Post Operative Care

Caring for yourself whilst recovering from spine surgery is highly important! Below we have additional information for Mr Malham’s patients that can be followed after your neurosurgery.


These general guidelines will assist you in looking after yourself during your neurosurgery operative recovery.


EPWORTH RICHMOND CERVICAL SPINE POST-OPERATIVE GUIDELINES DISCECTOMY

The following are some general guidelines to assist you in looking after yourself and your neck following your recent surgery.

If you have any questions, please do not hesitate to ask your physiotherapist.


The first 6 weeks:

– No heavy lifting (>2-5kg) – limit your lifting to light, household items

– No twisting, straining or bending your neck forward excessively

– No slouching – this can gradually strain your neck and result in pain. Maintain a good posture!

– Do not lift your arms above your head for prolonged periods i.e. no hanging out
the washing

– Do not drive a car (unless otherwise instructed by your surgeon)

– Log roll in and out of bed

– No working (unless otherwise instructed by your surgeon)

– You may need to wear a supportive collar depending on the surgeon’s orders and procedure.


Basic rules of lifting:

– Bend your knees and keep your back very straight.

– Hold objects in very close to your body.

– Never lift and twist – move your feet to step around

– Pushing is better than pulling

– Divide a heavy load into two smaller loads if possible i.e. shopping bags, get help if the item is heavy


Good Posture:

– Good posture is important as it reduces strain on your neck and back. Maintaining a good posture will help your recovery.

– Avoid slouching and a forward head When sitting it may help to use a position. Stand very straight. Small rolled towel or cushion behind your low back.


Between 6 weeks and 6 months:

– Gradually ease back into your normal activities. Increase the amount of activity, as you feel comfortable. Walking and swimming are good exercises to build up your strength and endurance.

– Please seek advice from your surgeon regarding returning to jobs involving heavy manual duties, or to sporting activities

– Please note these guidelines are general only. Your specific problems may vary and instructions from your surgeon may override these guidelines.


Collars

You may need to wear a collar after your operation to support and protect your neck. Nursing staff or the physiotherapist, will fit you with a collar if the surgeon orders it.


Before you go home, make sure you understand exactly when you must wear the collar, for example:

– When sitting up or walking

– In bed

– When showering

– When shaving


If you have any problems with the collar after you go home, ring your Physiotherapist on (03) 9426 6065.


EPWORTH RICHMOND POST-OPERATIVE GUIDELINES FOR LUMBAR LAMINECTOMY & DISCECTOMY

Please note these guidelines are general only. Your specific problems may vary and instructions from your surgeon may override these guidelines. 

 

A discectomy involves removing part or all of an intervertebral disc in order to decompress spinal nerves which may have become compressed when the disc prolapses or bulges out. The compression of spinal nerves can cause severe pain in the legs or feet, numbness, pins and needles and/or weakness in the legs. Bladder and bowel function may also be affected.


A “microdiscectomy” is a discectomy performed via tiny incisions with special instruments which cause less disruption to muscle tissue. This is known as a “minimally-invasive” technique.


Following discectomy, it can take up to 3 months for the disc to recover. Initially, the disc wall is weakened (from where it has been trimmed) and is therefore at risk of bulging out again.  For the first three months after surgery, it is essential that you AVOID excessive bending and twisting of your back as well as any heavy lifting.


Decompression of the spinal nerves may also be achieved by removal of part “laminotomy), or all “laminectomy” of the bony arch at the back of the vertebral body.


Some surgeons may also place a small stabilisation device (a “DIAM”, or a “Wallis Implant”) between the spinous processes to free pinched nerves or to support a weakened disc or arthritic joints.


The aim of back surgery is to relieve the nerve compression causing leg pain, weakness and/or difficulty walking. Your surgeon will discuss your individual case with you.


After your Surgery

  • You will start on a daily walking program. Aim to be walking at least 6-8 times daily before discharge home from the hospital
  • REST is very important to allow for healing
  • Sit only as directed by your surgeon.
  • DO NOT bend or twist the back
  • NO heavy lifting (nothing greater than 5kg)
  • Complete any exercises given to you by your physiotherapist


Below are some general guidelines for this post-operative period of up to 12 weeks.


GENERAL ADVICE

  • Getting in & out of Bed

    THE “LOG ROLL”


    Your hips and shoulders must roll over together as a unit (or like a log) so that the spine does not twist.


    Do not shuffle the hips back and forth; try to roll in one smooth movement.


    Once on your side, drop your legs off the edge of the bed and push up through your side using your elbow and hands.


