Lumbar Microdiscectomy Patient Information 1
Information for Patients undergoing Lumbar Microdiscectomy Admission to hospital can be a daunting experience for most people. The information enclosed in this leaflet is designed to give you information about your stay in hospital and what to expect. This information is intended to be used as a guide to your hospital experience that may vary slightly depending upon your individual requirements. The Walton Centre is a Regional unit that admits people 24 hours a day, 7 days a week depending upon the urgency of their condition. The surgical procedure that you are to be admitted for is called a Lumbar Microdiscectomy. This is performed for someone who has a prolapsed disc in the lower back area, sometimes known as a slipped disc. What is a Prolapsed (slipped) Disc? The spine is composed of small bones called vertebrae which all sit on top of each other to form your spinal column. 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. Spinal Cord The spinal cord and nerves run through the middle of your spinal column. This acts 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 some nerves to transmit these messages to the body. A prolapsed disc occurs when one of these cushions (discs) has a weakness at the edge and some of the internal tissue pokes out putting pressure on a nerve causing your symptoms. 2
What does a prolapsed disc cause? Prolapsed discs can cause various symptoms depending on which nerves they press upon. Prolapsed discs in the lower back area cause symptoms in the legs. Usually, the pressure on the nerve causes pain to radiate down the leg and this is called sciatica. Occasionally, there may be numbness or weakness in your leg. In a few cases the pressure can affect the nerves that supply the bladder and the bowel and this can affect the ability to pass urine and can cause numbness around the genital or anal area. In this very specific case it should be dealt with as an emergency and immediate attention is required. Treatment Most attacks of sciatica settle themselves after a few weeks and will not require any surgery. The non-surgical option for treatment is to allow the body s natural healing process to relieve the symptoms as slipped discs can resolve themselves with time relieving the pressure on the nerve. This can be helped by treatment from a physiotherapist, taking painkillers and keeping yourself active. In some cases osteopathic treatment or an epidural injection may also help. If the pain does not settle spontaneously and persists with a degree of severity then surgery can be considered. Surgery allows considerable relief of pain and symptoms in 80-90% of cases. It will, however, only relieve the leg pain and any backache will often remain. Surgery also allows the relief of symptoms earlier than if you wait for a natural recovery. What does surgery involve? A microdiscectomy procedure allows the part of the disc, which is causing the pressure on the nerve, to be removed with minimal disturbance of bone and tissue. This is achieved with a microscopic surgical technique. Microdiscectomy involves having a small incision on the lower back whilst under general anaesthetic (You are fully asleep). A microscope is used for the surgery to give a better picture of the tissues and to minimise the disturbance to the surrounding structures, 3
improving the accuracy. The disc is approached from behind and the fragment that is pressing on the nerve is removed, the complete disc is not excised. What are the advantages and disadvantages of surgery? The advantages of surgery are that there can be up to an 80-90% chance of significant relief of leg pain. However there is no guarantee that there will be any relief from back pain or an improvement in any leg weakness or changes in sensation/feeling that you may have had prior to surgery. 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. Risk from anaesthesia Small risk of increased pain in back or leg Risk of injury to the nerves causing weakness or numbness in the legs and / or the genital or anal area. Risk of injury to the nerves that supply the bladder, bowel and sex organs, which could result in problems with bladder, bowel and sexual function Leak of spinal fluid Infection, this includes infection from MRSA bacteria (infection with MRSA is rare). Haematoma, (blood clot) In 6% of patients another piece of disc at the same level can move out and cause pressure again. It is also possible for a prolapsed (slipped) disc to occur at another level in the spinal column at some time in the future. Pre-operative assessment You will be brought into the hospital for a clinic appointment for your pre-operative assessment. This is usually a few weeks before you are due to be admitted. Please see preoperative assessment booklet. Admission to Hospital You will be seen in the admissions area and informed which ward you will be taken to after surgery. The day of surgery You will be kept fasted (nothing to eat or drink) and need to wear a theatre gown following your morning bath or shower. At some time prior to surgery you will be taken to the X-Ray department for your back marking. Back marking is an injection of dye into your back, which allows the surgeon to access, with greater accuracy, the correct level of your spine during your surgery. Back marking involves one injection into the back, it does not take long and you will be away from the ward for approximately. 20 minutes. The dye used can give your skin a greenish appearance and will make your urine green, it can also give your stools a greenish tinge, this is because the dye is absorbed by the body in the same way as water, and passed out of the body in the same way as water. Following this you will return to the ward until it is time for your surgery. 4
If you feel unwell in any way following your back marking it is important that you tell the nursing staff. Very occasionally patients can have a reaction to the back marking dye, and this can sometimes require medical intervention. You will be collected for theatre and taken to the theatre reception area. From theatre reception 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 and surgery performed. Please see anaesthetic booklet. After surgery you will be taken into the recovery room where you will be monitored whilst you wake up from your anaesthetic, and you will be made comfortable for your transfer back to the ward. Back on the ward When you are eating and drinking your drip will be removed, your wound will be checked regularly and you will be encouraged move around. 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. Some patients will be able to go home the evening of the day of they have their surgery. In all cases when a patient is able to go home the same day as their surgery, individual circumstances are taken into consideration. Discharge Home Your stitches or paper stitches will need to be removed, in most cases 7 days after your operation; the Nursing staff on the ward will clarify this for you before you go home. 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. Some patients may have dissolvable stitches, which do not need to be removed and 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 0151 529 8853 Tissue viability team on 0151 529 5599 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. You will be sent an outpatient appointment by post, to return for a check-up about 2-3 months after your discharge from hospital. It is not unusual for you to get increased back pain for a few days to a few weeks after surgery. There may be a few twinges and pains in your leg for a few weeks to follow and occasionally there may be a flare up of leg pain in the first few days. 5
The evidence shows that patients who return to a normal routine as quickly as possible make the best recovery. You should start walking immediately and try some gentle swimming as soon as the stitches are removed/dissolved. 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. Physiotherapy Following Microdiscectomy 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. You may see the physiotherapist the day after your operation, or you may attend a physiotherapy group the day before or after your surgery. You will be expected on your first day post-op to: Be up and walking around. Begin your exercises 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. You may experience some hip and back pain; this is due to the position you were in, in theatre whilst you had your surgery and this should resolve a few days after 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 o Use a firm mattress (not hard) which allows absorption of your hip and shoulder. o Lie horizontally in any position you find comfortable. Sitting posture o For the first few days sit for only 20-30 minutes at a time o Gradually increase your sitting time as you feel able o Use an upright chair o Get up and stretch every 20-30 minutes Standing Posture o Think about: o Standing tall o Stomach in o 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. 6
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 adviser. Lifting technique 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. 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 7
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 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. 8
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. 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. 9
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. 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. 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 a microdiscectomy is and 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 0151 529 8853 Physiotherapy team 0151 529 5451 Secretary to your consultant via hospital switchboard on 0151 525 3611 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. Produced by: Spinal nurses Reviewed: Oct 2017 Review Date: Oct 2020 The 10
11
The Walton Centre NHS Foundation Trust Lower Lane, Fazakerley Liverpool, L9 7LJ Tel: 0151 529 5511 Fax: 0151 529 5500 Visit www.thewaltoncentre.nhs.uk alternatively, log on to: www.thebraincharity.org.uk or call 0151 298 2999 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 2020 12