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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery. You may bleed more than usual or get an infection. Even if surgery is done correctly, nerves in the area where the disk is removed could be injured. You may have numbness or pain along a nerve path. This may cause problems with your muscles like paralysis (loss of movement). You may have problems controlling your bowel or bladder. You may become impotent. This means a man may not be able to have an erection.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• Your spine may be unstable (weak) because bone was removed during surgery. You may need to have surgery later to fuse (lock) that part of your spine. The dura (tough tissue covering the spinal cord) may be torn, causing fluid to leak out of the spinal cord. You may need to lie flat in bed for a time, or need more surgery because of this. Problems after surgery may be short or long-term. If you do not have a laminectomy, your pain and other back problems may get worse. In time, you may need surgery to repair or remove more disks, and your recovery may take longer. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Call button:

You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Gown:

A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

An IV (intravenous)

is a small tube placed in your vein that is used to give you medicine or liquids.

Before Surgery:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During Surgery:

• After you are asleep, you are positioned on your stomach, your side, or in a sitting position. A belt is put over your legs for safety. Your caregiver cleans your back and neck with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
• An incision (cut) is made in your back over the herniated disk or disks. Caregivers spread the muscles of your spine apart and then remove bone (lamina). The herniated part of the disk or disks is removed. The incision is closed with stitches (thread) or staples.

After Surgery:

• Activity:
  
  
  • After surgery, keep the bed flat or with the head of the bed raised no more than 5 to 10 degrees. While lying in bed, you may to turn from side to side by "log-rolling". To do this, while turning to your side, keep a pillow between your legs and move your whole body at the same time. Ask your caregiver to show you how to do this. Do not sit except when using the toilet. You may be helped to walk the same day of your surgery.
    
    
  • Your caregiver will tell you when it is OK to get out of bed. Call your caregiver the first time you get up. To get out of bed, roll onto one side near the edge of the bed using a log-roll. Push up to a straight position by pushing off the bed with your arms. Keep your back straight as you swing your legs over the edge of the bed. Do not twist your body when getting up. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.
  
  
• After surgery: You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. An adult will need to drive you home and should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.
  
  
• Prevent constipation: 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.
  
  
• 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 get up to go to the bathroom without the brace. You may need to wear the brace for about 3 months.
  
  
• Assessments: Caregivers will check your hands and feet often to make sure nerves going to those areas are working correctly. Tell caregivers if you feel tingling, or lose feeling in your hands, feet, or another part of your body.
  
  
• Deep breathing and coughing: This will help decrease your risk for a lung infection after surgery.
  
  
  • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Food and drink after surgery: You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.
  
  
• Drinking liquids: Men 19 years old and older should drink about three Liters of liquid each day (about 13 eight-ounce cups). Women 19 years old and older should drink about two Liters of liquid each day (about 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, healthy liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty.
  
  
• Ice: Ice causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Caregivers put crushed ice in a plastic bag and cover it with a towel. Put this on your back 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.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Patient Controlled Analgesia (ah-null-G-z-uh): This is also called "PCA". Caregivers may connect a machine to your IV that can put pain medicine into your IV. You may be taught how to give yourself the pain medicine by pushing a button whenever you feel pain. It is set up so you cannot give yourself too much medicine.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• 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.