Treatment Options

Treatment Options
Conventional Treatments for Lumbar Disc
Herniations
There are many treatment options available for
disc herniation. Treatments fall into two major
categories: nonoperative and operative
treatment.
onoperative Treatment
The mainstay of therapy for herniated lumbar
disc is conservative treatment! i.e.! nonsurgical.
This is because in the majority of patients the
symptoms resolve or subside to a level allowing
normal activity within "#$ wee%s. There are
numerous nonoperative treatment modalities.
&ost encompass a combination of bed rest!
physical therapy! chiropractic care! and
medication. 'nalgesics or muscle rela(ants can
sometimes help relieve pain. The most
commonly prescribed drug therapy involves
)'*D) +non steroidal anti inflammatory drugs,.
These reduce inflammation that may be the
causative factor underlying nerve root pain.
-roper e(ercise can also help prevent bac%
problems and is included in many treatment
regimes. ' physical therapist or chiropractor can
wor% to create an individuali.ed e(ercise plan to
best suit each patient. The vast majority of
patients are treated with nonoperative
techni/ues. )urgery should only be considered
when aggressive nonoperative treatment has
failed.
Operative Treatment
0hen nonoperative treatment fails to relieve
symptoms! surgery may be indicated. Careful
evaluation is done before any surgery. The type
and timing of any operation depends on many
factors: Type and location of herniation! severity
of the disorder! amount of nerve compression!
previous operations! etc. &ost spine surgeons
use the most advanced technology and the least
invasive approach when applicable.
Conventional discectomy surgery for the
removal of a herniated lumbar disc is one of the
most commonly performed procedures in the
1nited )tates. 'n incision is made vertically
along the midline of the bac%! usually about 2
inches long. -araspinous muscle is stripped off
the spinous process and the lamina. ' small
window is created in the lamina overlying the
disc herniation. The nerve root is identified and
gently retracted to e(pose the offending disc
herniation. The disc material is then removed
and wound is closed in a way that restores the
normal anatomic layers.
-ostoperative recovery is relatively fast. 3elief
from nerve root compression is often immediate!
but bac% pain associated with the surgical
approach can be intense. -atients are up
wal%ing the same night or the ne(t morning after
the surgery! and usually discharged home in 2 to
4 days. The vast majority of patients e(perience
significant pain relief. 3ecovery of motor and
sensory function may be variable.
5volution of -osterior &inimally *nvasive )pine
)urgery Technical and research developments
have provided new treatment modalities for the
patient with spinal disc disease since the
disease6s description by &i(ter and 7arr in 894".
-ercutaneous Treatment Options
-ercutaneous techni/ues +performed through
the s%in, derive their origins and continued
success from these medical advances and
patients6 desire for a less invasive yet effective
therapy for this common ailment. 'dvances in
percutaneous techni/ues and endoscopy have
allowed for a rapid e(pansion of interest and
wor% in the field of minimally invasive
discectomy that complements the current
popularity of outpatient surgery. -ercutaneous
techni/ues include chemonucleolysis! manual
and automated discectomy! and endoscopic#
assisted discectomy. These approaches!
although diverse in their methodology! share
some common! desirable /ualities: for e(ample
they: i. may be performed under local
anesthesia: ii. afford a minimal amount of soft#
tissue dissection: and iii. do not preclude the use
of open surgery in the future.
Chemonucleolysis
*ntravenous papain injection in rabbits was
found to result in floppy ears from a transient
loss of cartilage. This discovery was cleverly
applied to disc disease! and found to dissolve
the nucleus pulposus in humans. The initial
e(perience was presented in 89$". *ts use has
been the subject of much controversy in
subse/uent years.
-ercutaneous ucleotomy
The first report of percutaneous discectomy was
in 89;<! using a dorsolateral approach to the
disc. 'lthough the dorsolateral approach was
the most widely used! a more lateral!
retroperitoneal approach +behind the membrane
lining of the abdominal or pelvic cavities, was
proposed. This was not widely accepted due to
the ris% of damage to retroperitoneal structures.
