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Laminectomy
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 four to six days.
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 have a catheter in your bladder so that you will not need to worry about getting up to pass urine. You will have sequential compression devices on your legs, which gently squeeze your calves to decrease the chance of clots in the legs.
For pain control you will have either an epidural infusion or a PCA.
- an epidural infusion consists of a small tube that is inserted in the spine at the time of surgery, and a pump that delivers a slow steady amount of a drug like Morphine and local anaesthetic to the spine. The dose can be adjusted according to your pain level.
- a PCA (patient-controlled analgesia) consists of a drip in the arm and a pump that delivers a drug like Morphine into the drip. You can control the amount of medication you receive by pressing a button. There is a safety mechanism built in so that you cannot give yourself too much.
The day after
You will have a wash in bed with the help of the nursing staff.
You will be seen by the physiotherapist. The physiotherapist will stand you up and you will usually be able to walk a short distance.
The second day after surgery
You will be able to have a shower with the help of the nursing staff. Prior to your shower, the drip will be removed from your arm. If you have an epidural catheter in your back, this will also be removed. The outer dressing will also be removed, leaving a small waterproof dressing that you can shower in. This inner dressing may need to be changed today if it is not sticking properly. The sequential compression devices will be removed. Your stockings will be taken off for your shower and then reapplied.
The catheter in your bladder will be removed. The nursing staff will observe that you are able to pass your urine normally afterwards. You need to tell them if you have not passed urine within six hours after the catheter is removed.
You will use tablets for pain relief. If necessary you can have an injection.
Your physiotherapist will visit, take you for a walk and give you instructions about your activities during the recovery period, including an exercise programme. You will need a rollator (walking frame with wheels) at the start to help you walk.
The next day or two
You will be able to have a shower with less and less help.
You will progress to walking without the rollator and start taking walks yourself. Your progress will be supervised by your physiotherapist.
The day of discharge
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. If you live more than one hour (100 km) from Brisbane, it may be better that you stay in Brisbane until two weeks after surgery.
Your wound will be reviewed and the dressing will be changed.
When you get home
You can expect some pain in the back and down the legs. The leg pain 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 about ten days from surgery. 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 two weeks.
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, increase your activity level slowly with an aim to be back to most activities at six weeks. You need to gradually build up your sitting, standing and walking tolerance. You should be safe to drive at two 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. The telephone number is 07 3230 5444.
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