the leaking of the fluid in the spinal cord called cerebral spinal fluid (CSF). What happens after I have been put on the waiting list? You will receive a letter from the hospital letting you know the date of your pre-operative appointment and your surgery. Any concerns about the dates please contact your consultant s secretary. Can I make lifestyle changes to prepare for surgery? Yes you can. The following information should help you: Keep Active The better condition your muscles are in before the operation the easier your recovery is likely to be. Activities like cycling, swimming and walking are good ways to keep healthy without causing you too much discomfort. Activities of daily living Continue with general activities of daily living as you are able. Pacing Pacing is a way help you manage what activities you do, how much you do them and for how long. Activities should be undertaken at a comfortable pace to ensure your pain does not increase. 7
Tips for general health We will have done an assessment with you in the clinic and will contact your GP if there are any concerns. Usually we will see you two to four weeks prior to surgery to do final health checks and for you to ask questions. If you have any further problems with your general health while you are on the waiting list you should get them checked out by your GP as soon as possible. Weight loss Your weight will affect how you cope with anaesthetic and your recovery from surgery. If you are over weight it is important to follow a weight loss programme before surgery and to assist you in your recovery. Your GP can help with this. Tips for healthy eating Eat less fat Avoid foods such as biscuits, chocolate and pastry. Trim excess fat off any meat you eat. Choose lean cuts of meat or eat fish instead of meat. Use low fat milk and low fat spreads. Grill instead of fry food. My personal belongings what do I bring? Only bring minimal belongings to hospital e.g. toiletries, nightwear and a small amount of loose change. A bag will be provided for you to put your belongings in for the transfer to a ward if appropriate. Do not bring valuables such as IPod s, laptops, expensive mobile phones, jewellery, wallets, purses and bank cards, into hospital. Remember to bring your medication and mobility aids (i.e. walking stick) with you when you come in. Visiting Visiting times are 2:30pm until 8:30pm. If your visitors find these times difficult, please speak to the ward staff to arrange an alternative time. All visitors are asked to use the alcohol gel at ward entrances when entering and leaving the ward. No flowers or plants are allowed in the wards. Please ask your visitors not to use their mobile phones on the ward as they disturb other patients. Cut down on sugar Avoid sugar in drinks and cereals. Use dried fruits like raisins to sweeten cereals and puddings. Eat more fruit and vegetables You should eat five portions of fruit and vegetables a day. 13
Coming into hospital The day before your admission It is important to your recovery and wellbeing that you: Get plenty of rest. Ensure you have a good diet. Increase your fluids by a couple of glasses of water or preferred non alcoholic drink. Avoid smoking. If you can do this longer than a day this is to your health advantage. Avoid alcohol. What time should I come in? Depending on your proposed time of surgery it will be morning or afternoon as described in your admission information either by telephone, mobile text or letter. Food and drink before surgery You can eat until midnight the night before you come into hospital. Please do not eat anything after this time. On the morning of your operation you may have a drink of water, black coffee or black tea. This must be finished by 6am unless you are advised otherwise by one of the team. I take medication in the morning should I take it? Yes - it is important you take your medication unless you have been told to stop certain tablets by the doctor prior to coming in for your operation or procedure. A small amount of water, black tea or coffee can be drunk with your medication. Your medication should be taken by 6am. Stop smoking Smoking increases your risk of complications from anaesthesia and slows down your recovery time. By stopping smoking prior to surgery your recovery should improve. Please see your GP or contact the New Leaf scheme on 0115 934 9526. There are smoking cessation advisors in our clinics who can provide you with help and support. Pre-operative information You will be invited to attend a pre-operative health assessment clinic. This assessment includes: Discussion with a spinal doctor or nurse about your planned surgery. This includes the risks and benefits and signing the consent form. You will then have the opportunity to ask questions about your operation and admission to hospital. General health checks which may include blood and heart tests. Occasionally some tests are not available on the day and a further visit will need to be arranged. You may also be required to see other people such as an anaesthetist. In preparation for your admission to hospital you will be asked to complete questionnaires. Your blood pressure, pulse, temperature and urine will be checked. We will also undertake routine infection screening. Please ensure you bring a list of your current medication and information about your current medical health and let us know if you think that you will have any difficulty caring for yourself initially after surgery at this appointment. This appointment can last for up to four hours so please bring with you any drinks or medication that you may require during that time. 12 9
Pre-operative exercises These are important exercises as they will make up part of your post operative physiotherapy regime, these will be explained to you after surgery by a physiotherapist. You may find them a little uncomfortable. If you find that they increase your symptoms you should stop doing the exercises or do what you feel comfortable with. Lie on your back with your legs bent. Pull your stomach muscles upwards and inwards to a flattened position. Also try and bring in your pelvic floor muscles. Hold for seconds. Repeat times. Prepare your house for when you come home after surgery Make sure all loose rugs and trailing wires are removed or secured down to reduce the risk of tripping over them and falling. Move all items that might obstruct your pathway throughout your property. Reduce using the stairs by bringing items you may need during the day, downstairs. Excessive bending, lifting and twisting should be avoided initially. Re-arranging items that you use most frequently for example clothes, post, pans and food to waist height can help. Lie on your back with your knees bent. Slowly roll your knees from side to side keeping your upper back still. Repeat times. It is advisable to sit in a firm upright chair with your back supported, relaxed, and your feet touching the floor. Some people find that slip on shoes and a long handled grabber (to pick things up off the floor or hard to reach) is useful. Lie on your back. Bend one leg and pull your knee towards your chest with both hands to a point where you feel a comfortable stretch. Repeat times. Lying on your front (preferably) if this is not comfortable then lye your back. Pull in your stomach muscles and tense your buttock muscles together. Hold for seconds. Repeat times. 10 11