Postoperative Instructions

Pain Control

  • There may be discomfort in the surgical area.
  • Oral analgesics, muscle relaxants, and non-steroidal anti-inflammatory medications may be used as prescribed by your physician. Dr. Yeung has found that the routine post operative use of long acting opiods, augmented by short acting medication, and the use of interferential neural stimulation (RS Medical) will help with your post-operative recovery.
  • You may feel transient numbness and weakness in your leg from the local anesthetic used during surgery. This will usually start improving the first post op day. Occasionally, when the feeling comes back you will feel pain in the same or different area when the anesthetic wears off. Report this to Dr. Yeung, and he will monitor it. Depending on your surgical findings, there may be some expected nerve discomfort, especially if the herniated disc had to be freed from the irritated nerve, or if an inflammatory membrane was ablated.
  • You may experience post-op muscle spasm. This can be treated with medication or spinal blocks.
  • Dysesthesia, if it occurs, will usually go away in one week to several months. Rarely, it may be longer. How aggressively it is treated depends on its severity. If severe, it is usually treated aggressively with foraminal epidural blocks, sympathetic blocks, and medication. It is imperative that you contact Dr. Yeung if this occurs so it can be treated and resolved optimally.

Hospital Stay: Not Needed

You will remain in the recovery room until you are alert enough to leave. Have someone available to drive you home. Under certain rare circumstances, you may be advised to stay overnight in the hospital. If this is the case, the surgical facility will arrange your transfer. You should be able to rest comfortably at home or in your hotel. If you are from out of town, it is usually safe to travel one or two days after surgery, but an overnight stay is recommended.

Diet

  • Follow your regular diet.
  • You may eat after leaving the surgical facility.

Elimination

Avoid straining to have a bowel movement; a laxative may be used if needed, especially if you are taking opiod analgesics.

Hygiene

  • You may shower 1-3 days after your surgery.
  • No tub baths or hot tubs for about one week or until the wound is dry and healed.

Activities of Daily Living

  • Light activities may be resumed the evening of surgery.
  • Assistance may be needed the first few days with food preparation, lifting, and cleaning.

First Postoperative Week

  • Moderate activities with rest periods as needed.
  • No sexual relations until you are well on your way to recovery.
  • No lifting, bending, or twisting.
  • No lifting of more than 5 to 15 pounds after 1 week; no lifting over 25 pounds for 6 weeks.
  • You may return to work within 1 to 4 weeks after surgery or as able.
  • You may resume driving 1 - 2 weeks after surgery or sooner if you are able to do so safely-remember to maintain neutral positioning-do not slouch.

Body Mechanics

  • Important to maintain a neutral spine position with all postures and positions. Bend at the hips, knees, and ankles while keeping your back in neutral. Do not twist or forward bend at the waist.
  • Coughing or excessive strain on your back in the first 3 months may result in recurrence of your leg pain from a recurrent herniation.
  • Standing - weight evenly distributed on feet, keep knees soft, tighten buttock muscles.
  • Standing to sitting - bend at hips and use a step position.
  • Sitting - feet flat on the floor, weight through your sitting bones, and back straight. Avoid sitting for more than 40 minutes at a time without a break.
  • Sitting to side lying - no twisting, lower to side, and brace with abdominals.
  • Side lying to back lying - brace with abdominals and log roll.

Exercises

Strenuous exercise, such as tennis or skiing, may be resumed when indicated by your physician.

  • Walking

Week 1: 10 minutes - 3 times/day
Week 2: 15 minutes - 3 times/day
Week 3: 20 minutes - 3 times/day

These are walking guidelines only - you may walk as much as tolerated as long as your pain is not increased by walking.

  • Abdominal Bracing
  • Gluteal Sets
  • Partial Sit-Ups
  • Hamstring Stretch
  • Quadriceps Sets
  • Side lying Quad Stretch
  • Sit to Stand Transfers
  • Calf Stretch
  • Press-Ups
  • Swimming may be resumed 7 to 10 days after your procedure.

2-4 weeks after surgery, a formal program emphasizing lumbar stabilization followed by McKenzie type extension exercises is recommended for maximum benefit. If your surgery involves multiple levels or if it is primarily for discogenic pain, it is recommended that physical activity be restricted for 4-6 weeks to allow the annulus to heal and strengthen.

Wound Care

  • There will be tape strips across the incision which will fall off after several days. There will be a small dressing that may be removed the 3 days after your procedure. Sutures are not necessary.
  • Have someone check your wound site for increase in redness, drainage or swelling. Monitor your temperature - if your temperature rises above 100 degrees or any of the above wound changes occur, contact Dr. Yeung's office.
  • A follow-up appointment will be scheduled for you at one or two weeks postoperative with your surgeon.

In general, your choice of an endoscopic approach to your back problem is similar to choosing an arthroscopic approach to the knee or shoulder compared to the open approach. The results are similar, but the surgical morbidity is much less. You are encouraged to discuss all alternative approaches for your condition with your physician. It is hoped that this information will allow you and your physician to make the choice that is best for you.

New Developments

Recent advances in endoscopic surgical technique has allowed for successful endoscopic treatment of conditions such as Failed Back Surgery Syndrome caused by recurrent disc herniation, lateral recess stenosis, foraminal osteophytes, facet cysts, and many degenerative conditions of the lumbar spine such as degenerative and isthmic spondylolisthesis. Where the patho-anatomy can be accessed through the foraminal approach, treatment options may be possible. Biologics are also being considered for tissue healing and regeneration.

This approach is also possible for nucleus replacement or fusion. Advancements are being made yearly, and more alternatives to fusion will be available for painful degenerative conditions of the lumbar spine each year.

Glossary
Nucleus: The inner portion of the disc which has a gel-like consistency composed mostly of water and is surrounded by the annulus fibrosus (collagen).

Rev. 9/4/2001
Rev. 6/10/2003
Rev. 7/9/2004

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