The ne(t significant improvement in the
techni/ue came in the 89=>s with the use of an
automated discector! giving rise to the
automated percutaneous lumbar discectomy.
The automated discector is a suction shaver that
can perform controlled removal of disc material.
The laser has been applied with some success
using a similar approach. 'lthough most of the
e(perience has been in the lumbar spine! a
series of cervical cases has been reported! but
is not the focus of this chapter. Controversy and
criticism surround the many reports concerning
percutaneous nucleotomies. These techni/ues
may all be considered indirect techni/ues
because they remove the central disc but do not
directly address the offending pathology causing
nerve root compression.
Central disc removal reduces the pressure
within the disc space! an effect casually %nown
as ?popping the balloon?. @urthermore! it creates
a defect in the annulus fibrosus through which
disc material may herniate in the future. This
herniation is directed away from the nerve root.
'lso! with an indirect approach to the pathology!
scar formation around the nerve roots may be
minimi.ed. The cru( of the medical debate is
regarding these techni/ues6 efficacy. )everal
studies have shown that percutaneous
nucleotomy! whether automated or manual!
does not have the same success rate as open
lumbar discectomy.
5ndoscopic Discectomy
The marriage of the endoscope with the
percutaneous techni/ue was logical
progression. -ercutaneous evaluation of the
spinal canal and endoscopic visuali.ation of disc
pathology were described in 894=. 5ndoscopy
was used to improve the blind techni/ue of
percutaneous nucleotomy by allowing the
surgeon to confirm instrument placement and to
observe disc removal from within the disc space.
The ne(t limitation to overcome in the case of a
percutaneous procedure was the inability to
directly remove the herniated disc from beneath
the nerve root in the spinal canal. *ntradiscal
approaches could only indirectly remove
herniated disc material by pulling it down into the
disc space. 5ndoscopic approaches with a
wor%ing channel were developed to directly
visuali.e and address the disc at the nerve root
level.
Direct 5ndoscopic 'pproaches
The desire to e(pand the utility of endoscopic
techni/ues led to the development of direct
endoscopic approaches. 0ith these techni/ues!
compressed nerve roots could be directly
decompressed. The endoscopic transforaminal
approach +also termed the foraminoscopic
approach, was the first percutaneous approach
directly visuali.e the pathology during nerve root
compression. The epidural space and the nerve
root can be seen through the neural foramen. '
percutaneous approach with a small fiberoptic
scope and $#mm wor%ing channel is performed.
The nerve root is identified and disc material that
is compressing the root is removed through the
wor%ing channel. The techni/ue seems
particularly well suited for the treatment of far
lateral discs
Discectomy and &icrodiscectomy
7oth terms mean the surgical removal of part or
most of a vertebral disc. The difference between
discectomy and microdiscectomy is the latter
procedure uses a microscope during surgery.
5ither procedure can be used when appropriate
to remove herniated or ruptured discs. The
advantage to microdiscectomy is the incision
and instruments used are smaller in si.e. 'ny
procedure that is less invasive enables the
patient to recover more /uic%ly.
L1&7'3 &*C3OD*)C5CTO&A
-age 8 of "
The -urpose of this *nformation
This information is being provided to you in
order to prepare you to ma%e decisions about
your own health care. *f you should ultimately
decide that surgery is the best treatment option
for you! this section will help you understand
what happens during a lumbar microdiscectomy
and will help you prepare for your role in the
healing and recovery process. 3ead it
thoroughly and answer the /uestions before
ma%ing your final decision about your treatment
options.
The Health Care Team6s 3ole
The duty of your health care team is to:
8.evaluate your condition:
2.establish a diagnosis:
4.present the various treatment options:
".offer a specific treatment recommendation:
<.provide you with the information you need to
ma%e a decision: and then
$.support you in the decision you ma%e.
The -atient6s 3esposibilities
Aou are the only one who can decide to have
surgery. *t is important that you ta%e ownership
of this decision! recogni.ing the limitations your
particular physical condition places on the
potential success of each of the treatment
options.
*f you choose to have surgery! your physical
condition and your mental attitude will determine
your body6s ability to heal. Aou must approach
your surgery with confidence! a positive attitude!
and a thorough understanding of the anticipated
outcome. Aou should have realistic goals#and
wor% steadily to achieve those goals.
