Surgical Management of Spinal Stenosis
Edited By: Richard J. Bransford, M.D.
Last updated Friday, December 23, 2005
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Recovering from surgery
Pain and pain management
Surgery through the front of the neck and discectomies are
usually not especially painful and often patients will go home from the
hospital the day after the procedure with good pain control on oral pain
medications.
The more invasive lumbar spine surgeries with laminectomies
and fusions are some of the most painful operations one can have. The muscles
on the back are very large and during the procedure, must undergo extensive
manipulation, causing significant pain after surgery. The pain is usually
managed by epidural catheters, patient controlled analgesia (PCA), or
combinations of medications.
Use of medications
For simple discectomies, oral pain medication is all that is
usually required.
For any other surgery for stenosis, such as laminectomies or
fusions, usually a patient controlled analgesia (PCA) pump, or an epidural is
used to control pain for one to three days before switching to oral pain
medications. When they go home, most people are taking Oxycontin, MS Contin,
Percocet, Vicodin, Oxycodone, or a combination of narcotic and muscle relaxant.
Effectiveness of medications
Pain medications can be very powerful and effective. Their
proper use lies in the balancing of their pain relieving effect and their
other, less desirable effects. Effective pain control is an important part of
the post-operative management. Being psychologically prepared is also helpful.
Patients who have been on high dose pain medications before surgery usually
have a harder time gaining acceptable pain relief than patients who are not on
narcotics.
Important side effects
Pain medications can cause drowsiness, slowness of
breathing, difficulties in emptying the bladder and bowel, nausea, vomiting and
allergic reactions. Patients who have taken substantial narcotic medications in
the recent past may find that usual doses of pain medication are less
effective. For some patients, balancing the benefit and the side effects of
pain medication is challenging. Patients should notify their surgeon if they
have had previous difficulties with pain medication or pain control.Hospital stay
After surgery,
the patient spends an hour or so in the recovery room. For significantly
complicated or long cases, the patient may need to spend a night or two in the
intensive care unit (ICU).
A drainage tube
is often used to remove excess fluid from the surgical area. The drain is
usually removed on the first or second day after surgery. Bandages cover the
incision. They are usually changed the second day after surgery.
Generally, the
patient is up walking the day after surgery with assistance from a physical
therapist.
Patients are discharged as soon as the incision is dry, he
or she is comfortable with oral pain medications, can perform the usual
activities of daily living with minimal assistance, and a home support system
is in place.Recovery and rehabilitation in the hospital
Recovery from spinal surgery for stenosis depends largely on
what surgery was done to alleviate the stenosis.
Most patients having discectomies will feel pretty well
within hours after surgery and will go home the day of or the day after
surgery. These patients usually see a therapist while in the hospital to review
any precautions and make sure they can perform the usual requirements of daily life.
Patients undergoing anterior cervical spine decompression
and fusion also recover fairly rapidly and are ready to go home a day or two
after surgery. Some patients experience hoarseness
of the voice and difficulty swallowing.These patients will require assistance
by therapists to be cleared for discharge.
Patients undergoing laminectomies and fusions will recover
more slowly. Therapists will try to get
these patients up and walking the day after surgery, but these patients are generally
slower to mobilize and to regain their strength and independence.
Occasionally, the elderly or those who undergo extensive
surgery, will not be able to go home after their surgery and may need to spend
a period of weeks to months recuperating in a rehabilitation center or skilled
nursing facility.
Hospital discharge
At the time of
discharge, the patient should be relatively comfortable on oral medications,
should have a dry incision, should understand their limitations and should feel
comfortable with the plans for managing the surgical site.
Most patients
do not need to see a therapist for exercises after discharge. The main mode of
therapy for the first few weeks is walking. Patients should not lift more than 5
to 10 pounds.
Convalescent assistance
Many patients may require help after surgery with daily activities,
such as putting on shoes and socks. This depends on what type of surgery they
had. Before patients can go home, they need to demonstrate their ability to
perform most daily activities, such as dressing, getting out of bed and walking
to the toilet, etc. If they are unable to do these things, they may need to go
to a skilled nursing facility or a rehabilitation facility to get more
care.Surgery for at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 to make an appointment. Our clinical center is located in Seattle Washington, USA
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