A microdiscectomy operation was performed to decompress the dural sac and root at the l5-s1 level. 01/29/15 The operation went without complications, and she was discharged on the 4th day. Two weeks later I felt pain in my buttock and foot. The pain persisted. 1.5 months after the operation, acute pain appeared and I could no longer move. Admitted to the hospital, 03/16/15 Dexamithasone was given. The pain has subsided, but the symptoms persist, pain in the buttock and foot, when you sit down, stand up and do exercises, I can’t sit for a long time, pain begins in the lumbar region and a burning sensation in the heels, for about 5 minutes it goes away. I also notice swelling where the operation was, but a little lower. I don't feel any pain when walking
Considering the symptoms, you need to do an MRI of the lumbosacral spine to clarify the cause of the pain, because After discectomies, relapses of intervertebral disc herniations often occur, even after a short period of time after surgery, and adhesive epiduritis at the operation site. Dexamethasone has anti-inflammatory and decongestant effects, so it could help in both situations. According to your description, this is a clinic of S1 radicular syndrome, but its cause can be found out after surgery based on MRI results. For now, try taking Nucleo-CMF Forte 1 caps 2 times a day, regardless of meals, for about 15 days and Katadolon Retard 1 tablet 1-2 times a day after meals for about 10 days, limit salt intake so as not to increase swelling
I did an MRI and am sending you a description. I take NSAIDs. There is pain
According to the MRI description of the lumbosacral spine, a herniated L5-S1 intervertebral disc, which was partially removed and freed the right nerve root, is now pressing on the left S1 root, and there has also been a posterior displacement of the L5 vertebra, and most likely instability of this vertebra as a result of the operation. This all causes your symptoms. Consult your operating neurosurgeon or neurologist, maybe they can suggest you some kind of rehabilitation center to recover after surgery and eliminate pain. Try adding electrical procedures and compresses with dimexide to reduce the tableted NSAIDs, take Nucleo-CMF Forte and catadolone in a course.
The most interesting thing is that everything radiates to the right buttock and foot... just like my buttock hurt before the operation..
I wanted to ask you .. and if it’s not a secret .. why in a short time the hernia comes out ... again .. and why the implant is not inserted .. and is it possible to go to a chiropractor .. it’s only been 3 months since they did it ...
Physio from 16.03 Lazor with magnets 10 rubles, ultrasound.. with lidase 10 rubles +5 darsenval, and now electrofores with proserin on the foot.. I’ve already registered ..
nucleo-cmp is problematic even to order...thanks for your help....
Considering that the description of the MRI and the symptoms do not match, send pictures before and after the operation to exclude the radiologist’s mistake. Manual therapy can be done as early as 2 months after surgery; Nucleo-CMF Forte can be replaced with Keltican.
I went to a neurosurgeon and looked at the picture and he said... they wrote cicatricial adhesive epiduritis... when I said,
that they were admitted to the hospital with acute pain .. I heard the words ischalgia .. or lumbodynia, and now there is pain, that the buttock hurts
it's all from adhesions..
I asked what can be used to resolve adhesions..he replied that it’s not for me, please contact a neurologist, mine isn’t here
surgical treatment is not indicated...
... didn’t say anything more .. wrote LFK ..
what am I doing wrong?
adhesions form, what can be done. there is something,
from physio procedures... with lidase I did ultrasound on March 26.03 10 times... after which time to repeat.
Yes, the MRI is only the previous disc .. and now the description. but I didn’t take the disk.. just a photo.
Talk to your doctors about the following treatment regimen to see if you have any contraindications:
1. dexamethasone 4 mg IM - once a day for 5 days
2. ketonal 5% 2 ml IM - once a day for 5 days.
3. Keltican 1 drop 3 times a day. Or nucleo-cmp 1 drop. 2 times a day
4. Phlebodia tablet 600 mg No. 30. One tab. per day.
In a clean cup, mix the drugs listed above, for ease of use with a syringe. Moisten a bandage folded in four layers, measuring 10x10 cm, in this solution.
Attention! It is necessary to wring out the bandage until it is damp to avoid burns!
Before applying the compress, wipe the skin with a swab soaked in alcohol or vodka.
Place a compress on the lower back, where the scar from the operation is. Cover the top with a piece of cellophane or compress paper measuring 11x11 cm, and a piece of cotton wool measuring 12x12 cm on top.
Secure with a belt or bandage.
