Home › Patient Info › Operations procedures › Spinal fusion back › Lumbar Laminectomy and Fusion

Lumbar Laminectomy and Fusion

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.

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 need to discuss this with your surgeon as you will likely need to cease this medication. 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 your 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 and admission paperwork

Your x-rays and scans will be taken to the theatre on the morning of 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 arm (if applicable) 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 approximately two and one half to three hours, but you may spend up to four 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. Intravenous antibiotics are given to you at this stage and a catheter will be inserted into your bladder.

The surgery

You will be placed on the operating table lying with your back up (i.e., face down) resting on a frame. 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 10 to 15 cm long. The muscles covering the spine will then be detached and retracted to expose the laminae of the vertebrae. Usually some of the laminae need to be removed to decompress the spine. In some cases, a high-speed burr is used to make a groove along each side of the laminae that need to be removed. The groove is deepened with an osteotome (chisel) and the laminae are then lifted off. In other cases a smaller amount of laminae needs to be removed and this is done with special instruments. This allows access to the dura, or delicate tube containing the spinal fluid and nerves. The compressed nerves are then freed by removing bony spurs, ligamentous tissue or disc prolapse. A small incision is made over one buttock to insert a navigation probe to aid placement of the pedicle screws. The fusion is performed by inserting screws into the vertebrae through the pedicles. Once the holes have been made through the pedicles into the vertebrae, the screws are inserted and the position is checked with the image intensifier. The bone on either side of the spine near the pedicle screws is then roughened up. The aim of this is to achieve a fusion (with the bones healing together). The rods are then inserted to connect the screws to each other. The navigation probe is removed.

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 and free to move into a comfortable position. You will be quite drowsy. You will have a drip in your arm for fluids and for pain control you will have a PCA. A PCA (patient-controlled analgesia) consists of a drip in the arm and a pump that delivers a drug like Morphine, Pethidine or Fentanyl into the drip. You can control the amount of medication you receive by pressing a button. There is a lockout safety mechanism built in so that you cannot give yourself too much medication.

You will have a bulky dressing over the wounds on your back and a wound drain. 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 another set of stockings (sequential compression devices) on your legs, which gently squeeze your calves to decrease the chance of clots in the legs. The physiotherapist may visit you and assist you to stand on this day if you are well enough.

You will be allowed fluids to drink.

The Day After Surgery

You will have a wash in bed with the help of the nursing staff.

You will be allowed to resume a normal diet.

You will be seen by the physiotherapist. The physiotherapist will stand you up and you will usually be able to walk a short distance with the aid of a rollator (walking frame with wheels).

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. The outer wound dressing and wound drain 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 be given 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 progress to walking without the rollator on this day and start taking walks yourself. Your physiotherapist will make sure you can cope with stairs and will supervise your progress.

The Day of Discharge

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 in an upright seat, 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 and you intend to travel home by car, it may be better that you stay in Brisbane for several days after you leave hospital. Alternatively, you may travel by plane after a few days.

Your wound will be reviewed prior to leaving the hospital and the dressing will be changed.

When You Get Home

You can expect some pain in your back and down the legs. This is normal post-surgery and you should not be concerned. You should take the painkillers prescribed for you on a regular basis for the first three weeks and then reduce to an “as needed” basis for the next few weeks. You will also be able to reduce the strength of your medication. If you become constipated, you may need to increase your fluid or fresh fruit intake or obtain appropriate medication from the chemist.

You should make an appointment with your GP to remove the dressing 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 to three weeks or until you resume normal activities.

You should follow the guidelines given to you by your physiotherapist with regard to physical activity and your exercise programme. For the first week, you should spend most of the time resting at home, alternating between lying down, standing and walking. After this, increase your activity level slowly with an aim to be back to most activities at seven weeks. You need to gradually build up your sitting, standing and walking tolerance. Sitting can be the most uncomfortable of these activities so we advise you to avoid prolonged sitting in the first four weeks after surgery.

You should endeavour to complete your exercise programme twice a day and to take progressively longer walks building up to 30 minute sessions twice daily. Once your wound has healed, you may do pool work as advised by your physiotherapist.

You should avoid sudden twisting and bending 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. You should not lift, pull or push anything heavy (i.e. nothing over 5 kg) until you have been reviewed by Dr Licina at the post-op visit.

You should not sit in low chairs. You should continue to sleep on your back or on your side with a pillow between your knees for the first month. If a fairly passive role is taken, you may resume sexual activity 4 weeks after your operation.

You should be safe to drive at four weeks. You may return to work at six weeks if you have a sedentary job such as administrative or clerical, or eight weeks if your job is more physical.

We will phone you on the following Monday after your surgery to check how you are and remind you of your post-operative appointment with Dr Licina. This is usually seven to eight weeks after surgery and an x-ray is also taken on this day. The cost of this post-op visit (not the x-ray) is included in the surgical fee. Any subsequent visits pertaining to this surgery will be charged at the rebate rate.

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
You require scripts for more painkillers