After Lower Back Surgery: A Guide (2006)

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Con­tents

1. Why You Should Read This Pam­phlet
2. Ques­tions to Ask Your Doc­tor Before Going Home
3. Lower Back Surgery Pic­ture Guide
4. Con­trol­ling Pain After Surgery
5. Man­ag­ing Con­sti­pa­tion
6. Car­ing for Your Wound After Back Surgery
7. Warn­ing Signs That You Might Have a Prob­lem
8. Mov­ing Around When You Get Home
9. Self Care
10. Meal Prepa­ra­tion and House­keep­ing
11. Gro­ceries
12. Dri­ving
13. Rid­ing in a Car
14. Fit­ness Exer­cises
15. Sex­ual Activ­ity
16. Addi­tional Resources & Information


1. Why you should read this pamphlet

The infor­ma­tion in this pam­phlet will help to answer your ques­tions about recov­ery after lower back surgery. The pur­pose of this pam­phlet is:

  • to pre­pare you for what to expect dur­ing the 23 days you will be in the hospital.
  • to guide you in return­ing to your daily activ­i­ties after you leave the hospital.
  • to give you the infor­ma­tion you need to keep your back healthy and pre­vent re-​injury.

What to expect while you are in the hos­pi­tal
On the fol­low­ing page, you will find a pic­ture guide. It will show you what to expect to hap­pen in the hos­pi­tal after your surgery on your lower back (laminec­tomy or diskectomy).

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2. Ques­tions to ask your doc­tor before going home

  • When can I go back to work?
  • When can I start dri­ving a car?
  • When can I start sex­ual activity?
  • When can I start favourite sport/​exercise?
  • When can I start [other activ­i­ties not men­tioned above]?
  • other

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3. Lower back surgery pic­ture guide

DAY OF SURGERY DAY 1 AFTER SURGERY DAY 2GOING HOME
Activ­i­ties Mov­ing with help
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  • Phys­io­ther­apy
  • Walk­ing with help
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  • Able to walk on your own and do stairs.
  • Use this pam­phlet to help you.
  • Please arrange for some­one to drive you home.
  • Usual time to leave the hos­pi­tal is 9:00 AM.
Breath­ing Exercises Deep breath­ing 10 times every hour using incen­tive spirom­e­ter
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Deep breath­ing 10 times every hour using incen­tive spirom­e­ter
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Deep breath­ing con­tin­ues
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Pain Con­trol Pain con­trol using a pump (Patient Con­trolled Anal­ge­sia = PCA)
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Med­ica­tion for PAIN and lax­a­tives for con­sti­pa­tion
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Pre­scrip­tion for pain med­ica­tion when leav­ing the hos­pi­tal
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Food Liq­uid → Reg­u­lar meals
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High-​fiber, high pro­tein meals
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High-​fiber, high pro­tein meals at home
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Care of Wound Ban­dage check by nurse
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Ban­dage change by nurse
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Check your wound daily for:

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4. Con­trol­ling pain after surgery

Paiin can result from:

  • Your wound
  • Swelling around the nerves that were “pinched” before the operation
  • Swelling around the wound

This pain may con­tinue even after you leave the hos­pi­tal. This does not mean that your oper­a­tion was not a success.

You will recover faster when your pain is well controlled.

When pain is well con­trolled you are able to eat, sleep and move around more easily.

Talk to your nurse and doc­tor when you have pain. Tell them if the pain med­ica­tion you are tak­ing is giv­ing you the relief you need.

Pain is eas­ier to con­trol when it is treated early and reg­u­larly. It is never a good idea to try and “hold off” as long as pos­si­ble between doses of pain med­ica­tions. This could cause pain to get worse and make it harder to relieve.

While you are in the hos­pi­tal, nurses will often ask you to rate your pain from 0 (zero) to 10 (ten). 0 means you are not hav­ing any pain and 10 means you are hav­ing the worst pain you can imagine.

