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Discectomy - Patient Pathway

Introduction

This is a guide to your upcoming operation. In it we explain what is likely to happen at each stage of the process. However your care will depend on your individual needs, so your progress may vary from this basic outline. Please become familiar with this guide and discuss any aspects you wish to with your surgeon or the nursing staff.

You will be admitted on the morning of surgery, unless this is impractical or you have some significant medical problems. You should expect to be in hospital for two days, which means that you will go home on the day after surgery.

Before Surgery

You should stop taking anti-inflammatory drugs at least five days prior to surgery as they can increase the risk of bleeding. These tablets include Voltaren, Nurofen, Brufen, Feldene, and Indocid (Celebrex is not a problem). If you are on low-dose aspirin (eg. to prevent stroke or heart attack) you may continue to take these.

You should keep the skin near the operation site clean. If you have a cut or pimple on the skin in the area, you should notify your surgeon prior to surgery.

Admission

You should not eat or drink 6 hours prior to surgery. This usually means from 2 am on the morning of your operation. (You may not be the first patient on the list, but the order may need to be changed unexpectedly)

You should bring with you

• Personal effects (nightgown or pyjamas, slippers, dressing gown, toiletries)
• Any medication you are taking
• All relevant x-rays, scans and reports

Prior to going to theatre, you will

• Have a shower with an antiseptic soap (Betadine)
• Be dressed in a theatre gown and disposable underwear
• Have special stockings fitted (to help prevent blood clots)
• Be asked to mark the painful leg with an arrow on the thigh using a marker pen

If you wish, your surgeon will speak to a family member in person or on the phone after surgery. Please notify the nursing staff of the details.

After Surgery

When you return to the ward, you will be resting in bed and free to move into a comfortable position. You will have a drip in your arm for fluids. You will have a bulky dressing over the wound on your back.

You will be seen by the physiotherapist, usually on the afternoon after surgery. (If the surgery was late in the day, you will be seen the next morning.) The physiotherapist will take you for a walk and give you instructions about your activities during the recovery period, including an exercise programme.

For pain control you will have injections (Morphine) and tablets (Panadeine Forte) available. Most people require either no injections or only one or two, as tablets are usually enough to control the pain.

The day after

Prior to your shower, the drip will be removed from your arm. The outer dressing will also be removed, leaving a small waterproof dressing that you can shower in. Your stockings will be taken off for your shower and then reapplied.

Your physiotherapist will visit, take you for a longer walk and make sure you can cope with stairs. You should go for some longer walks and make sure you can manage by yourself.

If you are walking safely and able to look after yourself, and only need tablets for pain, you will be able to go home. You may travel home in a car, but you should stop for a break if the trip is longer than half an hour or so.

When you get home

You can expect some pain down the leg. It usually lasts only a short while and not as severe as the pain was before surgery. This is normal and you should not be concerned. You may take the tablets given to you as needed for pain.

You should take the dressing off after four days. If it falls off before this and the wound is clean, you should not worry. There are no stitches to remove as they are dissolving and under the skin. As the body dissolves the stitches, there is sometimes a mild reaction around the wound, seen as some redness and inflammation. You should wear your stockings for one week.

You should follow the guidelines given to you by your physiotherapist with regard to physical activity and exercise. For the first week, you should spend most of the time resting at home, alternating between lying down and sitting. After this, you should increase your activity level slowly with an aim to be back to most activities at six weeks. You should be safe to drive at four weeks. You may return to work at four weeks if you have a sedentary job such as administrative or clerical, or six weeks if your job is more physical.

You should ring and make an appointment to see your surgeon six weeks after surgery.

You should expect a phone call from the nursing staff to check that all is well on the day after you get home.

You should see your local doctor or contact your surgeon if

• You develop severe and constant leg or back pain
• You have bleeding or discharge from your wound
• You are unwell and have a fever