The decision to have or not to have surgery
includes weighing the ris%s and benefits
involved. Aou will ma%e the final decision! so as%
/uestions about anything you do not
understand.
)ince medical care is tailored to each person6s
needs and differences! not all information
presented here will apply to the patient6s
treatment or its outcome. )ee% the advice of
your physician and other members of the health#
care team for specific information about the
patient6s medical condition.
Table of Contents and...
0e encourage you to
use this information to
help you ma%e a
decision about which
treatment option is best
for you. 'fter reading
this information
thoroughly and
...a Decision &a%ing
Buide
The operation
• 0hy is a portion of
the vertebra
removedC
• How is the pressure
on the nerve root
answering these
/uestions! you will have
the information you
need to ma%e a truly
informed decision.
The patient6s
responsibilities
• 0hat is the health
care team6s roleC
• 0ho will ma%e the
final decision about
whether or not to
have surgeryC
The anatomy of the
lumbar spine
• 0hat carries the
majority of your
body6s weightC
• 0hat is the role of
the intervertebral
discsC
• 0hat is the role of
the spinal nerve
rootsC
relievedC
• 0hat is the
difference between
healing and
recoveryC
• 0hat factors
influence the
healing processC
0hat to e(pect after
surgery
• 0hat influences the
speed at which you
will recoverC
• 0hy is it normal to
have some pain
after your surgeryC
• 0hat must you do
to commit to a
healthy lifestyleC
The recovery process
• 0hat will determine
when you leave the
hospitalC
• 0hat e(ercise is
best for your bac%
0hat happens when a
disc rupturesC
• 0hat part of the
disc rupturesC
• 0hat are the
symptoms of a
ruptured discC
• How is a ruptured
disc diagnosedC
Treatment options! ris%s
and benefits
• 0hat are the
treatment options
for a ruptured discC
• 0hen is surgery not
an optionC
• 0hen is surgery
recommendedC
• 0hat are the ris%s
of having surgeryC
• 0hat factors
influence your
chances for
successC
after surgeryC
• 0hy is a firm
mattress importantC
• How can you
reduce the
medication you
ta%eC
• 0hat helps prevent
the recurrence of a
ruptured discC
The decision#ma%ing
process
• 0hat is the goal of
collaborationC
• 0hy should you
ma%e decisions
about your health
careC
• 0ho will ma%e the
final decision about
whether or not to
have surgeryC
OT5: *f there is anything you do not
understand about the information provided here!
it is your responsibility to as% a member of your
health care team for assistance before you
ma%e your final decision.
'natomy of the Lumbar )pine
The )pinal Column and the Dertebrae
Aour spinal column consists of 2" separate
bones! called vertebrae! plus the five fused
bones of the sacrum and the four fused bones of
the coccyx +often referred to as the ?tail bone?,
+@ig. 8! below,. The vertebrae are stac%ed one
on top of another and can be divided into:
8.The cervical +nec%, spine: the top seven
vertebrae!
2.The thoracic +chest, spine: the middle 82
vertebrae! and
4.The lumbar +lower bac%, spine: the bottom
five vertebrae.
)upport for the Dertebral +)pinal, Column
'ttached to the vertebrae are muscles! tendons
and a group of strong bands! called ligaments.
Together! they support the spinal column and
help to protect its delicate nerves.
The 3ole of the Dertebral +)pinal, Column
Aour spinal column enables you to wal% upright.
*t is the central support for your upper body and
carries the weight of your head! chest and arms.
The vertebrae in the lumbar +or lower bac%,
portion of your spine carry the majority of this
weight. The constant pressure from this weight!
even when you are simply sitting in a chair! is
what usually leads to problems associated with
the lower bac%.
The 3ole of the *ntervertebral Discs
The bony vertebrae of your spinal column are
separated from one another by ?pads? of tough
cartilage! called intervertebral discs +@ig. 2!
above,. These discs act li%e ?shoc% absorbers?
during activity! allowing the spine to move freely.