Fear of Addic­tion to pain relief med­ica­tion is com­mon among patients. The truth is that med­ica­tions used to treat your pain rarely cause addic­tion. This hap­pens less than 1% of the time. (McCaf­fery, & Pasero, 1999). Your doc­tor, nurse and phar­ma­cist know how to use these med­ica­tions safely. Please talk with them about your fears about your pain con­trol medication.

Side effects: Pain relief med­ica­tions can cause con­sti­pa­tion, nau­sea, and vom­it­ing, or drowsi­ness. These side effects can be reduced or pre­vented with the help of your nurse and doc­tor. Side effects usu­ally stop after a few days. If nec­es­sary, your doc­tor can change the med­i­cine or the dose. Please talk with your nurse and doc­tor about your past expe­ri­ences with pain medications.

Tips to help with your pain:
  • Ask a fam­ily mem­ber to fill your pre­scrip­tion on the way home from the hospital.
  • Take pre­scribed pain med­ica­tion when you feel your pain is more than 3 out of 10 on the pain scale.
  • Do deep breath­ing to relax your back muscles
  • Change posi­tion often and never stay in a painful position
  • Lis­ten to your body dur­ing exer­cise – too much pain will tell you that you are going too far.

Foods high in pro­tein help with wound heal­ing. They include:

  • Meat
  • Beans and nuts
  • Cheese, yogourt, milk and eggs

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5. Man­ag­ing Constipation

Con­sti­pa­tion often hap­pens right after surgery. This can be because of:

  • Side effects of strong pain med­ica­tion such as mor­phine, hydro­mor­phone, codeine
  • Not mov­ing as much as usual

Try to have a bowel move­ment before com­ing to the hos­pi­tal.
Try to have a bowel move­ment by the third day after your surgery.

Tips to keep your bow­els moving:

  • Eat lots of fibre such as All Bran™, prunes, fresh fruit and vegetables
  • Drink plenty of liq­uids (approx­i­mately 8 glasses per day) such as water, soup, juice, and milk
  • Get up and move about as much as possible.
  • Stool soft­ener (exam­ple: Colace™) and lax­a­tive (exam­ple: Senokot™, Milk of Mag­ne­sia™ or Lactulose™)

Please tell your doc­tor and nurse if you have a his­tory of con­sti­pa­tion or other bowel problems.

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6. Car­ing for your wound after back surgery

To help your wound heal please fol­low the instruc­tions below that apply to you as requested by your doctor.

Car­ing for wounds closed WITH stitches or staples

  1. You should keep your wound cov­ered with a ban­dage until your stitches/​sta­ples are removed.
  2. You should keep your wound and ban­dage dry at all times until your stitches/​staples are removed. If it acci­den­tally becomes wet, replace it imme­di­ately with a new dry bandage.
  3. Change your ban­dage every sec­ond day until your stitches/​staples are removed. Your nurse will organ­ise it with your CLSC. After your stitches/​staples are removed you no longer need to keep a ban­dage over your wound.
  4. Your stitches/​staples will be removed on _​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​
  5. When you take a shower cover the ban­dage with plas­tic and water­proof tape to make sure it doesn’t get wet.
  6. After your stitches/​staples are removed you may take a shower with­out cov­er­ing your wound. Use warm water and mild soap. Remem­ber to pat dry (never rub) your wound after your shower.
  7. A fam­ily mem­ber, or a friend should look at your wound every day after your stitches/​staples are removed. If you are alone you can use a mir­ror to look at your wound. At first, you might find the wound look­ing slightly red or swollen. It might also be sore if you touch it. These are nor­mal signs of heal­ing and they should grad­u­ally go away in the next few weeks.

Car­ing for a wound closed WITH­OUT stitches or staples

  1. You may remove the outer ban­dage that cov­ers your wound five days after your operation.
  2. You can take a shower seven days after your oper­a­tion. Use warm water and mild soap. Remem­ber to pat dry (never rub) your wound after your shower.

    The steri-​strips (small paper strips along your wound) should start to fall off by them­selves within two weeks after your oper­a­tion, If they are still on after two weeks, gen­tly peel them off after your shower.