Do all this at the same time, and not in pieces. Be sure to show it to a doctor in person. let him determine exactly whether there are any contraindications (heart, kidneys, etc.)
thank you..for helping..
but after not much time, swelling appears on my back, the swelling is not large, and again it spoils the whole picture... please tell me what else can be done or I need time here...
and stiffness is already appearing... it’s hard to get up.
and I also began to feel... when I was sitting, my tailbone began to ache... why all of a sudden.
Pain in the buttock and foot persists.
yes, I visited a neurologist, showed pictures, found nothing so serious, cicatricial adhesive EPIDURITIS, AND THERE ARE HERNIAS.. SAYS THAT THEY COULD NOT TOUCH THEM, LIKE THE ROOF WAS POVED AWAY, I DON’T UNDERSTAND ANYTHING, can’t say anything.. about my situation ..said that you can instill actovigin and xanthinol nicatinate
You should have talked to your doctors to see if you have any contraindications, and if not, then you should have applied the entire regimen. and not limit yourself to just a compress. Regarding “edema and swelling,” it is extremely difficult for me to say exactly the nature of this phenomenon without seeing and palpating.
In neurology, pain after spinal surgery is usually referred to as “operated spine syndrome.” It came to us from Western literature where the term Failed Back Surgery Syndrome - FBSS (lit. Failed Back Surgery Syndrome) is widely used. Also in foreign literature you can find the term Failed Neck Surgery Syndrome - FNSS (lit. Failed Neck Surgery Syndrome). Postlaminectomy syndrome is also a synonym for these terms. In the future we will use the term “Operated spine syndrome”
Operated spine syndrome is a condition of a patient who, after undergoing one or more operations aimed at reducing lumbar or radicular pain (or a combination of both), continues to have persistent back pain after surgery.
According to statistics, the proportion of cases of recurrence of back pain after surgery on the lumbar spine ranges from 15% to 50%, this depends on the type of surgery and methods for assessing the results. Even if we assume that this value is 15%, then in the USA alone, where, according to the literature, 200,000 such interventions are performed annually, 37,500 new patients with back pain after spinal surgery should appear per year. It should be noted that throughout the world the percentage of such patients is less than in the USA (according to foreign literature, in all countries of Western Europe the same number of similar interventions are performed annually), but even despite this, it is obvious that this medical problem has a very large meaning.
Causes of back pain after surgery
The progression of the operated spine syndrome is determined by the fact that each repeated operation in the form of decompression and so-called meningoradiculolysis often only intensifies the pain syndrome due to the worsening of the scar-adhesive process in the operation area. Often the reasons for the recurrence of back pain after surgery or the deterioration of the patient’s condition are the following: prolapse of the hernia at a new level, prolapse of the remnants of the sequestered disc, unresolved compression of the nervous structures in the area of the radicular funnel or, not always diagnosed, destabilization of the spinal segment, which leads to dynamic or constant compression of the ligaments and roots of the spinal cord. However, operations with complete removal of the sequestered disc under the control of intradiscal endoscopy, decompressive operations with foraminotomy and stabilizing operations also do not always eliminate back pain after surgery.
Unfortunately, in more than 20% of cases, the cause of pain in the lumbar region and radicular pain in the legs remains unidentified, despite the fairly high capabilities of diagnostic methods.
Treatment of pain after spine surgery
From the above, an obvious conclusion follows: further operations to relieve pain after spinal surgery should not be performed, since this not only will not correct the situation, but, on the contrary, may cause harm.
The question arises - what can be done in this case.
First of all, you should turn to the standard treatment regimen for chronic pain syndromes.
You should start with complex conservative treatment, which should include both drug therapy and all possible methods of non-drug therapy (physiotherapy, manual therapy, psychotherapy, etc.).
However, it should be noted that in this case, due to the delay in starting treatment, the pain after spinal surgery has time to become chronic and may turn out to be incurable, i.e. not amenable to treatment. That is why the operated spine syndrome is one of the most common indications for the use of the spinal cord neurostimulation ( SCS ) . A more detailed description of this method can be found in the corresponding section. Therefore, we will focus on something else, namely the importance of timely access to this method of treatment. Below (see Fig. 1) shows the dependence of the effectiveness of SCS for operated on spine syndrome on the number of previous operations.
The diagram in Fig. 1 clearly demonstrates the decrease in the effectiveness of SCS with a large number of repeated operations.
Figure 2 shows the dependence of the effectiveness of SCS on the “delay period,” i.e., from the time that has passed from the moment pain appeared after spinal surgery to the application of the treatment method. What is clear is that the later the SCS was used, the lower the proportion of positive results.
