Lumbar Microdiscectomy

This operation is generally effective at alleviating most, if not all symptoms. Mr Gomes will assess and discuss the chances of success in your individual case. Most patients will have relief of radicular pain. This can occur immediately for some and over several weeks or months for others. It is unlikely that motor or sensation loss will improve after surgery however, with the improvement of radicular pain this can facilitate further rehabilitation and strengthening.

The improvement of your symptoms will be related to a number of factors including:

• How long you had symptoms prior to surgery.
  
• Whether spinal nerves have been permanently impaired by the disc prolapse.
  
• Your personal goals and expectations of surgery.
  
• How well your body responds to surgery.
  
• Your compliance to the rehabilitation requirements.
  
• Your ability to achieve and maintain a healthy weight.
  
• Regular exercise leading up to and following your operation.

No surgery is risk free. Mr Gomes will talk to you about risks during the consent process.

General risks of surgery include:

• A blood clot in the leg (deep vein thrombosis) that can travel to the lungs.
  
• Pneumonia, heart attack, stroke, urinary tract infection – measures are taken to prevent these at the time and post operatively.
  
• Complications related to the anaesthetic.

Specific risks of lumbar spine surgery include. The chance of these happening will be discussed by Mr Keith Gomes during the consent process.

• Cerebrospinal fluid (CSF) leak secondary to a tear in the tissue covering spinal nerves. This can occur when the disc is stuck to the lining of the nerve and is usually repaired at the time but may need further surgery.
  
• Infection of the operated site.
  
• Neurological deficit resulting in loss of motor control or sensation.
  
• Incontinence.
  
• There is a chance of a recurrent disc prolapse.

Your surgery may get cancelled if you are not fasted. Unless specifically instructed, do not eat or drink after:

• Midnight for a morning case.
  
• 7 am for an afternoon case.

You may be admitted to hospital the day of surgery or the day before. You will go home usually about 3 days after your operation. You will need to bring:

• Your regular medication.
  
• The information pack given to you at your consultation.
  
• Pathology results. Your Anaethestist or Physician will contact you about this before your surgery.
  
• Any questions that you have written down and wish to ask. If there is anything you do not understand please ask.
  
• Your scans, if instructed by Mr Gomes.

Your regular medications need to be checked with your Anaesthetist. Generally, you should take your normal medication with a small sip of water the day of your operation. Patients taking blood thinning medication will be taken off these for an appropriate amount of time prior to surgery.

Pain management after a lumbar microdiscectomy is important. Overall patients experience a significant reduction in their pain symptoms but will have pain at the operation site which is generally short lived. During your hospital stay you will be given oral pain medication. Your pain must be under control before you go home. When you are discharged you may be ordered one or more of the following medications:

• Strong pain medication. As your pain begins to improve you can start to reduce the amount you are taking. This may cause constipation, so it is important to maintain a healthy diet, high in fibre to avoid this.
  
  
• Regular paracetamol (Panadol), anti-inflammatories and medications like pregabalin (Lyrica) that help reduce post-operative nerve sensitivity. These may continue for a little longer than the stronger pain medication. You will be guided about the use of these by the Physician that works with Mr Gomes.

It is important you follow these instructions to protect your back and allow healing to occur. Your recovery period must be carefully considered before you have your surgery. Our team advises using the time leading up to surgery to anticipate issues related to adhering to these instructions and make arrangements accordingly.  

Mr Gomes will discuss options for a long-term exercise program aimed at optimising recovery based on your own individual circumstances.  

Week 1

• Gentle walking in and around the house.
  
• Sitting on a straight back chair for maximum of 20 minutes or less if back pain/soreness occurs – best to lie down if this occurs for a short period.
  
• No bending at the hip (bend at knees), straining, twisting, pushing or lifting > 2kg.
  
• Lie on a firm mattress on back or side.
  
• No strenuous activity.
  
• Inpatient rehabilitation may be required
  
• No driving.

Week 2

• Wound check by GP or wound clinic care Nurse.
  
• Can ride in car as a passenger, but for less than 20 minutes.
  
• Increase walking distance and frequency, ideally on flat or gentle slope.
  
• Can climb stairs with assistance.
  
• Do not lift anything heavier than 5 kg – ideally for the first 6 weeks after your operation.
  
• No driving for at least 2 weeks after surgery or until you have fully recovered- then as sitting comfort allows, remembering your back precautions. Returning to driving may have insurance implications which needs to be checked.

Week 3

• Increase walking time, distance and degree of slope as tolerated.
  
• Light office work and housework ok- not hanging out the washing, carrying baskets of clothing, no vacuuming or mowing the lawn.
  
• Sitting restriction 20 minutes still applies
  
• Consult with Physiotherapist or other Health Professional regarding a graded exercise program.

Week 4 and beyond

• Continue exercise program with an emphasis on general health as well – loss of weight if required, regular graded exercise which helps strengthen the truncal and abdominal core muscles while paying attention to body mechanics and spinal column alignment
  
• No playing sports or return to gym until you have discussed this with Mr Gomes.

This will depend on your job and physical requirements to fulfil your normal role. Those in more manually intensive jobs may require a minimum of 6 weeks away from work. Light duties may need to be introduced as an interim measure.

A follow up appointment with Mr Gomes will be made prior to or at the time of your surgery. If you are unsure of your follow up appointment time, please contact Mr Gomes’ rooms.

• You may have dissolvable suture or staples.
  
• Make an appointment with your GP 5-7 days after discharge to check your wound.
  
• If you have staples, your GP will remove them in 7-10 days after surgery. A new dressing will be applied, and this is to remain on for a further 4 days, then it is to be removed.
  
• Keep your wound dry for 12 days after surgery.
  
• Avoid swimming, spas or baths until your wound has completely healed or until Mr Gomes has cleared you to re-commence these activities.