  3. A fam­ily mem­ber, or a friend should look at your wound every day for the first two weeks after your oper­a­tion. If you are alone use a mir­ror to look at your wound. At first, you might find the wound look­ing slightly red or swollen. It might also be sore if you touch it. These are nor­mal signs of heal­ing and they should grad­u­ally go away in the next few weeks.

Infor­ma­tion for ALL patients regard­ing car­ing for your wound

GEN­ERAL WARN­ING SIGNS that you might have a prob­lem with the heal­ing of your wound: If you should expe­ri­ence any of these, call your surgeon’s office.

  • Any increase in the amount of red­ness, pain, or swelling
  • Any leak­ing (drainage) from the wound, for exam­ple, the ban­dage becomes a lit­tle wet from leak­ing from the wound and needs to be changed
  • Any small area of open­ing along the wound
  • Slight fever with­out any flu-​like symptoms

If you should expe­ri­ence any of the above, please con­tact your surgeon’s office.

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7. Warn­ing signs that you might have a problem

SEVERE WARN­ING SIGNS

SEVERE WARN­ING SIGNS that you might need IMME­DI­ATE med­ical attention:

If you should expe­ri­ence any of the prob­lems below, imme­di­ately call your surgeon’soffice.

On evenings, nights, and week­ends or if you are unable to reach your sur­geon, go to the Emer­gency Room of the Royal Vic­to­ria Hos­pi­tal. If you live out-​of-​town go to the Emer­gency Room of your local hos­pi­tal.

  • Large area of open­ing along the wound
  • Large amount of drainage or leak­ing (for exam­ple, ban­dage becomes wet and needs to be changed more than twice a day)
  • Swollen, red wound with foul-​smelling green­ish or yel­low­ish discharge
  • Fever (higher than 38 degrees Cel­sius or 100 degrees Fahren­heit and flu-​like symp­toms (e.g. chills, feel­ing unwell, severely tired)
  • Severe headache that will not go away
  • Increas­ing pain, weak­ness or numb­ness in your legs
  • Trou­ble breathing
  • Prob­lems con­trol­ling your bowel move­ments or blad­der (urine)

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8. Mov­ing around when you get home

Dur­ing the six weeks fol­low­ing your oper­a­tion you should grad­u­ally return to your nor­mal activ­i­ties (light house­clean­ing, self-​care) unless your doc­tor tells you not to. Walk­ing is a good way to exer­cise to improve your gen­eral strength and nergy level. You should only feel a lit­tle pain when doing these tasks.

Some prob­lems that you might have in your daily life are:
  • Back pain
  • Lack of strength in your legs
  • Lack of energy (you will get tired easily)

Fol­low­ing these instruc­tions from the phys­io­ther­a­pists and occu­pa­tional ther­a­pists will help you to pro­tect your back from re-​injury.

image Lying down
Lying down puts the least amount of pres­sure on your back. Your phys­io­ther­a­pist can help you find the posi­tion which is most com­fort­able for you. Use a firm mat­tress or couch. Soft pil­lows can pro­vide sup­port for your neck and legs (under knees).

To sit up, log-​roll onto your side and push off with your arms while gen­tly swing­ing your legs to the floor.

image

image Stand­ing
Main­tain the three nat­ural curves of your back when you stand.

If you are stand­ing for more than a few min­utes, it may be more com­fort­able if you place one foot on a stool. Your work­ing sur­face should be close to your waist height.

When and if you must work in a stooped (for­ward) posi­tion, you should change your posi­tion every 1015 min­utes by stand­ing upright and bend­ing back­wards approx­i­mately 510 times. Remem­ber to stop if you start to feel pain.







Sit­ting
image Sit­ting puts more pres­sure on your spine than lying or stand­ing. When your phys­io­ther­a­pist tells you, you may begin to sit but for no longer than 1015 min­utes at a time.

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Type of chair: When you do sit, use a chair with a straight back­rest. Arm sup­ports will make it eas­ier for you to sit down and get up. You may want to place a small towel or pil­low between the chair and your lower back to help main­tain your nor­mal lum­bar (lower back) curve. Stand up and change posi­tions when you begin to feel any pain in your back. A higher seat will help you get up with min­i­mal pain. If the chair is too low, you can add a firm pil­low on your seat.