If the use of SCS is ineffective, the question of transferring to treatment with narcotic analgesics is raised.
To cure back pain after surgery by choosing the most effective treatment method, you need to immediately seek advice from a specialist in this field.
Back pain caused by the sacroiliac joint
Pain from the sacroiliac joint often occurs when lifting heavy objects in an awkward position, or when there is tension in the joint, supporting ligaments and soft tissues. The sacroiliac joint is also susceptible to the development of arthritis due to various diseases that damage the articular cartilage.
If your back hurts with multiple myeloma
Multiple myeloma is a rare cause of back pain that is often misdiagnosed in its early stages. Is a unique condition that can cause pain through multiple mechanisms, combined or individually. These mechanisms include stimulation of nociceptors.
If your back hurts due to Paget's disease
Paget's disease is a rare cause of back pain, often diagnosed by non-contrast radiography performed for other purposes or when the patient detects swelling of the long bones. In the early stage of the disease, bone resorption occurs and the affected areas become vascularized.
Herniated discs are one of the most serious pathologies of the spine. Indeed, as a result of disc protrusion, compression of nerve endings or the spinal cord is possible. The most common hernia occurs in the lumbar spine, since this area is subject to the greatest stress. Typically, the pathology develops in people 30-50 years old, but can even occur in teenagers. In some patients, the symptoms of a lumbar disc herniation are constant, severe, and cause serious discomfort. Others hardly notice the disease. But in any case, it is very important to consult a doctor in time and begin treatment for the pathology.
The lumbar spine consists of 5 vertebrae. Between them are intervertebral discs, which act as shock absorbers and provide mobility. The lower back can withstand increased stress throughout the day. This section is the basis of the spine; it bears the entire weight of the body. At the same time, the vertebrae are protected from destruction by the discs, which take on almost the entire load.
Intervertebral discs are flat cartilaginous formations. Inside the fibrous tissue shell there is a semi-liquid core that acts as a shock absorber. When under stress or injury, the disc compresses and springs, protecting the vertebrae. But sometimes the fibrous membrane ruptures and the core leaks through it. It can compress the spinal cord or nerve roots. This is how a herniated lumbar disc is formed.
The cause of destruction of the fibrous ring may be degenerative changes in cartilage tissue that occur due to impaired blood supply and tissue nutrition. This has been happening more and more recently due to a sedentary lifestyle, since the lining of the disc receives nutrients only when the spine moves. Therefore, the fibrous ring gradually begins to crack, and the nucleus pulposus gradually leaks out.
But in certain situations, rupture of the annulus fibrosus may occur. This happens when there is an injury, a sharp bend or turn of the body, or lifting heavy objects. In this case, a sharp pain occurs, which is associated with compression of the nerve roots.
Pathology manifests itself differently in each person. Sometimes the symptoms of a lumbar disc herniation increase gradually or there is no serious discomfort at all. In other cases, severe pain appears immediately. It depends on which direction the nucleus pulposus protrudes, how much it affects the spinal canal or spinal nerves. It is the symptoms and their characteristics that become the diagnostic criterion for the doctor.
All manifestations of a hernia can be divided into three large groups:
The severity of these symptoms can vary and depend on the stage of the disease, how affected the nerve roots are and the general condition of the spine.
In the later stages of the pathology, the characteristic signs of a hernia are the so-called “cauda equina” syndrome. It includes paralysis of one foot, absence of the Achilles reflex, loss of sensation in the legs, and disruption of the pelvic organs.
At the first stage of disc destruction, when cracks just appear on the fibrous ring, the pathology does not cause any special problems for the patient. But the effectiveness of treatment depends on how early it is started. Therefore, it is very important to recognize the first symptoms of a lumbar hernia in time and consult a doctor.
First, the patient feels a dull aching pain in the lower back. They are not strong, not even everyone pays attention to them. Fatigue and some stiffness in movements may appear. Such symptoms are often inconsistent and occur from time to time, so diagnosis of the disease at this stage is rare.
Gradually the symptoms increase. The pain intensifies when bending the body, turning, or lifting heavy objects. It begins to spread along the sciatic nerve to the leg. Muscle weakness may increase. But such symptoms usually occur after exercise and go away while lying down. At this stage, it is still easy to get rid of the hernia, but if the patient does not see a doctor, the symptoms will gradually increase.
