Your personal guide to Microdiscectomy

Surgery :: Anterior Cervical Decompression Fusion
Disc Replacement :: Intra Discal Electro Thermal Annulaplasty (IDETA)
Posterior Lumbar Interbody Fusion (PLIF)

Following your consultation with Dr Diwan it has been decided that the best plan of action is for you to undergo a microdiscectomy.  This procedure requires a general anaesthetic and takes approximately 1.5 hours.  To begin Dr Diwan will make a small incision in your back about half the length of your thumb, at the affected level.  The nuclear material that has been causing your pain is then carefully removed and the incision closed. 

Preoperative instructions

• Smoking is prohibited for 4 weeks before your operation and 6 weeks after surgery.  Research suggests that smoking decreases new capillary growth under the incision lines which in turn slows the healing process.
• Limit your alcohol consumed for 1 week before surgery. 

 2 weeks before 

• The following medications should be discontinued 2 weeks before your surgery as the blood thinning agents in them can accentuate swelling and discomfort. 

Any non steroidal anti inflammatory such as:  Disprin, Naprogesic, Feldine, Voltaren, Tagamet, Nurofen.

If you have any questions regarding any medication please ask Dr Diwan.

Discontinue the use of natural remedies for the same period of time: Vitamin E, Evening Primrose Oil, Fish oil, Herbal teas, Green teas.

If you are in need of pain relief before your operation use either Panadol,  Panadeine,  Panadein Forte.

1 week before

• Plan, cook and freeze meals for the week following your operation
• Arrange a support person to be with you for the first day at home.  If this is not possible you will need to organize transport home from the hospital at least.
• Coordinate with the hospital administration your admission status for your stay St Luke’s Hospital 02 93560200, St George Public 02 93503032 or St George Private 02 95985581.

2 days before

• Cut finger and toe nails.  Remove nail polish.
• Pay any bills that are due in the next week, as well as taking care of any banking matters.
• Establish a comfort zone including items such as telephone, TV guide, tissues, phone book, in preparation for the first few days after your operation.
• Call hospital to confirm booking, fasting time and hospital costs.
• Call Dr Diwan’s office to confirm post operative appointment
• Pack for hospital: include comfortable cloths that do not have a tight waist band and slip on shoes if possible, reading material to help pass the time before your operation.

1 day before

• Fast from the specified time given to you by the hospital.
• Ensure you have all your relevant contact numbers.
• Remove any obstacles in your home that you could fall over after your surgery.

Day of surgery

• Do not eat any thing unless you have been instructed otherwise.
• When you have a shower pay special attention to your back and groin area. It may be advisable to also wash your hair as it may be a few days before you are comfortable enough to wash it again.
• Leave home in plenty of time.
• Take phone number of your support person.  
• Remember to take any X- Rays, CT scans that Dr Diwan does not already have.
• Take your medicare card and private insurance details if applicable.
• If you have any allergies remember to tell the anaesthetist.

What to expect following surgery

Pain- From the time you wake up from the anesthetic you should feel relief from your back / leg / arm pain. You may however feel some discomfort from the incision for up to a week.

Coping with the Blues- It is not uncommon for patients to feel a little depressed or emotional 1-2 days after your surgery.  This phenomenon is due to the drugs used in the anesthetic as well as the natural let down feeling, that people experience after meeting a long term goal, for example your back surgery.

Back stiffness-  You may experience back stiffness following your surgery.  This will resolve over the next few days.

Tingling / Numbness-  You may experience a degree of tingling and/or numbness that will subside over the next few days.

Calf compressors-  Following your surgery you will have calf compressors on your calves to reduce the risk of deep vein thrombosis (DVT).  These will massage your legs until you are up and walking.

Catheters and canulas-  You will have a cannula in your hand where the anaesthetic is given to you during the operation as well as a urinary catheter.  These will be removed as soon as you are fully awake (about 2 hours after your operation is complete).   

Postoperative instructions

1st week

• Do not bend at the waist to pick up anything, instead bend at the hips and knees.
• Rest and eat well to regain your strength.
• It is very important to maintain good posture at all times.
• To aid in back support tighten your stomach muscles and hold for 20 seconds then release, do this 10 times every 2 hours or as much as possible with out causing pain to your back.
• If you experience substantial pain, a high temperature and shivering you should contact the hospital or Dr Diwan.
• If Dr Diwan has advised a back brace for you, you are to wear it as directed. 

week 2

• Continue to wear your brace only if you have been instructed
• Begin gentle walking for up to 20 minutes at a time
• Begin mobilizing gently during the week
• Ensure you keep your first post operative appointment with Dr Diwan
• Do not lift anything greater than 5 kg

Following your appointment you will be given further instructions as to your rehabilitation.

Commonly asked questions

When do I see Dr Diwan after my surgery?

You should make an appointment to be seen in Dr Diwan’s rooms 10 days after your operation and again at week 6.                                                                                  

How long will I stay in hospital?

Most people choose to stay over night in hospital following their operation, however it is possible to elect to be a day only patient, providing Dr Diwan has assessed you to be fit for discharge.

When can I have a shower after my surgery and can I get my dressing wet?

You can have a shower the day after your surgery.  If your dressing becomes waterlogged carefully pat it dry.

Do I have stitches to come out?

The sutures used to close the incision are under the skin so there will be no stitches to come out.  When you come for your 1st appointment (10 days post op) the dressing will be removed and the incision line cleaned.

Do I have to wear a back brace?

Unless Dr Diwan feels it is necessary for an individual patient, Patients undergoing a microdiscectomy do not have to wear a brace following surgery

Is there a certain position that I should be in to sleep at night?

The most important thing is for you to be comfortable, the ideal position is lying on your back, with a pillow under your knees.  This however is not compulsory, if lying on your side is better for you, then this is also fine. 

When is it safe to engage in sexual relations?

This is a very personal thing and it will be up to you when you think that you and your partner are ready.  Clinically a two week period is recommended providing you are the less active partner.   

How long should I wait before driving a car?

The recommendation is to wait 2-3 weeks before driving a car.

 When can I go back to work?

This is assessed on a patient to patient bases, but to generalise if you have a physical type of job it may be up to 3 months, where a more sedate type of occupation you could be back at work as soon as 3 weeks.   

When is it safe to bend and/or lift items heavier than a bag of sugar?

Bending from the hips is fine if carried out in a controlled manner, the most important thing to remember is to avoid bending to lift any thing heavier than 4kg.  After 3 months you can begin to increase the weight you are lifting.