How a disc ?ruptures? +bulges outward, is shown
in the drawing to the right +@ig. 2! above, and will
be discussed in detail on the following section.
The *ntervertebral Disc ucleus
The center of each intervertebral disc is made
up of a gelatin#li%e substance +the nucleus ,!
surrounded by a fiber#li%e outer lining +the
annulus, +@ig. 4,. 's your body ages! the disc6s
nucleus begins to stiffen. This reduces fle(ibility
and increases the chances that a disc may
?rupture!? especially in the lumbar spine which
carries so much of your body6s weight.
The )pinal Canal
The spinal cord! which begins at the base of the
brain and runs within the spinal canal! ends in
the lumbar spine area in a bundle of nerves
%nown as the cauda equina +@igs. 4 E ",. The
spinal canal runs through the center of the spinal
column and protects the spinal cord and other
delicate spinal nerves.
The )pinal erve 3oots
't each vertebral level! a pair of nerves branch
off from the spinal cord or the cauda e/uina +one
to the left and one to the right,. These spinal
nerve roots are part of the body6s ?electrical?
system! carrying ?current? +for sensation and
movement, to specific parts of the body +@ig. ",.
The nerve roots are protected by an ?insulated?
covering in the same way a ?live? electrical line
is coated to prevent direct contact with the bare
wire. ' nerve root damaged by a ruptured disc
may have all or part of its ?insulation? rubbed off
at the point of injury. -rior to surgery there is no
way of telling how much has been rubbed off or
how much damage has been done to the nerve
+the body6s ?live electrical wire?,.
0hen a Disc 3uptures
0hat Happens 0hen a Disc 3upturesC
0hen the outer lining +annulus, of a disc ?tears!?
its center +the nucleus , may rupture and press a
spinal nerve+s, against the bony surface of a
vertebra +@ig.<,. This condition is often referred
to as a ruptured disc. Aou could thin% of it as
having a tube of toothpaste with a crac% in it.
5(ert pressure on the crac%ed tube +disc
annulus,, and toothpaste +disc nucleus, flows
out the crac%. 5ven pressure from everyday
activities can push the disc6s nucleus through
the ruptured annulus and pinch a spinal nerve
root+s,.
0hat Causes a Disc to 3uptureC
's we6ve discussed! your lumbar spine supports
the weight of your entire upper body and is
under stress every day. )imple ?wear and tear?
or the effects of aging can contribute to a disc
rupture. *n some cases! the rupture happens
during the course of normal! everyday activities.
*n other cases! it occurs as the result of a
specific injury. 1sually there is no way to
?prevent? it from occurring! however! you can
reduce your ris% by staying in good physical
condition and by using proper lifting techni/ues.
0hat are the )ymptoms of a 3uptured DiscC
0hen a lumbar spinal nerve is pinched! you may
e(perience pain in your lower bac%! pain or
numbness in your leg+s,! wea%ness in your legs
or feet! or numbness in one or both of your feet.
The pain can come from the pressure on the
nerve! the swelling within the nerve +caused by
the pressure, or injury to the nerve itself. Ta%ing
pain medication or drugs which reduce the
swelling may provide relief! but healing may not
occur as long as the nerve itself remains
pinched. *t6s similar to having your finger caught
in a door. 'n aspirin may help to ease the pain!
but healing won6t begin until the door is opened
and your finger is no longer being pinched.
How is a 3uptured Lumbar Disc DiagnosedC
The diagnosis of a ruptured lumbar disc is based
on:
8.your history of bac% andFor leg pain:
2.a physical e(amination of your bac% and
legs: and
4.diagnostic tests! which may include spine (#
rays! an &3*! a C'T scan or a myelogram.
+5ach of these e(amination has a specific
purpose.,
3eturn to Contents
Aour Treatment Options...
Treatment Options
There are a number of
treatment options for a
ruptured lumbar disc! each
accompanied by its own set of
ris%s and benefits. The four
basic approaches are as
follows:
8.Ta%ing Time: @or some patients! all that is
re/uired in order to heal and recover is time.