When you are work­ing in a sit­ting posi­tion, sup­port your feet, keep your work close to you and do not slouch.

Reach­ing down
You may have dif­fi­culty reach­ing for some­thing on the floor or in a low cupboard.

If your legs are strong enough, you may lower your body by bend­ing your knees, keep­ing your back straight.

image

Keep the things you often use in places where they can be eas­ily reached.

Lift­ing
For the first 6 weeks fol­low­ing your oper­a­tion, do not lift any­thing heav­ier than 2.5 kilo­grams or 5 pounds. If you must lift some­thing, keep your back straight, bend your knees, keep the object close to you and let your leg and arm mus­cles do the work, not your back. Move slowly and do not move sud­denly. These sug­ges­tions will help to pre­vent future pain and injury to your back.

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9. Self care

image Get­ting Dressed
Dur­ing the first weeks you may find it hard to put on your under­wear, pants, socks, and shoes. You may need help at first.

If you find it hard to get dressed when sit­ting down, try to dress while lying in bed.

When putting on your under­wear or your pants, always put your weaker leg in first.

Putting on your socks and shoes will be the most dif­fi­cult. A trick is to sit down and cross your leg over your knee to put your sock and shoe on.

Remem­ber the same idea of bring­ing your legs to your body while sit­ting for wash­ing (see below) also applies when dressing.

Wash­ing yourself

  • Dur­ing the first weeks, it may be dif­fi­cult to wash your legs and feet because bend­ing for­ward is not recommended.
  • Sit­ting on the bot­tom of the tub is not rec­om­mended as it puts too much pres­sure on your back when get­ting in and out.
  • To wash and dry your­self bring one leg toward you or cross you leg over your knee while sit­ting in a chair.

NEVER try to lean for­ward to reach your feet, as this will put too much stress on your back and cause pain.

Bath

  • You will be able to get into the bath­tub when you can com­fort­ably lift your foot over the rim of the tub.
  • To help you get into the bath­tub, place your hands on the walls to get bet­ter sup­port, and then step in. Do not hold on to the sink or grab the towel bar or soap dish bar.
  • Always use an anti-​slip mat in and out­side your bath­tub to avoid falls. Make sure that all sur­faces are dry before get­ting in the tub.
  • In the bath, do not sit on the bot­tom of the tub. It will put too much pres­sure on your back when get­ting in and out. Use a bath chair or remain stand­ing and have a shower.

After 6 weeks, ask your doc­tor if you may sit on the bot­tom of the bath­tub. Your doc­tor will need to judge if you are able to bend for­ward with­out hurt­ing your back.

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10. Meal prepa­ra­tion and house­keep­ing tasks

When you get home you can pre­pare your own light meals (break­fast, soup, sand­wiches, etc.) and do light clean­ing (dishes, etc.). These are good activ­i­ties to build up your strength and energy level.

When you carry light objects, you should hold them close to your upper body, with both hands so that you do not strain your back.

Ask a friend or fam­ily mem­ber to help you pre­pare big meals or do heavy clean­ing tasks like vac­u­um­ing, or wash­ing the floor. For Que­bec res­i­dents your local CLSC can pro­vide a list of pri­vate agen­cies. They can help you with house­keep­ing tasks/​services, and meal prepa­ra­tion. A fee would be charged for these services.

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11. Gro­ceries

Dur­ing the first 6 weeks, please get help car­ry­ing your gro­ceries. It may be help­ful to use a deliv­ery service.

After 6 weeks, you may begin to carry light bags close to your body. If you feel any strain in your back, it is too heavy for you.

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12. Dri­ving

Please ask your doc­tor when you may start dri­ving, that is: get­ting behind the wheel of a car.

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13. Rid­ing in a car

Please arrange for some­one to drive you home from the hos­pi­tal. A car seat is very low and can cause strain on your back while get­ting in and out of the car.

