309.662.7500

Back/Neck Pain

affectedTreatment

CONSIDER CERVICAL DISK SURGERY

Do you suffer from nagging neck and arm pain or weakness caused by a disk problem in your upper (cervical) spine? Is a simple turn of your head painful or even impossible? If nonsurgical care hasn’t helped you, your surgeon may suggest cervical disk surgery.

When Pain Takes Over Your Life

Any pain can be annoying. But ongoing pain or weakness in your neck or arm can restrict the use of your arm and hand. This can impair your ability to work. Even worse, you may have found that none of the treatments you’ve tried—rest, medication, physical therapy, injections—have relieved your symptoms. You may feel as though pain has taken over your life.

Cervical Disk Surgery May Help

Most cervical disk problems improve with nonsurgical care. But many people find relief from pain and weakness only after cervical disk surgery. During this surgery, your surgeon may be able to treat the problem causing your symptoms. Surgery has its limitations—it can’t remove all the effects of overuse or aging, and it does have risks. Yet, it may let you take control of your life again.

HOW HAS YOUR LIFE BEEN AFFECTED?

Take a look at how your cervical spine problem has affected your life by answering the following questions. This self-assessment may help you decide if the benefits of treating your neck problem outweigh the risks and inconvenience of surgery.

Physical Effects

  • Do you miss work because of your pain?
  • Does your neck pain shoot down your arm?
  • Does your arm or hand feel numb or weak?
  • Do you have headaches, or pain between your shoulder blades?

Social Effects

  • Are you unable to join in family activities because of your pain?
  • Does your pain force you to spend time alone, away from family and friends?
  • When you are with other people, do you find yourself distracted by your discomfort and unable to enjoy yourself?

Emotional Effects

  • Does your pain make you feel frustrated or depressed?
  • Are you afraid of losing your job due to too much time off?
  • Do you ever feel that other people think your pain isn’t real?
  • Do you feel that you have no control over your life?

Taking Charge of Your Recovery from Surgery

On the Road to Recovery

If you’re having back surgery, keep in mind that it’s only the first step in regaining your back health. Your doctor can help you as you recover. He or she may also refer you to a physical therapist (movement and exercise specialist). But it’s your job to speed recovery and prevent injury by taking good care of your spine. Read on to learn how. Each two-page spread in this booklet focuses on a different position or activity. On each spread you’ll find sections on Back Basics, Exercises, and Tips for Daily Living.

Back-Basics

A healthy spine forms three natural curves (the cervical, thoracic, and lumbar). When these curves are maintained, your spine is balanced or in a neutral position. The Back Basics sections in this booklet show you how to keep your back balanced in different situations. In general:

  • Sit or stand with your ears over your shoulders and your shoulders over your hips.
  • Don’t round your shoulders or lower back.
  • Learn to bend safely

Exercises

selfcareKeeping the muscles in your legs, buttocks, and abdomen strong and limber helps reduce stress on your back. The Exercises sections in this booklet present simple stretching and strengthening exercises. Your doctor or physical therapist will tell you how often to exercise and how many repetitions to do. For safe and effective exercise:

  • Breathe normally.
  • Avoid twisting, bending, or arching your spine.
  • Stop if you feel sharp pain.

Tips for Daily Living

Many everyday activities can put your back at risk. The Tips for Daily Living sections in this booklet give you advice on how to move safely and protect your back as you return to your normal routine.

The Lumbar Spine

The spine is made up of bones and shock-absorbing disks that support the body and protect the spinal cord and nerves. Back pain is often caused by damage to the lumbar (low back) spine. Surgery can help correct these problems. Learning more about your lumbar spine can help you understand how to recover from surgery and prevent reinjury.

Common Spinal Problems

Problems with any part of the lumbar spine can cause low back pain. A disk can protrude (herniate) and press on a nerve. Vertebrae can also develop bone spurs, which can narrow the spinal canal (stenosis).

Surgery for Lumbar Spinal Problems

Common types of lumbar spinal surgery include:

  • Laminotomy or laminectomy. Part of the lamina is removed to relieve pressure on a nerve or to allow access to a bone spur or disk.
  • Diskectomy. Part of a disk is removed to relieve pressure on a nerve.
  • Fusion. Two vertebrae are joined with bone grafts. Metal implants or plates may be used to add stability.

Your Recovery in the Hospital

After surgery, you’ll most likely stay in the hospital for a few days. During this time you’ll be monitored to make sure that your pain is under control and that you’re starting to heal. You’ll probably get on your feet within 24 hours after surgery. A nurse or physical therapist will teach you how to brace yourself, turn, and get out of bed safely.

Pain Control

Pain after surgery is normal. You may be given oral pain medications and ice packs to reduce pain and swelling. You may also have a PCA pump. This is a device that lets you control the amount of intravenous (IV) pain medication you receive, within limits set by your surgeon. Treating pain before it becomes severe often means that you use less pain medication overall. You may be asked to rate your pain on a scale of 1 to 10. If your pain isn’t being controlled, tell your nurse.

Supporting Your Spine

Abdominal muscles support the spine. Tightening these muscles to “brace” yourself helps prevent pain and reinjury.

  • Put your hands on the lower part of your stomach. Gently tighten your abdominal muscles by pulling in your stomach. Breathe normally without relaxing your abdomen.
  • You may be given a brace to keep your back stable. If so, you’ll be shown how to wear it.

Learning to Turn Safely

Twisting or bending your back after surgery is painful and can cause further injury. For safety, think of your body as a log from your shoulders to your hips. To “logroll”:

  • Brace your abdomen to help support your spine. Bend your knees slightly toward your chest.
  • Roll to one side, keeping your ears, shoulders, and hips in line. Be careful not to bend or twist at the waist.