2.Ta%ing &edication: @or others! medication
may reduce the inflammation or ease the
pain in the affected area and thereby
provide relief from their symptoms.
4.1sing -hysical Therapy: @or some! physical
measures such as physical therapy +or
gentle e(ercise, may provide relief and aid
in the recovery from a ruptured disc.
".Having )urgery: @or those patients whose
ruptured disc is causing a ?pinched? nerve!
lumbar microdiscectomy often is the
recommended treatment.
0hen Lumbar &icrodiscectomy is OT an
Option
The severity of your symptoms +pain! wea%ness!
lac% of mobility, and your general health and
physical condition will play an important part in
determining when surgery is not an option for
you. *n general! surgery is not an option when:
8.your bac% and leg pain is not caused by a
ruptured disc: or
2.you do not have leg symptoms:
4.there is a medical reason which prevents
you from having surgery:
".medication which reduces swelling or
relieves pain would provide you with
ade/uate relief:
<.physical measures would improve your
condition.
...and Their 3is%s and 7enefits
0hen Lumbar &icrodiscectomy *) an Option
Lumbar microdiscectomy is usually
recommended only when specific conditions are
met. *n general! surgery is recommended when
a ruptured disc is pinching a spinal nerve root+s,
and you have:
8.leg pain which limits your normal daily
activities: or
2.wea%ness in your leg+s, or feet: or
4.numbness in your e(tremities: or
".impaired bowel andFor bladder function.
The 3is%s of Having )urgery
)ome of the more common ris%s of having any
surgery include e(cessive bleeding! infection! or
a negative reaction to anesthesia. Certain
unforeseen circumstances could even lead to
death. Clinical e(perience and scientific
calculation indicate that these ris%s are low! but
surgery is still a human effort. Aou should feel
free to as% any /uestions you have about your
specific ris% factors.
)ince microdiscectomy involves surgery in and
around the spine! further nerve damage is a
possibility. *n some cases! the nerve is already
so damaged that the surgical procedure re/uired
to simply reach the nerve could be the ?straw
that brea%s the camel6s bac%.? The end result
could be numbness! paralysis or a loss of bowel
and bladder control. +However! deciding not to
have surgery may have e(actly the same
conse/uences. Aour decision should be based
on a weighing of the ris%s of having surgery
versus the ris%s of not having surgery.,
The 7enefits of Having )urgery
Aou can thin% of surgery as the first step in the
healing and recovery process. *t can help relieve
pressure on your spinal nerve+s, and! thereby!
help relieve your pain. *t also may help you
begin the process of regaining some of the lost
mobility in your e(tremities.
&icrodiscectomy and its )pecific 7enefits
Lumbar microdiscectomy is an operation on the
lumbar spine performed using a surgical
microscope and microsurgical techni/ues +@ig.
$,. ' microdiscectomy re/uires only a very small
incision and will remove only that portion of your
ruptured disc which is ?pinching? one or more
spinal nerve roots. The recovery time for this
particular surgery is usually much less than is
re/uired for traditional lumbar surgery.
Aour Chances for )uccess
Aour level of healing will be determined by your
age! your general health and the severity of the
damage to your spinal nerve! as well as your
attitude and your willingness to work at recovery.
&a%ing Aour Decision
0hen you consider your options!
%eep in mind the impact your
condition has on your way of life and
carefully weigh the ris%s and
benefits of having surgery against
the ris%s and benefits of not having
surgery. The decision is yoursG
*f Aou Decide to Have )urgery...
'pproach your surgery with a positive mental
attitude and with full confidence that you have
made the right decision. 0hile the surgeon
concentrates on finding and removing the cause
of your pinched nerve! you must concentrate on
the recovery process. Cooperate fully with your
surgeon and focus on the improvements you will
ma%e in the future#not on the problems of the
past.
The )urgical -rocedure
The )urgeon6s 3ole
Aour surgeon will:
8.review your neurological history and
e(amination:
2.review your diagnostic studies +such as a
myelogram! C'T scan or &3*,:
4.plan a surgical approach: and
".review the procedure with you.
