Anterior Lumbar Artificial Disc Insertion

Patient Management

INFORMATION SHEET FOLLOWING SPINAL SURGERY

Anterior Lumbar Artificial Disc Insertion

GENERAL ADVICE

Give yourself adequate time to recover over the next few weeks to months. Take things slowly and you will feel better off down the track. In this early recovery phase your body benefits from lots of rest and good nutrition. Don’t try to rush back into your pre-operative routines; these can be gradually re-established over the next 4-6 weeks. Avoid bending forward over the first four weeks. Generally you will go home from the ward or to a recognized rehabilitation unit. They are experts in this area and will give you good ongoing advice.

WOUND CARE

  • The sutures in your abdomen are all below the skin surface and are fully dissolvable.
  • Keep the wound dry over the first 7 days.
  • Initially the dressing can be changed on a daily basis for the first week.
  • The Nurses will also talk to you about wound care for when you go to home / rehab.
  • Let Mr Brendan O’Brien know through the rooms or the St Vincent’s Hospital if there is any:
    • Increasing wound redness, swelling or drainage
    • Increasing wound pain
    • Fever or temperature > 38.0
    • For a low grade fever – record the temperature daily at 8am 12md and 6pm and notify
    • Increasing abdominal / leg / back pain or loss of leg sensation

Remember: Increasing Pain is a RED FLAG

MOVEMENT / EXERCISE REGIME

  • IMPORTANT TO AVOID BENDING, TWISTING, PUSHING, STOOPING OR LIFTING anything you are not comfortable with, overall this is
  • Get up from a lying position by first turning onto one side.
  • Initially limit sitting to an upright posture for 20-30mins at a time, 4 times per day (usually aligns with mealtimes). Avoid lying on the sofa, use the bed instead.
  • Once you are home: continue walking in the house then progress to outdoors.
  • Gradually increase the distance you are comfortable with.
  • Start at approximately 10-15 minutes 2-3 times per day, if you are up to it.
  • Build on what you have learnt in rehabilitation.
  • Gentle Core muscle strengthening can begin after the first two weeks.
  • If you feel increased soreness or discomfort- REST and let us know if ongoing
  • Resumption of sexual activity: generally this is over the first four to six weeks, being careful to avoid unusual strain or positioning.
  • By the fourth week try to walk 2-3 times per day for 20 mins each at a comfortable pace

REMEMBER: THESE ARE GUIDELINES TO EXERCISE – NOT RULES

DRIVING / GENERAL ADVICE

  • It is advisable not to drive from time of discharge until reviewed in Rooms.
  • This is around four to six weeks post-operative
  • Alcohol intake is okay but should be limited to two glasses at any one sitting
  • Make all efforts to refrain from smoking as this definitely delays healing and bone fusion

MEDICATIONS

On discharge you will be on some medications (apart from your regular ones)

  • Analgesics
    • This is usually paracetamol/codeine combinations, tramadol or oxycodone, youwill find the doses can be gradually decreased over the first few weeks; others used may be endone or in association with long acting paracetamol. As a general rule take regular pain relief (eg every 4-6 hours) to avoid any pain rebound
  • Anti-Inflammatory Tablets
    • These can be continued if prescribed, over the first few weeks, as needed. Cease if there is any indigestion or heartburn
  • Antispasmodics / Muscle relaxants
    • Diazepam may be used to relax large muscles in your back, these my make you drowsy
    • Amitryptiline is another agent that helps relax muscles overnight and improves sleep profiles / cycle. This is not a sleeping tablet

ADVERSE OR UNEXPECTED SYMPTOMS after Discharge: What to Notify?

Notify Mr Brendan O’Brien if any of these occur or you become worried about:

Procedure Related:

  • Wound or wound care issues
  • Changes or new difficulty moving or controlling your legs or feet

General:

  • Fever, chills
  • Cough, shortness of breath
  • Calf or ankle swelling
  • Pain passing urine

RETURN TO WORK when appropriate

  • This should be delayed until you are reviewed in the rooms and feel well recovered.
  • Some light, seated short term computer work can be done from home if you must.
  • Avoid the temptation to overdo things in the first 3 months.
  • Return to work is often graduated through lighter duties, increasing by 25% contact hours per week over 2-4 weeks. This will be discussed upon your review and aided with the physio.
  • Please let us know if we can give you any required sick certificates before discharge.
  • Any necessary workcover certificates can be arranged through the rooms.

FOLLOW UP APPOINTMENT

You will be given a review appointment with Mr Brendan O’Brien for approximately four to six weeks after discharge.
If you are discharged on a weekend, please call the rooms the next Monday for an appointment.
Please encourage your GP or Rehabilitation Consultant to contact me at any time if he wants to discuss any concerns that arise in your care or progress.