Coming Home

The sooner you become active, the sooner you’ll get back to your normal routine. At the same time, you need to protect your healing back. Increase your activity level at a slow but steady pace. Use this booklet to guide your early recovery. You may also see a physical therapist during this time. Follow any guidelines your doctor or physical therapist gives you.

Your First Few Weeks

You’ll likely feel weak and tired at first, but you should feel a little stronger each day. Your incision may be sore. You may also feel some pain, tingling, or numbness in your back or legs. All of these symptoms should decrease as your nerves heal. Keep moving as much as you can without making your pain increase.

Preventing Setbacks

Increased pain for more than 2 hours after an activity means you’ve done too much too soon. When you feel pain, slow down and pay more attention to your posture and movements. By about the sixth week after your surgery, you should be well on the way to healing. But continue to let pain be a warning to slow down.

Your Walking Programwalks1

Walking is the best exercise for you after back surgery. It strengthens your back and leg muscles, increases your endurance, and relieves stress. Begin by walking around the house. Build up to several walks a day. You may find it helpful to set a goal. Talk to your doctor or physical therapist about setting a safe, realistic goal for yourself.

Call your doctor right away if you:

  • Feel persistent or severe pain, weakness, or numbness in your back or legs.
  • Notice drainage, swelling, or increased redness around your incision.
  • Have a fever, severe headache, or extreme tiredness.
  • Have difficulty breathing.
  • Have problems controlling your bladder or bowels.
  • Have swelling and tenderness in your legs.

Lying on Your Back or Side

Lying on your back or side puts less pressure on your spine than most other positions. On these pages, you’ll learn how to lie in a safe position. You’ll learn exercises to strengthen your abdominal and buttocks muscles, which help brace the spine. And you’ll learn tips for dressing and safe positions for sex.

Back Basics

To Lie on Your Back

  • Put a pillow under your neck and knees, or keep your knees bent.
  • When you change positions, tighten your abdominal muscles and logroll.
  • DO NOT lie on your stomach. This puts too much strain on your lower back.

To Lie on Your Side

  • Bend your knees toward your chest. Place a pillow between your knees and under your head and neck.
  • When you change positions, tighten your abdominal muscles and logroll.

To Sit Up

  • Starting on your back, tighten your abdominal muscles and logroll onto your side.
  • Slowly scoot to the edge of the bed.
  • Push your body up with one elbow and the opposite hand. At the same time, swing your legs to the floor. Keep your spine in a neutral position and your abdomen braced.
  • To lie down, reverse the above steps.

Exercises

Buttocks Squeeze

This exercise strengthens buttocks muscles.

  • Lie on your back with your spine aligned.
  • Squeeze your buttocks muscles together. Count to 5, then relax.

Partial Sit-Up

Partial sit-ups strengthen the abdominal muscles.

  • DO NOT do partial sit-ups unless your doctor or physical therapist says you can.
  • Lie on your back, spine aligned and knees bent. Brace your abdominal muscles and squeeze the buttocks muscles together.
  • Reach your hands toward your thighs and tighten your abdominal muscles to lift your shoulders off the floor. Focus your eyes on the ceiling, and don’t bend your neck toward your chest.
  • Work up to holding for 1 minute, several times a day.

As you get stronger, fold your arms across your chest while doing this exercise.

Tips for Quality Living

Getting Dressed

recoveryPutting on and taking off socks, slacks, and underwear may be easier to do lying on your back. A tool called a dressing reacher can be of help. To make dressing and undressing easier, wear loose clothes and slip-on shoes with closed backs.

Getting Ready to Lie Down

Before you lie down, make sure that you have the things you need within reach. Gather items such as medications, eyeglasses, reading material, and other things you may want. Be sure to place them so you won’t have to twist your back to reach them. If you aren’t able to gather the items yourself, ask a family member or friend to help.

Intimacy

Ask your doctor or physical therapist how soon it’s safe for you to have sex. Side-lying positions may be more comfortable. If you lie on your back, support your neck and knees with pillows. Avoid arching your back. Also, avoid shifting the position of your spine too rapidly. Take it easy, and see what works for you and your partner.

Standing and Turning

In general, standing puts less strain on your back than sitting. So be sure to get up and move around often during the day. These pages can show you how to stand and turn without twisting your back. The exercises here can help strengthen your calf muscles so that your legs can better support your back. Use the tips in this section to make grooming and kitchen work safer.

Back Basics

To Stand and Turn

  • Place one foot slightly in front of the other, or stand with your feet shoulder-width apart.
  • Keep your knees relaxed and your abdomen braced.
  • Turn by pivoting or stepping around with your feet. Think of this as a standing logroll. Be careful not to bend or twist at the waist.

If You Must Reach

  • Avoid reaching as much as possible. Ask for help in getting things off shelves.
  • When getting an object off a shelf, slide it to the edge toward your body. Test its weight by pushing up on one corner. If it’s light enough to lift, change your grip and bring the object close to your body.
  • If you must climb, use a stepladder. Go just high enough to reach the object without lifting your elbows above your shoulders. Climb up and down slowly, keeping your spine aligned. Hold on to a wall with one hand.
  • DO NOT climb if you’re taking pain medications. Some pain medications can make you dizzy or affect your balance.

Exercises

Heel Raise

Heel raises help to strengthen calf muscles.

  • Stand with your spine balanced. Hold on to a counter, table, sturdy chair, or railing.
  • Rise on your toes, then lower your heels to the floor.

Calf Stretch

Stretching calf muscles helps make standing and turning easier.

  • Stand with your spine balanced. Step forward with one foot. Place your hands on a wall or the back of a sturdy chair.
  • Keep both heels on the floor. Bend your front leg until you feel the stretch in your back leg. Count to 20, then switch feet.
  • DO NOT arch your back.

Tips for Daily Living

Washing at the Sink

While standing at the sink, bend your knees and hips. Keep your back in a neutral position.

