Laminectomy For Herniated Disk

WHAT YOU SHOULD KNOW:

  • A laminectomy (lam-ih-NEK-tuh-mee) is surgery to take out the bony arches (lamina) of one or more of the bones in your back. A disk (tough sac filled with a jelly-like substance) sits between each of the bones in the back and neck. These disks act as shock absorbers. The cover of the sac may weaken and leak or bulge out. This is called a ruptured (RUP-sherd) or herniated (HER-nee-a-ted) disk. After a sudden jarring injury, the disk, or part of the disk, may herniate and need to be removed. Increasing age may also cause a disk to weaken and herniate.

  • A herniated disk may put pressure on a nerve or the spinal cord. This pressure can make one leg or arm hurt or become numb. The muscles in that leg or arm may even get smaller. This is called muscle wasting. You will have tests, such as a CT scan or MRI, to see how bad your injury is. You may have already tried bedrest, medicines like ibuprofen (i-bew-PRO-fin), a chiropractor (KI-ro-prak-ter), or physical therapy. If these treatments did not make your problems go away, you may need surgery.
    Picture of a normal spine

INSTRUCTIONS:

Take your medicine as directed.

Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

  • Your caregiver may give you anti-inflammatory (in-FLAH-muh-tor-e) medicine such as ibuprofen (i-bew-PRO-fin). This helps to decrease the swelling and redness (inflammation) of the area around your stitches or staples.

  • If you are having pain or muscle spasms, your caregiver may give you medicine to relax the muscles in your back or neck.

  • You may be given stool softeners to keep you from getting constipated (KON-sti-pa-ted). Constipated means it is hard to have a BM. Stool softeners make your BM softer so you do not need to strain when having a BM. You can buy stool softeners at a grocery or drug store.

Keep all appointments:

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Activity guidelines:

  • Driving: Ask your caregiver when you can begin to drive again. During the first weeks after surgery, ride in a car as little as possible. The motion of the car may cause your back to hurt.

  • Lifting: Avoid lifting heavy objects. This means not to carry things like groceries or laundry. Do not lift anything over your head.

  • Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.

  • Sexual Activity: You may have sex when you feel ready. Some patients may have problems with sex after a laminectomy. These problems are usually short-term. Talk to your caregiver if you are worried. Caregivers can help you find ways to handle these problems.

  • Work: Ask your caregiver when you can return to work.

Bathing with stitches:

Follow your primary healthcare provider's instructions on when you can bathe. Gently wash the part of your body that has the stitches. Do not rub on the stitches to dry your skin. Pat the area gently with a towel. When the area is dry, put on a clean, new bandage as directed.

Wearing a brace:

A physical (FIZ-uh-kull) therapist may fit you for a brace to help support your back. You must wear the brace while walking or sitting in a chair. Ask your caregiver if you are allowed to go to the bathroom without the brace. You may need to wear the brace for about 3 months.

Constipation:

Do not try to push the bowel movement out if it is too hard. High-fiber foods, extra liquids, and regular exercise can help you prevent constipation. Examples of high-fiber foods are fruit and bran. Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work. You may also be told to take over-the-counter fiber and stool softener medicines. Take these items as directed.

Diet:

Eat healthy foods from all of the 5 food groups: fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster.

  • Your caregiver may want you to eat a diet high in calcium. Foods high in calcium are milk, cheese, ice cream, fish, and dark green vegetables, like spinach. High calcium foods help prevent bone loss.

  • It can take time getting used to a new diet. Special cook books may help the cook in the family find new recipes.

Drinking liquids:

Adults should drink about 9 to 13 cups of liquid each day. One cup is 8 ounces. Good choices of liquids for most people include water, juice, and milk. Coffee, soup, and fruit may be counted in your daily liquid amount. Ask your caregiver how much liquid you should drink each day.

Medicines:

Caregivers may suggest that you take medicine for depression (sadness), swelling, and to help your muscles relax. Injections (needles) to numb (make you lose feeling in) painful areas may also help decrease pain.

Movement guidelines:

  • Bending: When you stoop down to pick things up off the floor, bend your knees and keep your back straight. Do not bend at the hips

  • Sitting: When you sit down, put your feet on a footstool. Do this so your knees are at the level of your hips or higher. Do not sit in soft or overstuffed chairs. Firm chairs with straight backs give better support. Use a raised toilet seat if needed.

  • Sleeping: Make sure you have a firm mattress on your bed. When lying on your back, place 2 or 3 pillows under your knees and the lower part of your legs to raise them. When lying on your side, bend your knees and use a small pillow under your head and neck. This will decrease the strain on your shoulders, neck and arms. Do not lie on your stomach.

  • Twisting: Do not twist at the waist.

Managing pain:

  • Ice: Ice causes blood vessels to constrict (get small) which helps to decrease inflammation (swelling, pain, and redness). Ice is best started after surgery and for the next 24 to 48 hours afterwards. Put crushed ice in a plastic bag and cover it with a towel. Place this on the incision for 15 to 20 minutes every hour as long as you need it. Do not sleep on the ice pack because you can get frostbite.

