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Laminotomy
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 one or two days, which means that you will usually go home on the day after surgery. If your surgery is done as a day procedure, you must arrange for a responsible adult to stay with you at your home overnight post surgery.
Before Surgery
You should stop taking anti-inflammatory drugs at least ten days prior to surgery as they can increase the risk of bleeding. These tablets include Voltaren, Nurofen, Brufen, Feldene, Naprosyn, Indocid, Celebrex and Mobic. If you are on low-dose aspirin (eg. prescribed to prevent stroke or heart attack) you must discuss this with your surgeon as you will likely need to cease this. If you are currently taking Warfarin (Coumadin or Marevan), Plavix or Iscover tablets, you should notify your surgeon as you will need to stop taking this medication under medical supervision. You should also stop taking any vitamin or mineral supplements ten days prior to surgery.
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
- Medicare and private health fund membership cards
- Your medical consent & admission paperwork
Your x-rays and scans will be taken to the theatre on the day of your surgery by our staff.
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 indelible pen
If you wish, your surgeon will speak to a family member in person at the end of the day’s surgery list. Please notify the hospital nursing staff of the details.
The Procedure
You will be prepared for surgery by the nursing staff in hospital. You will be taken from the ward to the operating theatre on a trolley. The operation will take about fifty to sixty minutes, but you may spend up to two hours in the theatre complex, by the time you wait in the preoperative area, have the surgery and wake up in the recovery area.
The Anaesthetic
The anaesthetist will give you a general anaesthetic. A small needle will be placed in the back of your hand or in your forearm. This will be connected to a drip. You will be asked to breathe on an oxygen mask and the drugs to make you fall asleep will be injected through the drip. You will be asleep and not be aware of anything further until the operation is completed. Antibiotics are given to you at this stage.
The Surgery
You will be placed on the operating table lying with your back up (i.e., face down) in a kneeling position. This gives the best access to the lumbar spine. A needle will be placed in your back and an x-ray will be taken with an image intensifier (fluoroscopy). This will help identify the correct level at which to make the incision. Your back will be prepped (cleaned with antiseptic solution) and draped (covered with sterile sheets).
The incision will then be made. It is usually 3 to 5 cm long. The muscles covering the spine will then be detached and retracted to expose the space between the laminae of the vertebrae. There is a tough fibrous tissue called the ligamentum flavum between the laminae and this along with some surrounding bone will be removed. This allows access to the dura, or delicate tube containing the spinal fluid and nerves. The compressed nerve is identified and freed by removing any bony spurs, ligamentous tissue or disc prolapse. If the procedure needs to be done on both sides, the same procedure is repeated on the other side. Any bleeding is stopped and long-acting local anaesthetic (Marcain) is applied to the nerve and surrounding tissues. This provides pain relief for up to 12 hours.
The wound is closed with deep long-lasting dissolving stitches and more rapidly dissolving stitches are used to close the skin. These are just under the skin and do not have to be removed. A dressing is applied and you are transferred back to the trolley.
The Recovery
The anaesthetist will reverse the anaesthetic. You will wake up in the recovery room. The nurses there will check your observations and the movement in your feet. Once you are sufficiently awake, you will be transferred back to the ward. Once in the ward, your progress will follow the clinical pathway.
After Surgery
When you return to the ward, you will be resting in bed but will be free to move into a comfortable position. You will have a drip in your arm for fluids. When your fluid intake is adequate and you do not feel nauseated, the nurses will remove your drip. 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 with the aid of a rollator (walking frame with wheels) and give you instructions about your activities during the recovery period, including an exercise programme.
For pain control you will have injections (Morphine / Pethidine) and tablets (Panadeine Forte / Digesic / Tramal) available.
The Day After/the Day of Discharge
Prior to your shower, the outer wound dressing will 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.
Once you are walking safely and are 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 seated in an upright position, 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 (100km) from Brisbane and plan to travel home in a car, it may be better that you stay in Brisbane for a couple of days after your surgery.
When You Get Home
Frequently Asked Questions
Will I have any back or leg pain?
You will have discomfort in your wound from surgery, but this settles quickly, usually in the first two weeks. You can expect some pain / pins and needles down the leg and this may last four to five weeks, is intermittent and is not as severe as the pain was before surgery. This is normal until the affected nerve recovers and you should not be concerned. You should take the tablets given to you as directed for pain & obtain a further script from your general practitioner if required. If you become constipated from your pain relief medication, you may need to increase your fluid or fresh fruit intake or obtain appropriate medication from your chemist.
When should I remove the dressing?
You should take the dressing off six days after surgery. If it falls off before this and the wound is clean, you should not worry. There aren’t any 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 may also experience minor swelling over your wound but this usually subsides within 2 weeks.
How long should I wear my stockings?
You should wear your stockings for two weeks or until normal activities are resumed.
When can I start driving again?
As a general guideline, you may drive at 3 weeks. However, this is variable and dependent on whether you have a manual or automatic vehicle and is also influenced by comfort levels and how quickly you have recovered from surgery. If you have no leg pain and you are comfortable to sit, you may return to driving at 3 weeks.
How often should I do my exercises? When can I start a gym programme?
Your physiotherapist will provide you with a mobility & exercise programme & instructions about frequency & repetitions required. You should take progressively longer walks building up to 30 minute sessions twice daily.
You can usually commence a gym programme after seven weeks under the guidance of your physiotherapist.
What about swimming? How long should I wait before I can go back in the pool?
Once your wound has healed, you may commence hydrotherapy exercises. Gentle swimming may be started as early as 4 weeks after your operation. These activities should be under the guidance of your physiotherapist.
So what activities are limited?
You should not lift, pull or push anything heavy (i.e. nothing heavier than 5 kg) prior to your post-op visit with Dr Licina. Light weights may be lifted from table height & carried close to the chest. During this recovery time, you should avoid lifting babies from cots and placing children in their car seats. You should avoid prolonged or sudden bending and twisting movements of your spine and should not stretch past the point of pain. Reach for objects on the floor by bending your knees. Minimise work done with arms over your head.
When can I return to work? How long can I sit?
You may return to work at three to four weeks if you have a sedentary job, such as administrative or clerical work, but if your job is more physical, then you should return to see your surgeon at 7 weeks post-op before resuming work.
You should not sit in low chairs and after your operation, should build up your tolerance to sitting. Time is limited by discomfort.
Can I sleep on my tummy?
You should sleep on your back or on your side with a pillow between your knees for the first month. This helps to preserve the natural curve of your spine & does not cause undue stress on your back.
What about sex?
If a fairly passive role is taken, you can resume sexual activity 3-4 weeks after your operation.
When should I see my doctor / my physiotherapist / my surgeon?
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 or if your wound is hot, swollen & reddened round the edges
- You are unwell and have a fever
- You need a further script for painkillers.
We will contact you on the Monday following your surgery to check how you are and remind you of your post-op appointment with Dr Licina approximately seven weeks after surgery. The cost of this post-operative visit is included in the surgical fee. Any subsequent visits pertaining to this surgery will be charged at the rebate fee.
You should see your physiotherapist at 2 to 3 weeks post-operatively & again at 7 weeks for a review and upgrade of your exercises.
Finally
While surgery helps to relieve your pain and allows you to enjoy most, if not all, of your activities again, how well your back recovers depends upon the time and energy you put into strengthening and protecting your spine. The sooner you become active, the sooner you’ll be able to resume your normal activities. Take note of the advice given to you by your health providers. Be aware of maintaining good posture, moving wisely and exercising regularly so that you will obtain the best possible outcome from your surgery.