Showering

Use a hand-held shower to wash your hair. Or bend at the knees and hips under the shower head to avoid arching your back. To avoid bending, use a long-handled scrub brush. Use liquid soap so you don’t need to pick up a dropped bar of soap.

Working in the Kitchen

Store food and tools you use often on the counters or the middle shelves of the refrigerator. While working, stand with one foot in front of the other or resting on a stool.

Sitting

Sitting puts more pressure on your spine than lying or standing. At first, avoid sitting as much as possible. As your back heals, you can sit for longer periods of time. The exercises on these pages help strengthen your back and thighs to support your back as you sit. Use the tips in this section to help with sitting activities such as driving or using the toilet.

Back Basics

If You Must Sit

Use a firm, upright chair, and change position often.

  • Keep your feet flat on the floor, your knees level with or just below your hips.
  • Keep the curves of your spine balanced. Relax your shoulders.
  • If the chair doesn’t support your lower back, place a soft pillow or a lumbar support behind your lumbar curve. Or use a small towel, rolled up so that it’s 2 or 3 inches around. You may want to attach this support to your chair.

To Stand Up

  • Scoot to the front of the chair. Tighten your abdomen. Place one foot slightly in front of the other.
  • If the chair has armrests, grasp them for support. If not, put your hands on your knees.
  • Bend at the hips, press down with your hands, and use your leg muscles to push your body up. Keep your spine balanced.

To Sit Down

  • Back up to the chair. Tighten your abdominal muscles.
  • Bend at the hips and use your leg muscles to lower yourself onto the front of the chair. Don’t drop onto the chair.
  • Scoot back to let the back of the chair support your spine.

Exercises

Opposite Hand-Knee Push

This exercise strengthens the muscles in your abdomen and thighs.

  • Sit with your spine in a neutral position. You may want to use a lumbar support. Tighten your lower abdomen.
  • Lift your left knee and push against it with your right hand for 20 counts. Don’t arch your back.
  • Do the exercise again, using the left hand on the right knee.

Wall Slide

Wall slides help to strengthen your thighs.

  • Stand with your back against a smooth wall. Put your feet 18 to 24 inches away from the wall and slightly apart.
  • Relax your shoulders. If needed, place a rolled-up towel behind your lower back to keep your spine in a neutral position.
  • Slide slowly down until you’re halfway between sitting and standing. Hold for at least 10 counts, then slide back up.

Tips For Daily Living

Driving or Riding in a Car

Adjust the car seat so that your knees are level with or just below your hips. To get out of the car, pivot on your buttocks and swing your legs out, keeping your knees together. Don’t twist your spine. Use your leg muscles to stand. To get into the car, do the reverse.

Doing Desk Work

When you’re ready to go back to work, ask your physical therapist how to arrange your desk and workspace to protect your back.

Eating

Slide your chair as far under the table as possible. Don’t lean forward or put your elbows on the table.

Using the Toilet

Try using a toilet seat riser or portable commode. You can buy these at a drugstore or medical supply store.

Bending and Lifting

During the first weeks after surgery, avoid bending and lifting as much as possible. If in doubt about whether a task is safe for you, ask for help. On these pages, you’ll learn about safer ways to bend. You’ll learn the proper way to lift. You’ll also find exercises to stretch your legs, so that you can use them to lift instead of using your back. And you’ll find tips for grocer)’ shopping and child care.

Back Basics

To Bend Over

  • Tighten your abdominal muscles. Stand with your feet shoulder-width apart.
  • Bend at your knees and hips. Let your buttocks stick out. Don’t arch your back.
  • To stand up, pull your buttocks in and push up with your leg muscles.
  • Use a reacher for small objects.

To Bend to the Floor

  • Step forward with one leg. Keep your spine balanced.
  • Bend both knees until the lower (back) knee touches the floor. Hold on to something stable to keep your balance.
  • To stand, push up with your leg muscles.

If You Must Lift

  • Stand close to the object with your feet shoulder-width apart. Put one foot slighdy in front of the other. Tighten your abdomen.
  • If necessary, bend at the knees and hips to get closer to the object. Keep your spine aligned.
  • Pick up the object and bring it close to your body.
  • If you bend down to pick up the object, use the muscles in your legs and buttocks, not your back, to stand up.

Exercises

Hamstring Stretch

This exercise stretches the muscles in the back of your thigh.

  • Lie on your back with one knee bent. Tighten your abdominal muscles.
  • Put a towel or your hands around the back of the thigh of the straight leg. Slowly pull the leg toward you, keeping the knee straight. Hold for 10 counts, then switch legs.
  • Raise the leg a little higher each day.
  • If you feel tingling or pain in your back or legs, you’re not yet ready to do this exercise.

Quadriceps Stretch

This stretch is for the muscle on the front of the thigh.

  • Stand with your feet shoulder-width apart. To keep your balance, hold on to the back of a sturdy chair or a nearby wall with your right hand.
  • Grasp your left ankle with your left hand. Pull your left heel toward your buttocks. Don’t arch your back or lean sideways. Hold for 20 counts, then switch legs.

Tips for Daily Living

Grocery Shopping

Buy small amounts of groceries each time. Ask the checker to bag lightly and to use bags with handles. Put the shopping bags on the car seat, not in the trunk or on the floor.

Child Care

If you have small children, arrange for help while you’re recovering. Put the changing table on a raised surface, or adjust it to waist height. Use a reacher to pick up small objects, such as toys, from the floor. If you must lift a baby from a crib, lower the railing of the crib. Bring the child close to your body. Follow the lifting instructions on page 12.

Pushing and Pulling

Pulling is harder on your spine than pushing. So whenever possible, push, don’t pull. Also, avoid pushing anything heavy. This page can help you learn how to push and pull safely. It also includes a stretch to help you keep your chest, shoulders, and upper back relaxed.

