Care of Patient with Lumbar Surgery

【Major point】

Under anesthesia, the lumbar spine surgery involves decompression or internal fixation of the lumbar spine through the back.
After the operation, medical staff will guide you to get out of bed and wear a back brace.
The surgical wound should keep clean and dry, the stitches will be removed about 7~10 days after the surgery.
You need to get enough rest after surgery and avoid lifting heavy objects for one month.

What is lumbar spine surgery?
Under general anesthesia, spinal decompression or internal fixation is performed through the back to remove the hypertrophic discs, spurs that have compressed the nerves to achieve decompression, or implants are inserted to relieve nerve compression symptoms.

Why lumbar spine surgery is needed?
When patients experience spinal stenosis or tumors compressing nerves due to lumbar disc herniation, inducing symptoms such as limb weakness, numbness, and pain, this surgery can be performed to improve discomfort and preserve nerve function.

Preparation before surgery

The surgeon will arrange routine examination, including electrocardiogram, chest X-ray, blood tests, and various examinations depending on the patient's neurological symptoms (such as lumbar X-ray photography, Computed Tomography (CT), Electromyography (EMG) or Magnetic Resonance Imaging (MRI)), in order to recognize the location of the lesion.
The surgeon will explain the purpose, process, possible risks, and complications of the surgery to the patient and family members based on the results of the pre-operative evaluations. Informed consent forms will be filled out afterwards.
Do not wash it off after the surgeon make a mark on the surgical site.
Before the surgery, the nursing staff will arrange the patient to watch a lumbar spine surgery nursing guidance video and confirm the correctness of the patient's posture while getting in and out of bed.
An appropriate waist or back brace will be prepared according to the surgeon's advice, so that the patient can use it while getting out of bed after the surgery.
After 12 o’clock midnight at the night before the surgery, the patient is prohibited from eating and drinking. For daily oral medications, please inform the medical staff to assess whether you need to take them.
The patient should wear the surgical gown on the day of the surgery. Glasses (including contact lenses), movable dentures, nail polish, body accessories, amulet, and underwear should be removed.

What should I pay attention to after surgery?

After surgery, the patient may have wound drainage bags, intravenous catheter, urinary catheters, etc. on your body. According to the doctor's instructions, these equipment will be removed until the condition stabilizes. Do not remove the tubes by yourself and cause injury.
After the operation, the doctor will prescribe analgesics to relieve the wound pain. If the wound is still painful, you can inform the doctor or nurse to adjust the medication.
After the operation, the nurse will assist the patient to change position every 2 hours, adjust to a comfortable position, and apply ice pack around the wound for 15 minutes every 2 hours (except sleeping time) to relieve the pain for the first 3 days or until the pain is relieved.
The medical/nursing staff will evaluate the condition of patient if he/she can take some food or drink.
Usually, you can get out of bed and practice standing at the next day after surgery. The nurse will instruct and assist you how to properly fit the brace.
Keep the surgical wound clean and dry, the stitches will be removed about 7~10 days after the surgery, However, diabetic patients need to remove the stitches depending on the condition of wound healing. If the wound is red, swollen, hot, painful, or discharging, please return to the Neuro Surgery Clinic immediately.
Outpatient clinic follow-up regularly and avoid falling or strenuous exercise. The activities follow by the doctor's instructions:
1. Week 1: Have sufficient sleep and rest. The patient can take some short walks and take a ride but cannot drive. Also, avoid weightlifting and climbing stairs.
2. Week 2: The amount of activity can be increased, but the patient should not get too tired and still have to get sufficient sleep.
3. Weeks 3~4: The patient can do light work but repeated bending, lifting, rotating, and other actions that will cause back pressure are absolutely prohibited.
4. Week 8: The patient can engage in normal activities, but still must avoid repeated bending movements or excessive rotation. Lifting weights should not exceed 20 kg, and arm lifting weights should not exceed 10 kg.
5. Week 12: The patient can resume the previous workload, but still need to pay attention to avoid heavy work, such as lifting heavy objects from a high place.

References

Debono, B., Wainwright, T. W., Wang, M. Y., Sigmundsson, F. G., Yang, M. M., SmidNanninga, H., Bonnal, A., Le Huec, J. C., Fawcett, W. J., Ljungqvist, O., Lonjon, G. & de Boer, H. D. (2021). Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. The Spine journal, 21(5), 729-752. https://doi.org/10.1016/j.spinee.2021.01.001
Suzuki, A., & Nakamura, H. (2022). Microendoscopic lumbar posterior decompression surgery for lumbar spinal stenosis: Literature Review. Medicina, 58(3), 384. https://doi.org/10.3390/medicina58030384
Tong, Y., Fernandez, L., Bendo, J. A., & Spivak, J. M. (2020). Enhanced recovery after surgery trends in adult spine surgery: a systematic review. International Journal of Spine Surgery, 14(4), 623-640. https://doi.org/10.14444/7083

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