Presented by: Dr Paul Licina — Spine Surgeon Event: GP Education Day - 2013

1. PATIENT GUIDE
Operation: Lumbar Discectomy
Surgeon: Dr Paul Licina
INTRODUCTION
This is a guide to your upcoming operation. In it we explain what is likely to happen at each stage of
the process. Your care will depend on your individual needs, so your progress may vary from this
basic outline. Please become familiar with this guide and discuss any aspects you wish to with your
surgeon or the nursing staff.
You will be admitted on the morning of surgery, unless this is impractical or you have some
significant medical problems. You should expect to be in hospital for one day, which means that you
will go home late in the afternoon / evening on the day of surgery. You must have a responsible
adult staying with you overnight after your surgery.
BEFORE SURGERY
You should stop taking some anti-inflammatory drugs at least ten days prior to surgery as they can
increase the risk of bleeding. These tablets include Voltaren, Nurofen, Brufen, Feldene, Naprosyn and
Indocid. You may continue Celebrex and Mobic. You should also stop taking any vitamin or mineral
supplements ten days prior to surgery.
If you are on low-dose aspirin (eg. prescribed to prevent stroke or heart attack), you must
discuss this with your surgeon. If you are currently taking Warfarin (Coumadin or Marevan),
Plavix or Iscover tablets, you should notify your surgeon as you will need to stop taking this
medication under medical supervision.
You should keep the skin near the operation site clean. If you have a cut or pimple on the skin in the
area, you should notify your surgeon prior to surgery.
ADMISSION
You should not eat or drink 6 hours prior to surgery. This usually means from 2.00 am on the
morning of your operation. (You may not be the first patient on the list, but the order may need to be
changed unexpectedly)
You should bring with you
 Personal effects (nightgown or pyjamas, slippers, dressing gown, toiletries) in case you are
required to remain in hospital overnight
 Any medication you are taking
 Medicare and private health fund membership cards
 Your medical consent and admission paperwork
Your x-rays and scans will be taken to the theatre on the day of surgery by our staff.
Prior to going to theatre, you will be taken to the Day Surgery Unit and you will
 Have a shower with an antiseptic soap (Betadine)
 Be dressed in a theatre gown and disposable underwear
 Have special stockings fitted (to help prevent blood clots)
 Be asked to mark the painful leg with an indelible pen
If you wish, your surgeon will speak to a family member in person at the end of the day’s surgery
list. Please notify the hospital nursing staff of the details.

2. THE PROCEDURE
You will be prepared for surgery by the nursing staff in day surgery. You will be taken from the day
surgery unit to the operating theatre in a wheelchair / trolley bed. The operation will take about forty to
sixty minutes, but you may spend up to one and a half hours in the theatre complex, by the time you
wait in the preoperative area, have the surgery and wake up in the recovery area.
The anaesthetic
The anaesthetist will give you a general anaesthetic. A small needle will be placed in the back of your
hand or in your forearm. This will be connected to a drip. You will be asked to breathe on an oxygen
mask and the drugs to make you fall asleep will be injected through the drip. You will be asleep and
not be aware of anything further until the operation is completed. Antibiotics are given to you at this
stage.
The surgery
You will be placed on the operating table lying face down. A needle will be placed in your back and an
x-ray will be taken with an image intensifier (fluoroscopy). This will help identify the correct level at
which to make the incision. Your back will be prepped (cleaned with antiseptic solution) and draped
(covered with sterile sheets).
The incision will then be made. It is usually 2 to 3 cm long. The muscles covering the spine will then
be detached and retracted to expose the space between the laminae of the vertebrae. There is a
tough fibrous tissue called the ligamentum flavum between the laminae and this along with some
surrounding bone will be removed. This allows access to the dura, or delicate tube containing the
spinal fluid and nerves. The compressed nerve is identified and retracted out of the way. This
exposes the disc. The soft prolapse may be covered with annulus fibrosis (outer disc material), may
have passed through this, or even be floating free. The prolapse is identified and removed.
Sometimes an incision into the annulus needs to be made. Instruments are then passed into the disc
and any other loose fragments are removed. The whole disc is not removed – all of the annulus and
some or most of the inner gel (nucleus pulposis) remains. The hole in the annulus is not closed as it is
not possible to repair it. It repairs by itself with time.
Any bleeding is stopped; an anti-inflammatory steroid (Cortisone) and long-acting local anaesthetic
(Marcain) are applied to the nerve and surrounding tissues. These provide pain relief for up to 12
hours. The wound is closed with deep long-lasting dissolving stitches and more rapidly dissolving
stitches are used to close the skin. These are just under the skin and do not have to be removed. A
dressing is applied and you are transferred back to the trolley.
The recovery
The anaesthetist will reverse the anaesthetic. You will wake up in the recovery room. The nurses
there will check your observations and the movement in your feet. Once you are sufficiently awake,
you will be transferred back to the day surgery unit.
AFTER SURGERY
When you return to day surgery, you will be resting in bed but will be free to move into a comfortable
position. You will have a drip in your arm for fluids. This will be removed once you have had
something to eat and drink and are not nauseated. You will have a bulky dressing over the wound on
your back.
You will be seen by the physiotherapist soon after your surgery. The physiotherapist will take you for a
walk and give you instructions about your activities during the recovery period, including an exercise
programme.
For pain control you will have tablets (Panadeine Forte / Tramal / Digesic) available. Occasionally,
you may also be prescribed an anti-inflammatory medication.
DISCHARGE
Once you are walking safely and only needing tablets for pain, you will be able to go home. The
nurses will remove the bulky outer wound dressing and ensure the smaller waterproof dressing
remains securely sealed.