Back Basics

To Push

  • Keep your elbows close to your body. This will help you keep the handles of the object you’re pushing close to your body.
  • Take small steps. Step and push with your entire body, keeping yourself upright. Don’t bend forward.
  • Avoid housecleaning tasks such as vacuuming until your doctor says it’s okay to do so.

If You Must Pull

  • When standing, put one foot slightly in front of the other and bend your knees slightly.
  • Get close to the object. Brace your abdomen. Keep your spine neutral.
  • Keep your elbows locked to the sides of your body. Move back as you pull. Don’t arch or twist your back.

Exercise

Chest-Shoulder Stretch

This stretch relaxes the chest and shoulders.

  • Stand facing a corner with your back in a neutral position. Put one foot slightly in front of the other.
  • With arms bent at right angles, place your hands on the walls. Keep the elbows at shoulder height.
  • Gently lean toward the corner. Feel the stretch across your upper chest. Don’t arch your back.

Taking Care of Yourself

Taking care of your health can help you recover faster, feel better, and reduce the risk of reinjury. Factors that can affect your health and the health of your back include stress, excess weight, and smoking. Addressing these issues now can help you keep your back healthy in the long run.

Releasing Tension

Stress can lead to tight, painful muscles. Try these methods for releasing tension:

  • Deep breathing. Slow, calm, deep breathing can help you relax. Breathe in for a count of 5 or more. Then slowly let the breath out.
  • Visualization. Imagining a peaceful, secure scene can give you a sense of control over your body and surroundings.
  • Progressive relaxation. This is done by tightening and then releasing muscle groups. Start at the top of your head and work your way down your body. Tighten each muscle group for 5 to 10 counts. Then release the muscle group for the same amount of time.

Managing Your Weight

Excess weight increases the load on your lower back. So maintaining a healthy weight makes your back less prone to injury. If you need to lose weight, talk to your doctor about exercise and changes in your diet. Your doctor may recommend a weight loss program to help.

Walking for Back Health

Walking is part of your recovery. It’s also one of the best things you can do to maintain your back health from now on. Regular exercise can also relieve stress and help you manage your weight. Make a habit of walking often.

If You Smoke, Quit!

Smoking can slow your recovery from surgery. It keeps your muscles from getting the oxygen they need. And it may make your disks more prone to damage. If you smoke, talk to your doctor about how to quit. Your doctor may recommend a stop-smoking class. He or she may prescribe medications or aids to help you quit. Be persistent. It often takes more than one try to succeed in quitting.

Lumbar Spinal Surgery

Low fusionprocedureBack Problems

If you have a low back problem, you’re not alone. Low back problems are very common. Some are caused by aging or injury. Others are the result of daily wear and tear on your spine. No matter the cause, back problems are often very painful. And there are no magic cures. But treatment can help ease your pain and improve your quality of life.

When You Have Pain

Pain due to low back problems is different for each person. For some, pain gets worse with certain activities. For others, it hurts all the time. The location of pain can also differ. Pain may be only in the low back. Or, you may have pain in the buttocks and legs. You may also feel tingling, weakness, and numbness. Whatever your symptoms, a low back problem often puts limits on your life. Doing even simple tasks, such as lifting groceries or bending to help your child, can be frustrating. In some cases, constant pain can even lead to depression.

Surgery Can Help

If other treatments haven’t helped your symptoms, surgery may offer relief. Surgery often helps:

  • Ease back and leg pain.
  • Relieve pain during movement.
  • Reduce numbness or weakness.
  • Improve your quality of life.

Understand Your Role

For best results, plan to take an active role in your treatment and recovery. Talk with your doctor about what you hope surgery will do for you. Also keep in mind:

  • Recovery from spine surgery takes time, often several months.
  • You will be asked to limit activities that put stress on your back.
  • Physical therapy may be needed to improve your strength and mobility.

Learning About Low Back Problemshealthy1

Vertebrae are bones that stack like building blocks to make up your spine. The lumbar spine contains the five bottom vertebrae in your back. When the lumbar spine is healthy, you can bend and move in comfort. But if part of the lumbar spine is damaged, pain can result.

A Healthy Lumbar Spine

In a healthy lumbar spine, all the parts work together.

  • Disks are soft pads of tissue that act as shock absorbers between the vertebrae. The firm, fibrous outer layer of a disk is called the annulus. The soft center of the disk is called the nucleus.
  • The spinal canal is a tunnel formed within the stacked vertebrae. The opening between the vertebrae on either side of the spinal canal is called the foramen.
  • Nerves run through the spinal canal. They branch out from the spinal canal through the foramen on each side.
  • The lamina is the arched part of each vertebra that forms the back of the spinal canal. Facet joints are the joints where the vertebrae meet.

A Painful Lumbar Spine

Low back pain can be caused by problems with any part of the lumbar spine. A disk can herniate (push out) and press on a nerve. Vertebrae can rub against each other or slip out of place. This can irritate facet joints and nerves. It can also lead to stenosis, a narrowing of the spinal canal or foramen.

Pressure from a Disk

Constant wear and tear on a disk can cause it to weaken and push outward. Part of the disk may then press on nearby nerves. There are two common types of herniated disks:

  • Contained means the soft nucleus is protruding outward.
  • Extruded means the firm annulus has torn, letting the soft center squeeze through.

Pressure from Bone

With age, a disk may thin and wear out. Vertebrae above and below the disk may then begin to touch. This can put pressure on nerves. It can also cause bone spurs (growths) to form where the bones rub together. Stenosis results when bone spurs narrow the foramen or spinal canal. This also puts pressure on nerves.

An Unstable Spine

In some cases, vertebrae become unstable and slip forward. This is called spondylolisthesis. Slipping vertebrae can irritate nerves and joints. They can also worsen stenosis.