Pain is the main symptom of a herniated disc in the lumbar spine. It can be of varying intensity, appear independently or together with other symptoms. But it occurs in any case.
At the initial stage of a hernia, pain appears in the lumbar region. It is not strong, usually associated with load. But as the pathology progresses, the pain increases and spreads. This is due to the fact that the hernia grows and compresses the membranes of the spinal cord or nerve roots.
At this time, the pain intensifies when bending over, turning the body, raising the leg on the side of the affected nerve, walking for a long time or lifting heavy objects. Increased pain can also be caused by coughing or sneezing, or any shaking of the body. Gradually, when the bulging disc affects the nerve roots, the pain becomes sharp, shooting or burning. A lumbago occurs in the lower back, which can last from several hours to several days.
Now the pain is felt not only in the back. It affects the buttock, thigh, lower leg and even foot. Usually such sensations occur only on one side. Often shooting pain in the leg prevents the patient from walking and even standing. It can intensify with prolonged sitting, and only subsides when lying on the healthy side with a bent leg.
In severe cases of intervertebral hernia, the pain becomes so severe that the patient can only be saved by painkillers. After all, even in a lying position it does not go away. The patient tries to move less, which leads to the progression of degenerative changes in the disc due to deterioration in its nutrition.
Due to constant pain from a spinal hernia, spasm of the back muscles occurs. As a result of the fact that the patient seeks a body position in which it is easier for him, body distortion often occurs. Stooping or scoliosis develops. Sometimes one leg is shorter than the other. This leads to gait disturbance and loss of stability. In addition to pain and muscle spasms, other symptoms develop. They are related to the direction in which the hernia protrudes.
With lateral protrusion, the roots of the spinal cord are compressed. This may disrupt the functioning of the internal organs for which these nerves are responsible. If the hernia protrudes in the posterior direction, the spinal cord trunk is compressed. In the presence of such a vertebral symptom, there may be a disruption in the functioning of the pelvic organs, most often urinary or fecal incontinence. Intestinal upset often develops, regardless of food intake. There may be a frequent urge to urinate, and urine is released in small quantities. In men, potency gradually decreases, prostatitis appears, and in women gynecological diseases and frigidity develop.
In addition, the location of the disorders is related to which segments of the spine are damaged. Most often, a hernia occurs between the 4th and 5th lumbar vertebrae or in the area of the lumbosacral joint. Compression of the spinal nerves in front of the 5th vertebra causes pain and numbness on the outer surface of the thigh, in the area of the tibia, and on the back of the foot. A characteristic sign of such a lesion is the inability to move the big toe, as well as foot drop. If the sacral joint area is affected, symptoms spread to the buttock and back of the leg. The pain radiates to the heel, and there is also an absence of the Achilles reflex.
Prolonged compression of the spinal cord roots by a herniated disc can lead to their death. This condition is accompanied by certain symptoms.
In some cases, it is necessary to start treatment immediately. For example, with compression of the spinal cord trunk or with a sequestered hernia, when the nucleus pulposus completely comes out of the fibrous ring. These pathologies can threaten the patient's life.
Therefore, you need to urgently call an ambulance if the following symptoms appear:
Ignoring this condition is dangerous, as it can lead to complete paralysis of the lower limbs. But even in mild cases, the patient loses the opportunity to lead a normal life. Therefore, treatment of a hernia should begin as early as possible, when the first symptoms appear.
Many people are probably familiar with the experiences of our patient. Although everything has long been behind us and has begun to be forgotten. But I still remember doubts, a whole sea of doubts: is this possible, is that possible? And what not? After all, surgeons are laconic, and you can understand them too. They put it within strict limits, and that’s it. But even within this framework of what is not permitted, there are questions. There are few of them, but they exist.
This chapter, dear reader, was written to help patients and to relieve doctors. If after reading it you still have questions, do not hesitate to ask your doctor.
How to behave after surgery?
So, the operation to remove the hernia went without complications. How should the patient behave?
The surgeon's scalpel saves the patient's health. But at the same time, it absolutely inevitably causes certain mechanical damage to the body. Postoperative wounds of the skin, muscles and other soft tissues, the painful condition of the operated disc, inflammatory processes accompanying surgical intervention - all this suggests the need for an extremely gentle motor regimen. But the patient can still do something.