  • Pain Clinic: Treating pain after a laminectomy can be very difficult. The surgery may not get rid of your pain completely. Caregivers may suggest that you go to a pain clinic to help you learn new ways to live with pain. You will be shown different methods of pain control to try. You may try one or more of the following kinds of care or treatment for your pain:

    • Acupuncture: This treatment is based on a belief that our bodies have channels through which fluids flow. Caregivers will insert many small, thin needles just under your skin. This is believed to open the channels allowing fluids to flow better. This treatment may decrease pain and improve healing. Always see a caregiver for this treatment. Do not try to give this treatment to yourself.

    • Biofeedback: This training teaches your body to respond in a different way to stress. Teaching your body to relax can help you feel more in control. Caregivers may use a biofeedback machine so that you know right away when your body is relaxed. You can learn to do this without a machine. If you learn to take your pulse, you can make it slow down by thinking hard about it. This can work with breathing, temperature, and blood pressure too.

    • Cognitive Therapy: This therapy helps to make you aware of how you see things. You may have trouble seeing the good in things around you. Then you are more likely to feel depressed, sad or angry. Cognitive therapy teaches you how to see things in a more positive way.

    • Nerve blocks: This is a procedure where an anesthetic (an-iss-THET-ik) is injected through a needle. An anesthetic is a medicine that makes you lose feeling in an area. This procedure may used to help control pain after a laminectomy.

    • Nerve stimulation:

      • Transcutaneous Electrical Nerve Stimulation (TENS): This is a treatment that uses a small device giving out mild electrical impulses. These impulses produce a mild tapping, tingling or massaging feeling on your skin. This treatment may improve healing and reduce muscle cramps.

      • Spinal cord stimulation: This is also called dorsal cord stimulation. For this treatment, a doctor places a small device under your skin. This device sends small electric shocks to your spinal cord. This causes a tingling feeling, and may reduce pain.

      • Intraspinal narcotic pumps: In this treatment, doctors place a small pump under your skin. It is connected to a thin tube placed near your spine. The pump gives you small amounts of pain medicine.

      • Transcranial magnetic stimulation (TMS): In this treatment, brain stimulation with small electrical currents may cause you to feel a decrease in your pain.

    • Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.

    • Relaxation and stress management techniques: Relaxation is a way to focus your attention on something other than your feelings. For instance, good smells may change your mood and help you relax. Good smells may also help your brain make special chemicals called endorphins (n-DOOR-fins). Endorphins are a natural body chemical that can decrease bad feelings and pain. For example, you may listen to music or take a bath with aromatherapy (uh-ro-muh-THAIR-uh-p) oils. Candles, massage oils, and scented bubble baths are ways that smells can be used.

    • Hydrotherapy: In these treatments, you may be placed into a warm or cold water bath or pool. Caregivers may show you exercises to do in the water. Hot or cold packs may also be placed on your body in the areas where you are feeling pain.

    • Surgery: Surgery may be done to destroy the nerves that go to painful areas.

Resting:

You may feel like resting more after surgery. Slowly start to do more each day. Rest when you feel it is needed. Walking is good for you, but do not get overtired. Limit the times you walk up and down stairs to once a day, if possible, for 1 to 2 weeks.

Support:

Having a spine injury can be life-changing for you and your family. Accepting that you have a spine injury is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with a spine injury.

Wellness tips:

  • Eat a variety of healthy foods: This may help you have more energy and heal faster. Healthy foods include fruit, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat, and fish. Ask if you need to be on a special diet.

  • Drink liquids as directed: Adults should drink between 9 and 13 eight-ounce cups of liquid every day. Ask what amount is best for you. For most people, good liquids to drink are water, juice, and milk.

  • Get plenty of exercise: Talk to your caregiver about the best exercise plan for you. Exercise can decrease your blood pressure and improve your health.

  • Do not smoke: If you smoke, it is never too late to quit. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. Quitting smoking will improve your health and the health of those around you. If you smoke, ask for information about how to stop.

  • Manage stress: Stress may slow healing and cause illness. Learn new ways to relax, such as deep breathing.

CONTACT A CAREGIVER IF:

  • Your stitches or staples are swollen, red, or have pus coming from them. This may mean they are infected.

  • Your stitches or staples come apart.

  • Your bandage becomes soaked with blood.

  • Your pain is worse even after taking pain medicine.

  • You have a fever.

  • You feel weak, numb, or have pain in your back, buttocks, or legs.

  • You have chest pain or trouble breathing that is getting worse over time.

  • You have questions or concerns about your surgery, medicine, or recovery.

SEEK CARE IMMEDIATELY IF:

  • You cannot control when you urinate or have a BM.

  • You cannot feel or move your legs.

  • You see any clear drainage from your surgery area on your skin or bandage.

  • You suddenly feel lightheaded and have trouble breathing.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of the Blausen Databases or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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