Post-operative Back Surgery Instructions

For patients of Dr. Alan J. Appley, MD FACS – Acadiana Neurosurgery

LENGTH OF STAY
 
Microdiscectomy
  • Patients usually can be discharged on the first postoperative day. Patients can generally be discharged when liquids and oral medications can be taken.
DecompressiveLaminectomy or Laminotomies
  • Patients usually require 2-3 days in the hospital. With more extensive surgery, an extra day or two in the hospital may be required. Occasionally, a brief stay in a rehab facility may be beneficial.

 
FUSION (with or without instrumentation)
  • Patients usually require 3-5 days in the hospital. With more extensive surgery, an extra day or two in the hospital may be required. A brief stay in a rehab facility is often recommended for older patients or those with more extensive surgery.

 
WOUND CARE
 
You may shower immediately.
  • If you have staples or sutures, keep your incision dry for the first 3 days after surgery. After that, the staple or suture line may be washed in the shower. However, don't soak the incision in the tub or swimming pool until it has healed well (usually by the first post-op visit).
  • If you have steri-strips, keep them covered by gauze and plastic when showering
  • If your incision was closed with DermaBond®, then you do not have to cover the incision when showering; however, you should not scrub the area.

Whether you have steri-strips, staples or sutures, you are to paint your incision daily with peroxide (if you have steristrips, just paint down the middle where the incision would be; don't do this if you are allergic to peroxide).

  • Steri-strips are to be removed one week after surgery (or 10 days if this is a repeat surgery).
  • If you have staples (difficult closures or multiple surgeries), then you will need to be seen in the office 7-10 days after surgery for staple removal.

If your incision was closed with DermaBond® (“super glue”), then you should not paint the incision with peroxide, alcohol, ointment or petroleum jelly as that may loosen the adhesive. You should have received a specific set of instructions for patients with incisions closed with DermaBond®; if not, ask the nurse or our office for those instructions.

You must notify us if any of the following develop:

  • Fever
    • A low-grade fever (<101) is common for a few days after surgery. If this happens after you are discharged, you should take your temperature 4x/day until your temperature is below 100 for 24hrs. Call if the elevated temperature persists for more than 48hrs and/or your temperature goes above 101.
  • Redness or swelling of the incision.
  • Drainage from the incision.
  • Increasing, rather than decreasing pain at or around the incision site.

 
ACTIVITY
  • After a microdiscectomy you should drastically limit your sitting for the first 2 weeks. Standing, reclining, lying down and walking are the best positions.
  • There is no restriction to sitting if a discectomy was not performed. However, too long in any one postion will be uncomfortable and it is better to change positions frequently.
  • Walking is excellent, just don't overdo it.
  • Exercises for the upper body are OK after 2-3 weeks only if light weights are used and the back is protected.
  • Avoid sexual activities for 2-3 weeks.
  • Avoid twisting, bending and stooping for the first 2-3 weeks after a discectomy or decompression. If a fusion was performed, then these activities will be limited for 3 months.
  • No lifting for 6 weeks.

 
BACK BRACE

The use of your brace is a very important part of your surgery. It is vital that you wear it as directed. There are several types of braces that may be ordered.

Lumbar Corset
  • This is usually worn when the rigid brace has been removed after a fusion. It may also be used for occasional support after a discectomy or laminectomy has been performed. However, a corset is generally not prescribed immediately after surgery.

Rigid Brace (LSO or TLSO)

  • After a fusion is performed, rigid bracing is usually prescribed for 3 months. Occasionally, longer periods of bracing are required.
  • Usually, the brace can be removed and replaced while standing at the bedside. In addition, patients are generally allowed to use the restroom without having to put on the brace. However, longer periods out of bed or the recliner should be spent with the brace on (and snug).

 
PHYSICAL THERAPY
 
Microdiscectomy
  • Physical therapy (PT) is generally not necessary except to:
    • Provide strengthening if weakness is present
    • Provide a home exercise program for overall back strengthening and improved flexibility.
Laminectomy
  • PT is often prescribed in the hospital after surgery for assistance with walking and general strengthening.
  • Home or outpatient PT may also be prescribed if indicated.
Fusion
  • PT will be prescribed in the hospital and is usually also done at home or on an outpatient basis (at the PT clinic).
  • A conditioning program will usually also be prescribed once the brace is no longer required.

 
X-RAYS

If a fusion is performed, then follow-up x-rays are necessary.

  • A prescription for your first post-op x-ray 2-3 weeks after surgery should be given to you before surgery (along with the prescription for your post-op pain medication).
  • Have the x-rays taken as close to the appointment as possible (1-3 days) and bring the films with you to the appointment. It is also helpful to bring the pre-op x-ray with you for comparison.
  • X-rays are usually taken every 4-6 weeks for the first 3 months, then again at 6 months post-op. For each appointment, please bring the x-rays from previous visits so that the progress of the fusion can be monitored accurately.

 
PAIN

Microdiscectomy

  • Your leg pain should be much better, if not completely resolved, immediately after surgery. Any numbness should also be better, but often takes quite awhile to go away completely. Occasionally, some numbness may be permanent.
  • Discomfort from the skin incision is usually not too significant. There will be some soreness and muscle spasm on the side of the incision that corresponds to the side of the leg pain (the side of the disc that was removed). This pain should diminish fairly quickly as will the requirement for pain medication.

Laminectomy (with or without a fusion)

  • The leg pain will hopefully be much better right away.
  • However, there will be significant back pain and muscle spasm from this surgery. It will be several months before you will be able to “forget” that you had the surgery, but the early severe post-op pain should get much better over the first few weeks.

Don't be surprised if some of the leg pain seems to come back after a few weeks. It usually only represents inflammation due to healing and should respond best to NSAIDs (though not allowed for fusion patients). Call if the pain does not respond to rest and a brief return to your early post-op medication regimen.


 
POST-OP MEDICATIONS
 
Narcotic analgesics will usually be prescribed for the early post-operative period. Muscle relaxants will probably also be helpful. NSAIDs (nonsteroidal anti-inflammatory drugs) are helpful in reducing the requirement for narcotic analgesic medications and may also be prescribed. Over-the-counter NSAIDs (Motrin IB, Advil, Aleve, etc.) can be used instead of prescription-strength NSAIDs.
  • NSAIDs (e.g., ibuprofen, naproxen, diclofenac, Motrin, Advil, Naprosyn, Voltaren, etc.) impair the fusion process and are not allowed for 6 weeks after a fusion. However, there is evidence to suggest that some of the newer drugs such as Celebrex and Vioxx may not be a problem. These may be prescribed if necessary.

 
FOR QUESTIONS
  • Please feel free to call our office at (337) 235-7743 for any questions or concerns regarding your surgery. Our nurse, Amanda, will most likely be able to answer your questions and will always discuss your case with me or the physician covering my patients if I am not available.
  •  Email questions are welcomed and are probably more efficient. They will usually be answered by the next business day. However, do not use email for urgent concerns such as a possible infection or neurologic symptoms.

   

 

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