Post-operative recovery following lumbar decompression surgery

Introduction

This leaflet provides you, your family and / or carers with advice and guidance about what to expect, how to care for yourself, and what to do if you have any concerns after you have left hospital following lumbar decompression surgery.

Background

Lumbar decompression is an operation to relieve the pressure on the nerves in your back. The pressure is caused by natural ‘wear and tear’ changes in the discs, ligaments and joints. The precise medical term is Lumbar Stenosis - this means a narrowing of the space for the nerves in your lumbar spine. More information on this has been provided in the letters you have been sent by your surgeon and in the leaflet given to you before the operation.

The pressure on the nerves in your back may have caused you pain in your lower back, buttocks and legs. Sometimes, it can also cause numbness and weakness in your legs and disturbance to bladder, bowel or sexual function. The purpose of the operation is to relieve these symptoms – 85% (85 in 100) patients will experience improvement after the operation, but not always straight away.

Expectations regarding recovery

General advice and guidance

Wound care

• Keep the wound dry until completely healed. The wound will be covered with a small waterproof film dressing – please remove this carefully after 48 hours to check the wound and re-dress using the spare dressings given to you by your nurse. Please ask your nurse for one if you haven’t been given these.
• You should have received a Wound Information Leaflet regarding caring for your surgical wound. Please ask your nurse if you haven’t been given one.
• Your wound stitches are often absorbable, which means that they will not require removal. However, instructions for what to do if this is not the case will be included in your discharge letter (usually, you can make an appointment with your GP practice nurse to remove the stitches 10 to 14 days after your surgery)
• In some people, a small amount of fluid collects under the skin where the surgery was performed and, as a result, a small bulge under the skin develops. This usually disappears in the weeks following surgery as this fluid is reabsorbed by your body.

If you notice that your wound is persistently oozing, please contact your specialist nurse, GP or call 111 for advice.

If a clear, watery fluid is leaking from the wound and you develop a headache or a temperature, please attend A&E (Accident and Emergency) urgently for assessment.

Pain management

• You are likely to experience mild to moderate back pain following your surgery. This pain may worsen slightly initially, but you should experience a gradual improvement over the next 6 to 8 weeks. You should then notice a significant improvement by 12 weeks after surgery. Regular simple pain relief (such as paracetamol and / or ibuprofen) usually helps, and this should be taken as per package instructions.

If you experience severe pain in your back (particularly if this is new), or if you find the pain is significantly worsening, please contact your specialist nurse, GP or call 111 for advice.

If you develop new symptoms of limb weakness, numbness in your genitals or bowel / bladder / sexual dysfunction, attend A&E (Accident and Emergency) urgently for assessment.

Exercise

We encourage you to increase your activity slowly after your surgery.

• Walking is encouraged – increase your walking distance gradually until back to a normal level.
• It is important to keep your arms and legs moving to improve blood flow, and prevent them from becoming stiff or developing blood clots.
• Take regular rest, and let your body’s comfort your guide to what is safe.

For the first few weeks, avoid:

• Heavy lifting (more than 5kg in each hand).
• Strenuous exercise or contact sports (for example: lawn mowing, running, digging and football).
• Carrying out activities which involve excess ‘pushing’ or ‘pulling’, or twisting / bending of the back

Whilst intensive physiotherapy is not recommended until your surgical wound has totally healed, our physiotherapy team recommends an exercise programme.

Should you experience any continuing weakness or back pain three months after surgery, a physiotherapy review might be useful. Please contact your GP to arrange this.

Follow up

Your surgical team will arrange a follow-up appointment for you after your operation. This is typically held three months after your surgery to allow sufficient time for you to recover, and allow for an accurate assessment of your symptoms.

No further scans or X-rays are usually required for this appointment, and the assessment will be conducted either face-to-face or over the telephone by one of the surgical team or your specialist nurse.

British spine registry

As a team, we are keen to seek feedback on the quality of your experience with us, and on how successful your surgery has been in improving your symptoms.

