- Diskectomy:
- diet: liquids as tolerated on the day of surgery, resume preoperative diet on the day following surgery;
- pt may be up to void on the night of surgery (unless
dura was opened)
- patient may roll side to side in bed prn;
- narcotics (morphine and demerol) are not to be withheld from pts with routine lumbar
disc disease;
- all patients with lumbar disc surgery get a lumbrosacral corset from brace shop before discharge;
- w/ intra dural procedures: patient is to remain in bed w/ head of bed flat for 5 days;
- it is desirable to have patient on his side;
- w/ hold major analgesics until pt is alert & awake & cooperative;
- physical therapy:
- note that the nucleus excised may have the effect of increasing segmental motion;
- extension exercises should be encouraged since this is the most stable loading position;
- patients should avoid lateral bending and axial rotation;
- Hemilaminectomy
- may be up as the patient tolerates movement
- may stand with assistance on the night of surgery to void;
- may have adequate narcotics;
- Laminectomy:
- accumulation of epidural blood causing compression of spinal cord w/ resultant quadriplegia or paraplegia
is ever present danger w/ cases that have required complete laminectomy;
- check neurological status frequently to spot epidural hematoma;
- check neuologic status of legs;
- if a cervical laminectomy, no narcotics until the pt is awake;
- following a full laminectomy with dural opening below the mid - thoracic spine, maintain the patient
horizontal in bed for several days, depending on the surgeon;
- however, the patient may be rolled prn;
- cervical laminectomy: no narcotics until the patient is awake;
Kinematics of the lumbar spine: Effect of discetomy.
VK Goel et al.
Spine. Vol 10. 1985. p 543-554.