Your Medical Evaluationexam3

An evaluation helps your doctor learn more about your low back problem. The evaluation includes a medical history and physical exam. Certain tests may also be done. After the evaluation, your doctor will talk with you about the diagnosis. Then you can work together on a treatment plan that’s right for you.

Medical History

Your doctor will ask questions about your health and any history of back problems. Be sure to mention:

  • Health problems you may have, such as high blood pressure, heart disease, or diabetes.
  • Medications you take, including aspirin or ibuprofen. Also mention if you take herbal remedies or supplements.
  • If you smoke.
  • Whether back pain keeps you from doing things you like. Also mention if it makes you feel helpless or depressed.

Physical Exam

Your doctor will check your spine in a variety of positions. This may include tests to check for pain, such as raising your leg. Other tests measure your strength, reflexes, and whether you have any numbness.

Diagnostic Tests

To help diagnose your spine problem, you may have tests including:

  • Imaging tests, such as x-rays, an MRI (magnetic resonance imaging), or a CT (computerized tomography) scan. These tests take pictures of bones, disks, and nerves.
  • Blood and urine tests.
  • Other imaging tests, such as a discogram, myelogram, or bone scan. Contrast dye is sometimes used for these tests.
  • EMG (electromyograms) to look for muscle and nerve damage.

Nonsurgical Treatment

To help reduce back pain, your doctor may first prescribe nonsurgical treatment. This often includes limiting certain activities and having physical therapy (PT). You may also be prescribed medication.

Taking Care of Your Back

Making some changes in your daily activities can help your back feel better. Try these:

  • Learn how to reduce stress on your back while doing things like bending or walking.
  • Limit certain activities, such as lifting.
  • Improve your posture while sleeping or getting out of bed.
  • Use back supports, such as a lumbar roll, to relieve pain and keep the spine balanced.

Physical Therapy

Physical therapy can help low back problems. A PT program may include:

  • Exercises, such as walking, to improve your strength and mobility.
  • Education, to help you learn how to move without hurting your back.
  • Treatments, such as ultrasound, massage, heat, or cold. These help reduce pain.
  • Manual therapy, which helps improve movement of the spine.

Medication

You may be prescribed medication to treat pain, muscle spasm, and inflammation. Some medications are injected into joints or into areas near disks and nerves. Others are taken in pill form. Talk with your doctor about how your medications work. Also be sure to take pills as often as you’re told—not just when you have pain.

Surgical Treatment

If other treatments aren’t improving your quality of life, your doctor may recommend surgery. Plan ahead for both your surgery and recovery. Be sure to follow any instructions you are given. And talk to your doctor if you have questions about surgery or how the procedure will be done.

Planning Ahead

Planning ahead will help make your recovery easier and safer. Try these tips:

  • Stop smoking. Smoking makes it harder for bone to heal. Ask your doctor about quitting aids such as gum, patches, or medications.
  • Talk with your doctor about managing blood loss. You may be able to donate your own blood ahead of time. Or, you could receive blood donated by another person. In some cases, a drug called epoetin alfa is given before surgery to help reduce the need for transfusion.
  • Move household items you’ll need after surgery. Place them between hip and shoulder level. This keeps you from needing to lift or bend.
  • Arrange for rides. You may not be able to drive for a week or more after surgery.
  • Get a pair of slip-on shoes with closed backs. Then, you won’t have to bend to put on shoes.

Before Surgery

Follow your doctor’s instructions to prepare for surgery. Also, be sure to:

  • Stop taking aspirin and ibuprofen at least a week before surgery. Ask if you should stop taking other medications, herbal remedies, or supplements.
  • Arrange for an adult family member or friend to drive you home.
  • Don’t eat or drink after midnight the night before your surgery.
  • If you are told to take medication the day of surgery, swallow it with just a sip of water.

The Day of Surgery

Arrive at the hospital on time. Before surgery, your blood pressure and temperature will be taken. You’ll be given an intravenous line (IV) to provide fluids. You may also get medication to help you relax. Just before surgery you’ll be given anesthesia (medication to prevent pain). Local or regional anesthesia numbs just the surgical area. General anesthesia lets you “sleep” during the operation.

Reaching Your Spine

To operate on your spine, the surgeon will make an incision through your skin. The incision will be in your back (posterior approach), or in your abdomen (anterior approach). After surgery, the incision is closed with stitches or staples.

Posterior Approach

Your surgeon reaches the spine through your back. In some cases, a microscope is used to view damaged areas more clearly.

Anterior Approach

Your surgeon reaches the spine through your abdomen. This is done when your surgeon needs access to the front of your spine.

Types of Surgery: Decompression

Decompression is a type of surgery that takes pressure off a nerve. This can be done by removing bone from vertebrae. It can also be done by removing a portion of a disk. Sometimes, a combination of procedures are used.

Laminotomy

A laminotomy removes a portion of the lamina— the bone at the back of the spinal canal. The small opening that is created is sometimes enough to take pressure off a nerve. But in most cases, part of a disk or a bone spur that is pressing on a nerve is also removed.

Laminectomy laminectomy1

A laminectomy removes the entire lamina. This helps relieve pressure when a disk bulges into a nerve. If needed, your surgeon can also remove any part of a disk or bone spur that presses on a nerve. He or she may also enlarge the foramen to ease pain caused by stenosis. After the procedure, the new opening in the spine is protected by the thick back muscles.

Diskectomy

A diskectomy removes a portion of a damaged disk. Your surgeon may use a surgical microscope during the procedure (microdiskectomy). In most cases, a laminotomy must first be done to expose the disk. Then any part of the disk that presses on a nerve can be removed. Disk matter that is loose or may cause problems in the future is also removed. After surgery, there is usually enough disk remaining to cushion the vertebrae.