3. You may travel home in a car in an upright seat, but you should stop for a break if the trip is longer
than half an hour or so. If you live more than one hour (100km) from Brisbane and plan to travel home
in a car, it would be better that you stay in Brisbane for a couple of days after surgery.
If you have a problem such as vomiting on the same night after your surgery, you should contact
the hospital where you have had your surgery and speak to the nursing supervisor / senior nurse on
the surgical ward.
WHEN YOU GET HOME
Frequently Asked Questions
Will I have any back or leg pain?
You will have discomfort in your wound from surgery, but this settles quickly, usually in the first one to
two weeks. You can expect some pain / pins and needles down the leg and this usually lasts three
to four weeks, is intermittent and is not as severe as the pain was before surgery. This is normal
until the affected nerve recovers and you should not be concerned. You should take the tablets
given to you as directed for pain & obtain a further script from your general practitioner if required. If
you become constipated from your pain relief medication, you may need to increase your fluid or fresh
fruit intake or obtain appropriate medication from your chemist.
When should I remove the dressing?
You should take the dressing off after five days. If it falls off before this and the wound is clean, you
should not worry. There aren’t any stitches to remove as they are dissolving and under the skin. As
the body dissolves the stitches, there is sometimes a mild reaction around the wound, seen as some
redness and inflammation. You may also experience minor swelling over your wound but this usually
subsides within 2 weeks.
How long should I wear my stockings?
You should wear your stockings for at least one week or until normal activities are resumed.
When can I start driving again?
As a general guideline, you may drive at 2-3 weeks. However, this is variable and dependent on
whether you have a manual or automatic vehicle and is also influenced by comfort levels and how
quickly you have recovered from surgery. If you have no leg pain and you are comfortable to sit, you
may return to driving at two weeks.
How often should I do my exercises? When can I start a gym programme?
Your physiotherapist will provide you with a mobility & exercise programme & instructions about
frequency & repetitions required. You should take progressively longer walks building up to 30 minute
sessions twice daily. You can usually commence a gym programme after six weeks under the
guidance of your physiotherapist.
What about swimming? How long should I wait before I can go back in the pool?
Once your wound has healed, you may commence hydrotherapy exercises. Gentle swimming may be
started as early as 3 weeks after your operation. These should be under the guidance of your
physiotherapist.
Can I start cycling again?
Generally speaking, you can use a stationary bike at 2 weeks post-op and begin cycling at 4 to 6
weeks depending on whether you have any residual leg pain.
What activities are limited?
You should not lift, pull or push anything heavy (ie. nothing heavier than 5kgs). Light weights may
be lifted from table height & carried close to the chest. During this recovery time, you should avoid
lifting babies from cots and placing children in their car seats. You should avoid prolonged or sudden
bending and twisting movements of your spine and should not stretch past the point of pain. Reach
for objects on the floor by bending your knees. Minimise work done with arms over your head.
When can I return to work? How long can I sit?
You may return to work at two to three weeks if you have a sedentary job, such as administrative or
clerical work, but if your job is more physical, then you should return to see your surgeon at 7 weeks
post-op before resuming work.
You should not sit in low chairs and after your operation, should build up your tolerance to sitting.
Time is limited by discomfort.

4. Can I sleep on my tummy?
You should sleep on your back or on your side with a pillow between your knees for the first few
weeks. This helps to preserve the natural curve of your spine & does not cause undue stress on your
back.
What about sex?
If a fairly passive role is taken, you can resume sexual activity 2-3 weeks after your operation.
When should I see my doctor / my physiotherapist / my surgeon?
You should see your local doctor or contact your surgeon if
 You develop severe and constant leg or back pain
 You have bleeding or discharge from your wound or if your wound is hot, swollen & reddened
round the edges
 You are unwell and have a fever
Contact your local doctor if you need a further script for painkillers.
Post-Operative Contact
We will contact you by phone on the Monday following your surgery, to check how you are and remind
you of your post-operative appointment with Dr Licina. You need to make an appointment to see your
surgeon approximately seven weeks after surgery. The cost of this post-operative visit at seven weeks
is included in the surgical fee. Any subsequent visits pertaining to this surgery will be charged at the
rebate fee.
You should see your physiotherapist at 2 to 3 weeks post-operatively & again at 7 weeks for a review
& upgrade of your exercises.
Finally…
While surgery helps to relieve your pain and allows you to enjoy most, if not all, of your activities
again, how well your back recovers depends upon the time and energy you put into strengthening and
protecting your spine.
The sooner you become active, the sooner you’ll be able to resume your normal activities. Take note
of the advice given to you by your health providers. Be aware of maintaining good posture, moving
wisely and exercising regularly so that you will obtain the best possible outcome from your surgery.