Here are a few tips for get­ting into the car after your surgery:

  • You may put a firm pil­low on the seat to make it higher.
  • Posi­tion the back­rest to sup­port your back and make sure that the seat is as straight up as pos­si­ble (90°).
  • Push the car seat back­ward in order to make more space to get in and out.
  • When you get in, sit first and then lift one leg at a time into the car.

We rec­om­mend that you do not ride in a car (except to go home) for a period of two weeks after your operation.

When you begin trav­el­ling in a car start with short trips of less than 30 minutes.

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14. Fit­ness exercises

Gen­eral fit­ness is one of the most impor­tant ways to keep your back strong. While in the hos­pi­tal and for the first few weeks, walk­ing is the best way for you to improve your fit­ness level with­out putting too much stress on your back. Your phys­io­ther­a­pist and doc­tor will help you decide how to progress in the amount of exer­cise you do as you recover.

Once you are at home:
  • Begin with walk­ing. It is impor­tant to walk with­out back pain. so start with a short walk, per­haps from your front door to the side­walk. Then build up to 20-​minute walks. You may find it eas­ier to walk in a shop­ping mall.
  • Once you can walk for 20 min­utes with­out pain, you may begin to walk on small hills. Remem­ber, if it hurts, you are doing too much!
  • Lis­ten to your body and stop any activ­ity that causes pain. Remem­ber, your back is still heal­ing — do not force your­self to do more than your body is ready to do.

6 weeks after surgery — activ­i­ties to con­sider
Swim­ming, espe­cially the front crawl and back­stroke, is an activ­ity that is easy on your back. Check with your doc­tor or phys­io­ther­a­pist before start­ing this activity.

12 weeks after surgery
Exer­cises that place more stress on your back such as run­ning, bicy­cling, golf, alpine ski­ing, racket sports and con­tact sports should not be attempted before 12 weeks after your surgery and only after you have talked with your doc­tor or physiotherapist.

REMEM­BER: Your back needs to heal before you do activites that will put strain on it!

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15. Sex­ual Activity

You should talk to your doc­tor about when you may resume sex­ual activ­ity. You should start care­fully after your surgery. The key is find­ing com­fort­able posi­tions that don’t require a lot of move­ment– take a pas­sive role, and let your part­ner do the move­ment. If you lie on your back put small pil­lows or rolled tow­els under your neck and lower back to sup­port your spine. Avoid arch­ing and thrust­ing your back. If you expe­ri­ence pain, wait until it becomes more comfortable.

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16. Addi­tional Resources & Information

Ref­er­ences:
McCaf­fery, M. & Pasero, C. (1999). Pain: Clin­i­cal Man­ual (2d ed.) p.163. St. Louis: Mosby
Strayer, Andrea. (2005). Lum­bar spine: Com­mon pathol­ogy and inter­ven­tions. Jour­nal of Neu­ro­science Nursing,37(4), 181193.

Infor­ma­tion about InfoNEURO
This infor­ma­tion is pro­vided by Neuro-​Patient Resource Cen­tre
Mon­treal Neu­ro­log­i­cal Hosp­tial Room 354
Tel: (514) 3985358
E-​mail: infoneuro@​muhc.​mcgill.​ca
Web site: http://​infoneuro​.mcgill​.ca/

This infor­ma­tion is for edu­ca­tional pur­poses only, and is not intended to replace the advice of a pro­fes­sional health­care prac­ti­tioner, or to sub­sti­tute for med­ical care.

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Revi­sion of Your Recov­ery After Lower Back Surgery devel­oped by Martha Stew­art MSc(A), CNN©, Lau­rel Lowry BSc(N), CNN©, Ha Quach BSc(N), Erik De Agos­ti­nis, BSc(N), CNN©, Danielle St-​Arnaud, BSc(N), CPN©, Depart­ment of Nurs­ing, and Eileen Beany Peter­son MLIS, Neuro-​Patient Resource Cen­tre.
Reviewed by Dr. Jef­fery Hall, Depart­ment of Neu­ro­surgery.
Pro­duced by the Neuro-​Patient Resource Cen­tre 2006


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