Risks and Complications of Decompression

Risks and possible complications of decompression surgery include:

  • Infection
  • No improvement of pain, or worsened pain
  • Bleeding or blood clots
  • Nerve damage
  • Need for second surgery
  • Spinal fluid leak
  • Paralysis (very rare)

Types of Surgery: Fusion

Spinal fusion is a type of surgery used to make the spine more stable. It can also help ease lower back and leg pain. During the surgery7, two or more vertebrae are locked together (fused) using a bone graft. This keeps the bones from shifting and pressing on nerves.

The Fusion Procedure

Fusion surgery can be done using several methods. Talk with your doctor if you have questions about the steps of your procedure.

  • Part of a disk may be removed from between the vertebrae to be fused.
  • Bone graft (see below) is packed between the vertebrae. In time, the graft and nearby bone grow into a solid unit.
  • To keep the spine steady, metal supports may be used along with the bone graft. The supports are left in place after surgery.
  • The incision is closed with stitches or staples.

Understanding Bone Grafts

Bone grafts are very small pieces of material used to “cement” vertebrae together. Grafts can come from your own body, a bone bank, or artificial sources. In some cases, bone protein (BMP) may be used.

Risks and Complications of Fusion

Risks and possible complications of spinal fusion surgery include:

  • Infection
  • Bleeding or blood clots
  • Nerve damage
  • Bones not fusing, or bone graft shifting out of place
  • No improvement in pain, or worsened pain
  • Need for second surgery
  • Spinal fluid leakage Paralysis (very rare)

Recovering in the Hospital

After surgery, you’ll be moved to the PACU (post-anesthesia care unit). This is sometimes called the recovery room. You’ll stay there until you’re fully awake—often a few hours. Then you’ll be moved to your hospital room. The length of your stay depends on what type of surgery you had and how well you’re healing.

Right After Surgery

recovery_hopitialWhen you wake up from surgery, you may feel groggy, thirsty, or cold. Your throat may be sore. For a few days, you may also have:

  • Tubes to drain the incision.
  • An IV to give you fluids and medication.
  • A catheter (tube) to drain your bladder.
  • Boots or special stockings on your legs to help prevent blood clots.

Controlling Pain

You will likely have some discomfort after surgery. Your nurse may give you pain medication. Or you may have a PCA (patient controlled analgesia) pump. The pump lets you give yourself small amounts of pain medication. Some pain is normal, even with medication. But if you feel very uncomfortable, tell your nurse.

Getting Up and Moving

Soon after surgery, you’ll be encouraged to get up and walk. This helps keep your blood and bowels moving. It also keeps fluid from building up in your lungs. To help you move, you may be given a brace to support your spine. You may also see a physical therapist. He or she will teach you ways to protect your spine while moving.

Recovering at Home

Recovering from surgery takes time. To help speed your recovery, slowly increase your activities each day. Also be sure to take all your medications as directed. As you feel better, you may be given exercises to improve your strength and mobility. Exercise can also help ease your pain.

Get Back into Action

Gradually increasing your daily activities is important for recovery. Try these tips:

  • Get in and out of bed safely. Your physical therapist can help you learn how.
  • Make moving easier and safer. Use reachers, shower railings, and elevated toilet seats. Avoid lifting heavy objects.
  • Ask your doctor about driving and going back to work. You may be able to return to a desk job fairly soon. It may take longer for more active work.
  • Speak with your doctor if you have questions about safe positions for sex.

Take Pain Medication as Directed

You’ll be prescribed medication for your pain. Be sure to talk with your doctor about what your medication does and how long it takes to work. Also keep in mind the following:

  • Don’t wait for pain to get bad. Take medication on time as directed.
  • If you take pain medication for a long time, ask your doctor about how and when to stop. Never stop taking medications on your own.

When to Call Your Doctor

Call your doctor if you have any of these symptoms:

  • Increasing pain, redness, or drainage from your incision
  • A fever over 100°F (37.7°C)
  • New pain, weakness, or numbness in your legs
  • A severe headache
  • Loss of bladder or bowel control

Improve Your Strength with Activity

An exercise program supervised by your doctor can help you heal faster. It can also reduce pain.

  • Walking helps keep your back muscles strong and flexible. Start with short walks and add a few minutes each day.
  • Water aerobics exercises muscles with less stress on the back. Ask your doctor when it will be safe to get your incision wet.
  • A physical therapist can give you specific exercises to help your back heal.

Use Good Body Mechanics

To help protect your back, follow a few simple rules:

  • Lift with your legs. Hold objects close to your body. And don’t lift heavy objects until your doctor says it’s okay.
  • Don’t slump or slouch when you sit.
  • Keep your ears, shoulders, and hips in line with each other at all times.
  • Use your knees to bend down. Don’t bend over from your waist.
  • Turn with your feet, not your body.

Keep Follow-up Appointments

Be sure to keep all your follow-up appointments. These let your doctor check how well you’re healing. Your medication and activity levels may also be adjusted. Be sure to ask any questions you have during these visits. By working together, you and your doctor can help ensure a smooth recovery.

Planning for Low Back Surgery

Having a low back problem can be frustrating. You may have pain when you sit or stand or walk. Merely lifting a basket of laundry may cause pain to shoot down your leg. But you don’t have to live this way. Your doctor may have told you that either a laminotomy or a laminectomy is likely to reduce your pain. To better understand these procedures, read through this booklet. It can help you prepare for surgery. You’ll also find ways to make recovery go more smoothly.

When You Have Pain

Your back problem may be due to a sudden injury. Or aging and the wear and tear of constant use may have caused changes in your spine. When pain puts limits on your life and other treatments don’t help, surgery may offer the best relief.

Surgery Can Help

Laminotomy and laminectomy are surgeries that remove a small amount of bone from the spine. This takes pressure off nerves in the low back, which greatly reduces symptoms. These surgeries are not cure-alls, but they are especially good at reducing leg pain.