Aour 3ole
Aou must have a thorough understanding of the
diagnosis +what is causing your bac% andFor leg
symptoms, and the ris%s and benefits of the
proposed surgery. Once you are confident that
surgery is the correct option for you! turn your
thoughts to the future and the recovery process.
7eginning the Operation
*n the operating room! a lumbar
microdiscectomy begins with a small incision in
your lower bac%. Through this opening! your
surgeon will insert microsurgical instruments.
7ecause the wor% is viewed through a
microscope +@ig. $! above,! this approach
re/uires a relatively small incision.
3eaching The ?-inched? erve
Buided by diagnostic studies! your surgeon will
remove a small portion of bony material from the
bac% of your vertebra +@ig. ;,. Once this material
is removed! the surgeon can locate the e(act
area where the nerve root is being pinched.
*dentifying the Cause of the -ressure
Once the ?pinched? nerve is located! the e(tent
of the pressure on the nerve can be determined.
1sing microsurgical procedures! your surgeon
will remove the ruptured portion of the disc and
any disc fragments which have bro%en off from
the main disc +@ig. =,. The amount of wor%
re/uired to complete your microdiscectomy will
depend in part on the number of disc fragments
present and the difficulty presented in finding
and removing them.
Closing the *ncision
The operation is completed when each layer of
the incision is closed with suture material
+stitches, or surgical staples. *f the outer incision
is closed with staples or non#absorbable
sutures! they will have to be removed after the
incision has healed.
The Healing and 3ecovery -rocess
Once the ruptured disc has been removed!
healing can begin +@ig. 9,. Healing is the body6s
natural process of restoring its damaged tissues
to a normal! or nearly normal condition. Healing
occurs on its own! but is influenced by such
factors as general good health! physical fitness!
nutrition and rest. Recovery is the process
during which you work at becoming well. Aou
must commit yourself to staying in good health
+e(ercising,! maintaining a positive mental
attitude and following your physician6s
instructions.
3eturn to Contents
0hat to 5(pect 'fter )urgery
Have 3ealistic 5(pectations
3ecogni.e that healing and recovery will not
happen overnight. *t is a process. Aou may find
that much of your progress will be li%e ta%ing
?two steps forward and one step bac%.? 'ccept
itG 'nd then do all that you can to ma%e sure
your steps ?forward? are large ones and your
steps ?bac%ward? are small ones.
7e -atient anf -ersistent
During the recovery period in the hospital and at
home! try to rebuild your strength gradually.
3est when you feel fatigued # but be persistent
in your efforts.
*t is important for you to recogni.e that we all
heal at a different rate. The speed at which you
will recover depends in part on your age! your
general level of health! your overall physical
fitness and your mental attitude. Benerally! you
will heal more slowly if you are overweight! out
of shape or smo%e! or if you are a diabetic or
have other pre#e(isting medical problems.
5(pect )ome -ain 'fter )urgery
*t is normal to have some pain after any
operation. 'fter a lumbar microdiscectomy! there
may be some leg ?aching? which occurs as the
nerve+s, attempts to heal. Aou also may feel
some muscle spasms across your bac% and
down your leg+s,. 'nd if there was inflammation
in the nerve root! some pain may persist until
this inflammation diminishes. Aou will be given
appropriate medication to control your pain!
relieve bac% spasms and reduce inflammation.
7e -repared for )ome 5motional Changes
*t is not unusual to feel tired and discouraged for
several days following surgery. These feelings
may be your body6s natural reaction to the
cutbac% of e(tra hormones it generated during
surgery. 'lthough some emotional letdown can
be e(pected! you must not let it get in the way of
your recovery. Don6t loo% bac% at past problems.
*t is important for you to loo% at even the
smallest positive steps you ma%e as progress
towards your recovery goal.
Develop a -ositive &ental 'ttitude
Aou should begin to wor% on a positive mental
attitude even before the surgery is performed.
Direct your energies toward the solution of your
problem! rather than worrying about what
caused your problem. Don6t be discouraged by
minor setbac%s during the recovery process.
Concentrate on the progress you ma%e! and will
continue to ma%e in the future.
