One of two things can pinch a nerve in your back:

A disc Rupture
A disc rupture tends to occur in young patients (under 50) years old). This is treated by a microdiscectomy. The surgery is done to remove the piece of disc that is pressing on the nerve and any other loose pieces of disc. The whole disc is not removed.

A Bone Spur (a combination of bone and thickened ligament)
A bone spur is an enlarged piece of bone that grows from your spine and can press on the nerve. The ligaments around the spine may also become thicker. This is more likely to occur in the older patient (over 55-60 years old). The surgery to correct this condition is a microdecompression.

Often nothing has to be done to the disc space itself when a bone spur and the thickened ligaments pressing on a nerve are removed. This allows for a little faster recovery, and if this has been your operation, you may advance a little faster than outlined below.

This brochure covers:

After surgery care Showering Pain Medication Constipation Activities Exercise Sitting Guidelines

Standing Guidelines Sleeping Guidelines Brace (Corset) Guidelines Sex First 12 weeks after surgery Expected results from surgery Follow-Up

After Surgery

Wound Care: The wound from your surgery is about 1-1½" long. The bandage will probably be removed and the incision left uncovered before you go home (if not, remove your bandage when you get home). Your wound will need very little care.

Wounds tend to heal better if they are left open to the air.

Two things are holding the wound closed:

• Skin tapes (Steri-strips) are on the outside. These should fall off within two weeks. If not, you should take them off.
• Stitches under your skin that dissolve as your wound heals. At each end of your wound you will see the ends of the stitch.

It is normal to have some puffiness around the wound. This will go away with time. Please call the office if there is a lot of drainage.

Showering

You may shower 24 hours after surgery. Do not worry about getting your incision wet. Do not cover the incision with anything - just pat the wound dry. It is best to wait 5 to 7 days to soak in the bathtub.

Pain Medication

You will be sent home with pain medication (usually Vicodin [hydrocodone]). You should not need strong pain pills for more than a few weeks after surgery. If you need more pain medication, be sure to give the office 24 hours notice in advance to refill your prescription on weekdays. We do not refill prescriptions during evening hours or on weekends.

Constipation

Some patients find that they have trouble getting their bowels to move after surgery. This can happen because of:

• Decreased activity
• Pain pills
• Iron pills
• Effects of anesthesia

You can help prevent constipation by eating a lot of fresh fruits and vegetables and drinking plenty of water.

If you do have trouble with bowel movements, there are some stool softeners that can be bought without a prescription (e.g. Surfak, Correctol).

Along with the stool softener, use Metamucil on a daily basis. Suppositories and enemas are also available at most drugstores if you need them.

Again, the best treatment is prevention.

Activities

It is common to have twinges of pain in your legs or muscle cramps in your calves. These feelings will go away. If you have numbness or tingling, it usually is the last symptom to go away (weeks or months later). As you become more active, you may get some aching in your back. You do not need to limit your activities much because of backaches.

The basic rule is: Do nothing that increases back pain or brings on leg pain.

Right after surgery you will feel best:

• Lying down - in bed, on a sofa, in a reclining chair, even on the floor!
• Up walking around
• Standing

Sit as little as possible. This is the least comfortable position of all.

Exercise

It is important to start walking as soon as you are home from the hospital. Increase your walking time daily until you are walking at least 20-45 minutes twice a day or about two miles.

It is important to stretch the leg that was sore before surgery. Begin as soon as you are home from the hospital. Stretch gently 4 to 6 times each morning and evening.

This stretch (figure 1) is a good activity. To do this stretch:

• Put your leg on a low stool or step.
• Keep your knee straight and stretch your arm out to reach your toes. Use the left hand for the left leg. Use the right hand for the right leg. Keep your back straight.

Shoes

Always walk in comfortable flat-soles shoes.

Sitting Guidelines

When sitting down it is important to:

Reach back to the chair with both hands and slowly lower yourself to the seated position.

It is best to sit in a straight back chair with armrests. Use a small pillow in the curve of your lower back.

Keep your feel flat on the floor with your knees and hips at the same height.

Avoid soft "lounge" living room chairs.

Limit sitting to short periods of time.

Standing Guidelines

When standing it is important to:

Push off from the bed, chair or toilet with both hands.

Keep your head up and your back straight.

Sleeping Guidelines

Sleep on whatever feels best and any position that is comfortable.

Brace (Corset) Guidelines

Most patients feel better when wearing a light brace (corset) when they are up.

• Wear your corset when you are sitting, standing or walking.
• Wear your corset for 1 to 3 months.  You may remove the insert if it is uncomfortable.
• Do not wear the corset to bed.  You do not need to wear the corset if you get up to go to the bathroom in the night.

The corset will not prevent you from twisting or bending, but it will remind you of using the proper posture.

You may have sex as soon as you go home, if you want.  Any position is OK as long as it does not make your back or leg pain worse.

The First 12 Weeks After Surgery

Below are the basic guidelines for activities during the first 12 weeks after surgery.  By 3 months most patients are able to do all of their previous activities, even sports.  Golf?—Ask the surgeon!

Follow these guidelines when you are home after surgery:

Week 1. No bandages!  Walk! Get plenty of rest.  Go to bed early. You may ride in a car, but DO NOT drive.  Do not lift anything heavy.  You may walk up stairs.  You may take a shower or tub bath. 
Exercise: stretching and walking only.

Week 2.  Same as the first week, and also you may drive short distances. Warning: most pain medication causes drowsiness.  Avoid driving while you are taking pain pills.  You may begin standing and walking more.  Do not become over tired. 
Exercise: stretching and walking only.

Weeks 3-5.  You may start only light office work or light housework. NO bending, lifting or twisting. 
Exercise: stretching and walking only.

Week 6. Come to the office for a follow-up visit. 
Exercise: You may start an activity/exercise program with supervision.

Weeks 7-11.  You may start heavier work. NO repeated bending or twisting. 
Exercise: You should not lift more than 50 lbs. close to your body or more than 20 lbs. at arms length.

Week 12.  You may return to normal work. Avoid heavy lifting from floor level or other actions that put a lot of stress on your back.  Certain patients may require some time in physical therapy to prepare them for heavy work.

What Should I Expect as a Result of Surgery?

Results can not be guaranteed.  You will not be perfect after surgery, just better.  Most patients have little or no leg pain and are walking much better after a microdiscectomy/microdecompression. 

You may have a stiff back and/or some hip pain for the first few months.  Limit your activities that involve bending, lifting or twisting, and walk a lot.

There is no harm in eventually (after 6 weeks) trying to increase your work activities for short periods of time.

Follow-up

If you live in the area, you should be seen in the office 4 to 6 weeks after surgery. 

If you live further away, please call the office 4 to 6 weeks after surgery.  We will make sure that a doctor in your area has a copy of the office and surgery notes in case of emergency.

Remember:  If you live out-of-state, fill your prescription for pain pills before you leave Colorado. Doctors' licenses only allow pain pill prescriptions to be filled in the state where it is written