How You Benefit

Most people feel better soon after their surgery. Many feel almost back to normal within 1 to 3 months. Having a laminotomy or a laminectomy almost always does the following:

  • Reduces pain. Even the pain from surgery should be gone within weeks.
  • Relieves leg pain from the hip down to the foot.
  • Allows leg strength to improve. As the pain lessens, you’ll be able to use your legs more. This rebuilds muscles.
  • Reduces numbness in the affected leg.
  • Improves quality of life. After surgery, you should be able to move with greater ease. Many people return to tasks and sports they did before their back problems started.

Learning About Your Low Back

When it is healthy, the low back allows you to bend and stretch without pain. But if your low back problem pinches a nerve, you may have pain, tingling, or numbness all the way down your leg. Sometimes merely standing or sitting causes symptoms.

A Healthy Spinal Column

The spinal column is a stack of bones (vertebrae) that are separated by soft pads of tissue (disks). Each of these bones has a canal that runs top to bottom. Together these canals form a tunnel called the spinal canal. Running through this canal are nerves. These nerves carry signals between the brain and body. When a spinal column is healthy, the following parts fit together without pressing on the nerves:

  • Vertebrae are the bones that make up the spine.
  • The lamina of each vertebra forms the back of the spinal canal.
  • A foramen is a small opening. This is where a nerve leaves the spinal canal.
  • Disks serve as cushions between vertebrae. A disk’s soft center absorbs shock during movement. This allows each vertebra to rock back and forth and side to side, so the body can move freely.

When a Back Problem Pinches a Nerve

The symptoms in your back or leg may be due to pressure on a nerve. This pressure may be caused by a damaged disk or by abnormal bone growth. Either way, you may feel pain, burning, tingling, or numbness. If you have pressure on a nerve that connects to the sciatic nerve, pain may shoot down your leg.

Pressure from the Disk

Constant wear and tear can weaken a disk over time. The disk can then be damaged by a sudden movement or injury. If its soft center begins to bulge, the disk may press on a nerve. Or the outside of the disk may tear, and the soft center may squeeze through and pinch a nerve.

Pressure from Bone

As a disk wears out, the vertebrae right above and below the disk begin to touch. This can put pressure on a nerve. Often abnormal bone (called bone spurs) grows where the vertebrae rub against each other. This can cause the foramen or the spinal canal to narrow (called stenosis) and press against a nerve.

Preparing for Surgery

Imaging tests, such as x-rays and MRIs, help your doctor plan your surgery. An exam and tests are often done weeks before a laminotomy or laminectomy. Be sure to prepare for your surgery as instructed. Once at the hospital, you may be given forms to fill out. You may also meet with the person who gives the anesthesia (the anesthesiologist or nurse anesthetist).

Your Exam and Tests

You’ll have an exam to make sure you are healthy enough to have surgery. Be sure to tell your surgeon about all the over-the-counter and prescription medications you take. You will need to stop taking anti-inflammatories, such as aspirin and ibuprofen, before surgery. If you smoke, you should stop or do your best to cut down. Before surgery, you may have some or all of the following tests:

  • Imaging tests, such as x-rays and MRIs
  • An ECG (electrocardiogram)
  • Blood and urine tests

Preparing at Home

Make life easier and movement safer after surgery. Try these tips:

  • Store supplies between hip and shoulder level. That way you can get to them without reaching or bending.
  • Arrange for rides. You may not be able to drive for a week or more after surgery.
  • Find someone to help with chores and to run errands.
  • Get a pair of slip-on shoes with closed backs. That way, you won’t have to bend to put on your shoes.

The Day of Surgery

You should stop eating and drinking:

  • By the midnight before surgery.
  • ____hours before surgery.

In most cases, you can brush your teeth before going to the hospital. If you take a daily medication, find out if you should take it the morning of surgery. If you are to take it, swallowwith only a sip of water.

At the Hospital

You may be told to arrive at the hospital a few hours before surgery. Once there, your temperature and blood pressure will be taken. In some cases, tests may be done. Then one or more IV (intravenous) lines will be started. These lines provide the fluid and medications you need during surgery.

About the Anesthesia

Before surgery, you may meet with the person who will give the anesthesia. He or she may ask about your health history and check your weight. This helps determine the amount of anesthesia you will need to “sleep” through the surgery.

Risks of Surgery

As with any surgery, laminotomy and laminectomy each have some risks. These include:

  • Damage to a nerve
  • Blood clots
  • Spinal fluid leak
  • Infection

During Your Surgery

Once in the operating room, you’ll be given anesthesia. After you are asleep, an incision is made near the center of your low back. Your incision may be 2 to 6 inches long, depending on how many vertebrae are involved. In some cases, removing part or all of the lamina may be enough to relieve pressure on the nerve. But most often, disk matter or bone spurs must also be removed. Once the nerve is free of pressure, the incision is closed with stitches or staples.

Laminotomy

During a laminotomy, part of the lamina is removed from the vertebra above and below the pinched nerve. The small opening created is sometimes enough to take pressure off the nerve. But in most cases, disk matter or a bone spur that is pressing on the nerve is also removed.

Laminectomy

During a laminectomy, the lamina is removed from the affected vertebra. The opening created may be enough to take pressure off the nerve. If needed, your surgeon can also remove any bone spurs or disk matter still pressing on the nerve. After laminectomy, the opening in the spine is protected by the thick back muscles.

During Your Hospital Stay

After surgery, you’ll be sent to the PACU (postanesthesia care unit). When you are fully awake, you’ll be moved to your room. You can expect to feel some pain at first. To gain the best pain relief, answer honestly when you are asked how much you hurt. Soon, healthcare providers will help you get up and moving. You’ll also be shown how to clear your lungs.