Commit to a Healthy Lifestyle
ow is the time to commit yourself to a healthier
lifestyle. Aou can begin by ta%ing these
important steps:
H 0atch your weight: *f you are
overweight! you must gradually return to
your proper weight. Crash diets rarely
wor%. Commit yourself to better eating
habits and stay with them for the rest of
your life.
H 7ecome more active: Aour physician
will tell you when you can resume
normal physical activities after surgery.
&a%e up your mind now that you will
develop a regular aerobic e(ercise
routine! such as wal%ing! swimming or
riding a bi%e. However! always chec%
with your physician before starting any
e(ercise program.
The 3ecovery -rocess
Boing Home @rom the Hospital
*n general! hospital stays are becoming shorter!
especially for microsurgical procedures. 5ven
though you may feel somewhat uncomfortable at
the time you are released! your physician
usually will allow you to go home when:
8.your vital signs are stable:
2.you can wal% on your own:
4.you can eat without having nausea:
".you have resumed normal bladder activity:
and
<.your wound is healing.
3ecovering at Home
Once you are at home and you begin to resume
your normal activities! follow the guidelines listed
below +and contact your physician6s office if you
have any /uestions,:
H 5(ercise: Try to do as much as you
can. Daily wal%ing is the best e(ercise.
)et reasonable goals! but gradually
increase the distance you wal% each
day. Chec% with your physician before
starting any e(ercise program.
H )itting and standing: Do not sit or
stand for long periods of time. *f you
have muscle spasms in your bac% or
pain in your leg+s,! changing positions
fre/uently should help.
H )leeping: 3est when you feel fatigued!
but do not spend all of your time in bed.
-lease note that wa%ing up with a ?stiff ?
bac% is not uncommon. @or relief! try
ta%ing a short wal% or a warm shower. *f
you do not have a firm mattress! invest
in one # it is important for proper bac%
support.
H Caring for your *ncision: 0ash your
incision gently and pat it dry. *f you see
any increased redness! swelling or
drainage! notify your physician.
&edication
Aou should gradually reduce the amount of pain
medication you ta%e. 7egin by increasing the
amount of time between pills! and then reduce
the number of pills ta%en each time. ' certain
amount of discomfort can be e(pected until the
swelling goes down and the nerve sensitivity
decreases. )ubstitute moist heat! gentle
e(ercise and short rest periods for pain
medication whenever possible.
-reventitive &easures
The best way to avoid the recurrence of a
ruptured disc is to maintain a healthy lifestyle. *t
is important that you:
8.eat a well#balanced diet in order to aid
proper healing +avoid foods high in calories
and fat content,:
2.continue to eat a healthy diet in the future to
reach and maintain your proper body weight:
4.get the proper amount of sleep:
".participate in some form of regular aerobic
e(ercise +such as wal%ing! swimming or
riding a bi%e,:
<.ta%e e(tra care when lifting! bending or
twisting: and
$.ta%e care of other health problems +such as
heart disease or diabetes,.
3eturn to Contents
'bout *nformed Decision &a%ing
' -atient#Centered 'pproach
This information is provided to help you ma%e an
informed decision about your health care. *t is an
essential part of a patient#centered approach to
medicine! called collaboration! in which the
health care team +physicians! nurses and
technicians,! the health care institutions
+hospitals! insurance companies! etc., and the
patient's family all wor% towards achieving the
best possible recovery for the patient.
0hy the -atient is at the Center
5(perience has shown that patients who are
given the opportunity to ma%e decisions about
their own health care have less an(iety before
their surgery and recover more /uic%ly after their
surgery. 3ecogni.e that you have a right and a
responsibility to participate in the decisions
involving your health care.
The human body is an intricate networ% of
interrelated systems. 5ach system functions on
its own but is also influenced by and dependent
upon the others. 0hen illness or injury occurs! it
disrupts the function of one or more of these
systems.
)urgery is a human effort made to correct one
system6s malfunction! but it will affect all others.
7ecause of this comple( interrelationship!
surgical outcomes cannot be predicted.
0hen recovery is possible! it occurs as a
combination of the surgeon6s effort! the patient6s
faith! and a positive acceptance of the outcome.