This data is collated and utilised to improve our service. Please visit this website and fill out a short questionnaire to record this feedback: British Spine Registry (opens in a new tab).

Frequently asked questions

Do I need to keep my ‘TED’ (Thrombo-Embolus Deterrent) stockings on after I go home?

Undergoing spinal surgery puts you at a higher risk of developing blood clots in your legs and / or your lungs (Deep Vein Thrombosis or Pulmonary Embolism). Being immobile (not moving) also increases this risk.

‘TED’ anti-embolic stockings help to reduce this risk. They should be worn until you are able to walk around comfortably.

If you experience swollen calves, or chest tightness and shortness of breath, attend A&E urgently for assessment.

When can I have a shower?

The dressing you have been provided with is splashproof. You are able to shower 48 hours after surgery, so long as you avoid your surgical area and pat dry the dressing. If the dressing gets wet, you can replace the dressing. You may shower as usual once the wound has completely healed.

Can I drive?

You may resume driving if you are able to make an emergency stop (and provided you were legally allowed and considered safe under DVLA Regulations to drive prior to your operation).

When can I return to work?

This will depend largely on you, your recovery and what sort of work you do.

It is usually safe to resume working at a desk as soon as you feel ready to do so, but please discuss with the clinician at your follow up appointment before resuming any manual work. We can provide an initial 'fitness to work' note, and further notes can be obtained from your GP if required.

When can I expect to see an improvement in my symptoms?

You may see a gradual improvement in your leg pain and walking distance in the first three months after surgery. However, patients have reported continuing improvement up to two years after surgery.

I’m experiencing constipation. What should I do?

Constipation following this type of surgery is not uncommon, due to the medications you receive whilst in surgery. Avoid opiate medications (for example morphine and codeine) if possible, and discuss with your pharmacist about recommended over-the-counter laxatives.

If your constipation persists despite this, seek advice from your GP or from NHS 111.

I’m experiencing ongoing Bladder, Bowel or Sexual Dysfunction - what should I do?

If you experienced altered bladder, bowel, or sexual function prior to your operation, and your doctor advised you that this was in relation to your spinal condition, this can take a long time to improve. Please contact your specialist nurse or GP if you require further advice on how to manage this.

If these symptoms are new, attend A&E (Accident and Emergency) urgently for assessment.

My pre-operative symptoms have returned – is this normal?

After an initial period of improvement, approximately 1 in 5 patients experience a recurrence of their pre-operative symptoms a few days after surgery. This is, in most cases, due to a collection of wound fluid collecting over the nerves. Regular simple pain relief (such as paracetamol and / or ibuprofen) will usually help with this as well, though you may need to contact your GP for a prescription for alternative pain relief medication if this pain does not respond to over the counter medication.

If it is ongoing, or you feel your symptoms are gradually worsening, contact your specialist nurse for advice.

If there is redness and swelling over the wound, and / or fever, please attend A&E urgently.

Contacts / further information

If you have any clinical concerns or questions, please contact the neurosurgical clinical nurse specialist of your consultant:

• Aimee Bromwell (Mr Laing; Mr Francis; Mr Trivedi; Mr Kotter; Mr Crawford; Mr Hay)
  01223 257163
• Nicola Owen / Kirsty Grieve (Mr Timofeev; Professor Hutchinson; Mr Kolias)
  01223 216127
• Giandomenico Basile (Mr Mannion)
  01223 256990
• Peony Eschavez / Ruth Mead (Mr Brown; Mr Guilfoyle; Mr Helmy)
  01223 216189

If your surgery was completed by a consultant not mentioned on the list above, please contact any of the neurosurgical clinical nurse specialists, and they will be able to advise you.

Appointments

You should receive a letter through the post or via MyChart for a follow-up appointment. If this does not occur, or if you have queries in regards to this, please contact the neurosurgical secretaries via switchboard (01223 805000).

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals which allows patients to securely access parts of their health record held within the hospitals’ electronic patient record system (Epic). It is available via your home computer or smart phone.

If you are interested in this please let us know and we can provide information, or look on our website: Visiting our hospitals.