In the PACU

When you wake up, you’ll be on your back or side in the PACU. The nurses will give you medications to ease your pain. You may have a catheter (small tube) in your bladder. There may also be a drain in your low back. To help reduce the risk of blood clots, you might be wearing compression boots or special stockings.

In Your Hospital Room

You’ll be moved to your room when you are alert and your blood pressure and pulse are stable. An IV and the catheter are likely to still be in place. Healthcare providers will check on you often. The nurses will work closely with you to control your pain. Once you are in your room, family and friends will be able to visit you.

Controlling Pain

At first, you may be given pain medications by IV or injection. Expect to feel some pain, even with the medications. This is normal. But if the medication does not reduce your pain, be sure to tell the nurse.

PCA Puts You in Control

With PCA (patient-controlled analgesia), pain medication is sent through an IV line at the push of a button. To provide a steady level of pain relief, only you should push the button. For your safety, the pumps have special features to limit the amount of medication you receive.

Getting Up and Moving

You may begin to walk within hours after surgery. This reduces some risks of surgery, such as blood clots. With an TV and a PCA pump in place, walking may be a little tricky. But don’t worry. A healthcare provider will help you.

Clearing Your Lungs

Fluid can collect in the lungs after any surgery. To clear your lungs and prevent pneumonia, breathe deeply and cough. You should do this often— at least a few times each hour. A respiratory therapist or nurse may show you how to use an incentive spirometer. This machine can help you breathe in and out the right way.

Learning to Move More Safely

Either before or after surgery, you will be shown ways to move more safely. Practice what you are taught, and learn the keys to safe movement. Also follow all the other directions on these pages until safe movement becomes natural to you. This will ensure your best recovery. It will also help protect your back in the future.

Keys to Safer Movement

To move more safely, you need to follow a few simple guidelines. Whether you are getting into bed, standing, or doing a daily task, the keys to safer movement are the same. To protect your back, do these things:

  • Tighten the muscles in your stomach to support your spine.
  • Keep your ears, shoulders, and hips in a line.
  • Bend at the hips and knees, not at your waist.
  • Move your body as a unit. Do not twist at your shoulders or waist.

Getting Out of Bed

  • Tighten your stomach muscles. Roll onto your side. Be sure to move your body as a unit. Don’t ftvist.
  • Scoot to the edge of the bed.
  • Press down with your arms to raise your body as you gently swing both legs to the floor.
  • Place one foot slightly behind the other. Keep your stomach muscles tight. Then, use your leg muscles to raise your body.

Sitting and Standing Up

  • To sit, back up until the front of the chair touches the back of your legs.
  • Tighten your stomach muscles. Bend forward slightly from the hips (not the waist).
  • Using your leg muscles, lower your body onto the chair. Then scoot back.
  • To stand up, scoot to the edge of the chair. Place one foot slightly behind the other. Use your leg muscles to raise your body.

Standing and Turning

  • Stand with one foot slightly in front of the other.
  • Keep your knees relaxed and your stomach muscles tight.
  • To turn your body, move your feet. Step around. Do not mist.

Getting Into Bed

  • Back up until the edge of the bed touches the back of your legs.
  • Tighten your stomach muscles. Bend forward slightly from the hips.
  • Use your leg muscles to lower your body onto the bed.
  • Using your arm for support, lower your body onto its side. (Move your body as a unit, allowing your feet to lift onto the bed.)
  • Roll onto your back without twisting your waist.

Safe Sleeping Positions

  • Lie on your back with a pillow under your knees.
  • Lie on your side with your knees slightly bent. Keep a pillow between your knees.

Recovering at Home

At home, you are in charge of your recovery. Protect your back by taking care of your incision and returning to activity slowly. See your surgeon for follow-up visits. Also improve your strength and motion by exercising as directed.

Incision Care

Take care of your incision as instructed. Bathe or shower as directed, and change the dressing if you are told to. If Steri-Strips were placed over the wound, they should loosen as the incision heals.

Getting Back into Action

You’ll need to increase your activity level slowly. The information below will help you know what to expect.

  • Know that some days you will feel better than others. It helps to take short, frequent walks each day.
  • You may be able to drive or return to a desk job within weeks after surgery. If you do more active work, you may need to wait 2 to 4 months before going back.
  • As your back heals, you may feel ready to have sex. If you have questions about safe positions, talk with your surgeon or nurse.

See Your Surgeon

Follow-up office visits allow your surgeon to make sure your back is healing well. Stitches or staples are often taken out 1 to 2 weeks after surgery.

When to Call Your Surgeon

Call your surgeon if you have any of these symptoms:

  • Drainage from the incision
  • Redness near the incision
  • Fever above 100°F
  • Increasing pain, numbness, or weakness in your leg

Improving Strength and Motion

Strong, flexible muscles help protect your back. You may be taught special exercises. Or you may be told to do the ones shown here. At first, these may be easier to do on a bed than on the floor. Talk with your healthcare provider if doing your exercises causes new or lasting pain.

Lifting Safely

The first weeks after surgery, lift only objects that weigh less than 5 pounds. When you must lift, now or in the future, protect your back by following these steps:

  • Get close to the object. Lower your body by bending at the hips and knees. Keep your ears, shoulders, and hips in a line.
  • Hold the object close to your body.
  • Press down with your feet. Allow your legs to lift your body and the object.

Pelvic Tilt

  • Lie on your back with your knees bent and your feet flat.
  • Tighten your stomach muscles. Press down until the curve of your low back flattens against the bed or floor.
  • Hold 10 seconds. Repeat
  • 10 times. Do this twice a day.

Partial Sit-Up

  • Lie on your back with your knees bent and your feet flat.
  • Slowly raise your head and shoulders off the floor.
  • Hold 10 seconds. Repeat
  • 10 times. Do this twice a day.