    Once sitting, resist the urge to shuffle the hips forward one side at a time to get your feet on the ground- instead, slide your bottom forward by leaning back on your hands. Move symmetrically.


    To return to bed, the process is reversed.

  • Sitting

    You should sit in a straight-backed chair with armrests. A higher chair is much better than a lower chair. Never sit in a recliner chair with your legs up, as this puts the spine in an unnatural posture causing undue strain.


    Sitting may be restricted (check with your surgeon); otherwise, over the next 4-6 weeks, you may gradually start to build up your sitting tolerance. Be guided by your comfort.


    Sitting will make you stiff, so getting up and moving around regularly is wise. A small cushion or rolled towel positioned behind your lower back (a “lumbar roll”) helps to

    maintain correct spinal alignment – use this if it makes you more comfortable.


    Keep your computer screen or reading material at eye level when working at a desk.

  • Artificial Disc Replacement

    Peripheral Nerves


    Carpal Tunnel | Download PDF


    Ulnar Nerve | Download PDF


    A Patients’ Guide to Spine Surgery | Download PDF

  • Smoking

    Significantly delays bone and tissue healing. To optimise your outcome, you should not smoke.

  • Toilet

    You should lower yourself slowly and with a straight back. You may want to use a raised toilet seat or “over toilet frame” initially (please ask your therapist about this if you are not managing the standard toilet in the hospital). It may help to brace with your hands on your upper thighs as you sit down. Ensure you do not strain on the toilet.

  • Daily Activities

    For the first three months post-surgery you should avoid bending, twisting your back excessively. You will need to modify the way you perform your activities to ensure that you are looking after your back.

  • Personal Care & Dressing

    • Stand up in the shower
    • Stand on a towel to dry your feet instead of bending down
    • Choose clothes that fasten at the front and are easy to get into and out of
    • Do not stoop down to the tap. Use a face-washer to wash your face, and use a cup of water to rinse your mouth when brushing your teeth
    • Wear shoes that you can slip on easily, i.e. elastic-sided. Avoid reaching your feet.
    • You may need help/aids with socks and shoes or for picking up objects from the floor (ask your therapist about this if you need them).

  • Meal Preparation

    • Ensure that bench heights are suitable (so that you do not have to stoop over). Perhaps sit on a high stool to work on the bench
    • Avoid lifting heavy saucepans – slide them across benches
    • Double handles distribute the load more evenly.

  • Shopping

    • Make use of home delivery
    • Do not lift heavy bags
    • Push rather than pull a trolley.

  • Cleaning

    • Avoid heavy cleaning like vacuuming and mopping
    • For easier jobs, use long-handled appliances.

  • Laundry

    • You can load a top-loader washing machine. Avoid bending over and lifting out heavy loads of clothes.
    • Place clothes basket on a table or chair to minimise bending.

  • Safe Lifting

    You should not lift anything heavier than about 5kg for six weeks. Abide by the basic rules of lifting:

    • Bend your knees and keep your back very straight. The muscles of your spine are quite small compared with the large thigh and buttock muscles, so use these
    • for lifting.
    • Hold objects very close to your body. If held further out, more strain is placed on your back muscles, joints, and ligaments
    • Never lift and twist – move your feet to step around
    • Pushing is better than pulling – keep your back straight and use your leg strength to move an object. Pulling places a huge strain on your back.
    • Divide a heavy load into two smaller loads if possible e.g. shopping bags
    • Modify your environment to minimise the need to lift and move things.
    • Get help if the item is heavy.

  • Driving

    Returning to driving depends on your functional level and comfort after surgery. Your surgeon will advise you when it is safe to return to driving. (To drive against your surgeon's advice could affect your insurance coverage, so it is important to clarify this prior to discharge).


    Try to avoid car travel altogether in the first month; however, if you must be a passenger, get in carefully, as shown below. Once in, recline the seat 30-45 degrees. Use a small lumbar roll if the car seat does not provide adequate support. Return the backrest to vertical upon arrival, swing your legs out, and stand up.

  • Sleep

    Sleep in a firm bed if possible. Lying with a pillow under the knees is usually comfortable. If lying on your side, place a pillow between the legs to help maintain a straight spine.

  • Sexual Intercourse

    May be undertaken any time if comfortable. Lying on your back is generally easiest for the first few weeks.

  • Rehabilitation

    A period of rehabilitation may be required post-surgery to aid your recovery and to ensure a good return to independence and regular daily activities. Epworth has rehabilitation centres in Richmond, Brighton and Camberwell. There are also other private facilities in Melbourne and regional centres around Victoria.


