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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery. You may bleed more than usual, get an infection, have trouble breathing, or get blood clots. 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.
  
  
• 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: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Before Surgery:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• 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: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

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 will be taken to a room where you can rest until you wake up. You may be allowed to go home. If you are staying in the hospital, you will be taken back to your room. Do not get out of bed until your caregiver says it is OK. A bandage is used to cover your stitches or staples. This bandage keeps the area clean and dry to prevent infection. A caregiver may remove the bandage soon after surgery to check your incision.
  
  
• Bowel movements: Exercise such as walking can help you have regular bowel movements. Including foods such as fruit, bran, and prune juice, and drinking enough water can also help. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular.
  
  
• 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 breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Drinking liquids: Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 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: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
    
    
  • 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: You may be given stool softeners to soften your bowel movements, making them easier to pass.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Pressure stockings: These tight elastic stockings help to keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
  
  
• Physical therapy: A physical therapist helps you with special exercises. These exercises help make your bones and muscles stronger.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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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