    Where you go will depend on where you live and your specific needs. In rehabilitation, you will generally have two physiotherapy sessions daily, which may include hydrotherapy as appropriate.


    You should bring casual, comfortable clothes, such as tracksuits and comfortable, supportive shoes.

  • Discharge

    Please discuss with your surgeon whether this will be by car or ambulance.

PLEASE NOTE :
In the first few days following surgery you should notice some improvement in your leg pain or pins and needles. Numbness from prior to the operation often persists for a period of time (weeks to months).


For patients who had significant leg pain, weakness or numbness for a long time prior to surgery, it may take several weeks or months for these symptoms to improve, and in some cases, they may never fully recover.


It is very common to get occasional twinges of pain in the back, buttocks, hips or in one or both legs. Muscle cramping or spasms in the buttocks, back or legs may occur particularly at night. These will usually resolve by themselves.


As activity increases it is normal to get some back ache. This need not cause any alarm or cause you to stop exercising. Remember to increase your activity gradually and to “listen to your body” to help judge how quickly to progress. Remember, it is important to maintain an active lifestyle in order to make the most of your surgery.


ACTIVITIES ON DISCHARGE

  • Walking

    It is important to exercise daily. It is well-known that early activity after back surgery results in better recovery. Walking is the exercise of choice. Wear a pair of sensible, thick-soled shoes and walk on good footpaths and reasonably level ground. Have 2-3 exercise sessions per day, every day, and very gradually increase the amount of walking you are doing, i.e. by 2-5mins per session per day. It is important that you start with a distance you can comfortably manage. Remember, pain may come on after (and not necessarily during) exercise, so it is wise to start any new activity slowly and build up your endurance. It is best to exercise regularly every day rather than a lot one day and nothing the next.

  • Healthy Weight Loss

    Being overweight puts extra strain on your back and other joints and can place you at risk of further injury. As well as the cardiovascular benefits of keeping trim and fit, this is another good reason to get into a daily walking program! (The Heart Foundation recommends walking 30-45 minutes most days of the week).

  • Swimming

    Your wound should fully heal before entering a pool (usually 2-3 weeks). You should consult your surgeon first before commencing swimming. You may start with walking in chest-depth water. Please be advised by your surgeon as to when you may commence lap swimming (usually after six weeks).

  • Physiotherapy

    Generally, physiotherapy is not required in the first six weeks post-surgery. After your 4-6 week review with your surgeon, you may wish to attend the physiotherapist to assist in progressing your exercises and general fitness, to advise and support you in returning to work or to assist with returning to sport or other physical activity.


    You should get clearance from your surgeon first before attending the physiotherapist. Most private practice physiotherapists are familiar with spinal surgical patients and will be able to treat you effectively and safely.

  • Returning to Work

    Returning to work depends on the type of work you do. Some people may not be able to return to the same roles they had before the surgery (i.e. very heavy work or work involving repetitive bending and rotation under stress) or will have to wait at least three months. Further discussion with your surgeon is necessary.


    For office-based jobs, it depends on your functional level and comfort. A graduated return is recommended with certain duties modified so that you can perform them, for example, interspersing short (15-30 mins) periods of sitting and typing with standing or walking tasks. A workplace assessment could be organised through your employer or community physiotherapist. This looks at your work environment (i.e. desk/ office/ workshop set-up) and various tasks you must perform.

  • Sport

    You should not participate in high-impact activities (including golf) until after your surgical review in 4-6 weeks. Gentle walking is the best exercise. A physiotherapist can advise you down the track if you wish to return to sport.

REMEMBER

  • Avoid twisting and bending. Maintain a good posture
  • Log roll to get in and out of bed
  • No heavy lifting (greater 5kg)
  • No high impact sports
  • WALK daily


Follow-up Appointment with the Surgeon

This is generally between 2 – 6 weeks post-surgery, but for country patients it may be later than this. It is a good opportunity at this appointment to ask any questions you may have of the surgeon such as when you may return to certain activities. It is a good idea to keep a list of questions that may come up over the initial post-operative period.


If you would like to consult a physiotherapist after this appointment you should get clearance from the surgeon and take any documentation you have about your surgery to the physiotherapist.


A FINAL NOTE

Contact your surgeon if you:

  • Develop any new or increased back or leg pain, numbness, weakness or pins
    and needles
  • Have problems urinating or opening your bowels
  • Develop a fever or if you notice any ooze from the wound.


“If you have any questions that arise after your discharge from hospital, that you feel your physiotherapist may be able to assist you with, please phone them on (03) 9426 6065.”