You can get up, but be careful
Should I get up or hold off for now and be careful? Usually on the second day the patient is allowed to get up. The process of getting up must begin in such a way that you end up with your knees on the floor, and your hands and stomach resting on the near edge of the bed. Try to keep your back straight throughout the entire standing procedure, otherwise there is a risk of dehiscence of the postoperative wound. Okay, now you can carefully rise to your feet. But before you take a vertical position, listen to your feelings: whether dizziness has appeared, whether the pain has intensified. Is there a little? No problem, let's wait. Has everything disappeared? Amazing. Now lean on the chair previously placed nearby and stand up. Be bolder. Are you up? Very good.
For the first time, just stand for a few minutes. The main thing is that the psychological barrier has been passed. Now you can lie down, so to speak, with the feeling of having accomplished a great deed. Lie down slowly, maintaining the same positions as when getting up, only in reverse order. But still, getting up in the first two or three days unless absolutely necessary is not advisable. You have little to do, and if necessary, it is more advisable to use the ship for now. Although, if you feel quite confident and in good control, it is not forbidden to visit common areas. Just remember to keep your back straight, even if you have to sit down.
If before the operation you felt numbness in your limb, then as the sensitivity of the nerve root freed from compression by the hernia is restored, the numbness may give way to pain. But it's good pain. There is no need to worry too much in this regard. It usually goes away on its own after a few days.
But sometimes the opposite happens. Pain in the leg or buttock in the first days after surgery not only does not decrease, but even increases slightly. This phenomenon is possible if the patient has radiculitis, a disease of the nerve root that occurs in response to compression by a hernia. And the increased pain is associated with postoperative swelling of the soft tissues, which caused some deterioration in the blood supply to the diseased nerve fiber. Use the recommendations described in the section “Why does leg pain appear or worsen when walking?” This will significantly reduce treatment time.
Why is it better not to sit down yet?
During the first three weeks after the operation, it is not allowed to sit down, since in a sitting position, when the Patient forgets to keep his back straight, tension occurs on the skin of the back. And this, as already mentioned, is fraught with divergence of the seams. Although they are removed on the ninth or tenth day after the operation, the scar remains vulnerable and “asks” for very careful attention for another ten days. But provided you maintain correct posture, in particular a straight back in a sitting position, you can sit down before the expiration of the three-week period.
Never forget how your spine can feel in a particular position. As strange as it may sound, be careful in bed too. Often, having settled comfortably in it, a person relaxes and begins to feel absolutely protected. Which is not entirely correct after surgery, because too free movements are fraught with danger to the postoperative wound. When turning your body, avoid close contact of the diseased area with the plane of the bed. Therefore, when turning, lift the protected part of the body above the surface.
It would not be superfluous to remind you that the bed of the person undergoing surgery should be quite hard. Usually, during a hospital stay, a shield is placed under the patient’s mattress so that the spine does not accidentally end up in an undesirable position due to the stretched mesh.
Showering is allowed on the third day after the stitches are removed. But baths - only 3-4 weeks after you start sitting down.
I would like to say a few words about the possible sensations during this period of illness. They are quite diverse, often not entirely pleasant, but, in general, they are divided into two main groups: sensations that should not be taken seriously, and sensations to which you should draw the attention of your doctor. First we list those belonging to the first group.
slight general weakness, slight dizziness; feeling of skin tightness in the area of the postoperative wound; lower back pain when changing body position in bed; pain in the leg or both legs, noticeably less intense than the pain before surgery; slight increase in pain in the leg or both legs in the early morning hours; the appearance of pain in the leg or both legs, if before the operation there was a feeling of numbness, frozenness; a slight increase in the feeling of heaviness in the lower back when walking - in comparison with similar manifestations in the preoperative period; slight increase in body temperature in the first two days after surgery.
Let us remind you that you should not attach too much importance to all this. The process is going well. But the feelings of the second group must be taken more seriously. Let's list them.
severe general weakness; night sweats, chills; a significant increase in pain in the leg or legs at rest or while walking - compared to what it was before surgery; the appearance of difficulty urinating or an increase in these disorders; new or worsening weakness in the leg or both legs; a significant increase in heaviness in the lower back while walking - in comparison with similar manifestations before surgery.
When faced with sensations of the second group, you should immediately tell your doctor about them. He will give you the necessary recommendations and, perhaps, change the previous instructions in some way or prescribe additional medical measures. This will allow you to continue your treatment safely. The early recovery period begins.
Early recovery period
Well, ten days have passed since the operation and your stitches have been removed. Another ten days have passed - you can start sitting down.
Everything is getting better. The body is slowly recovering. He entered an early recovery period, which, as practice shows, usually lasts two months. During this time, your body will do a tremendous amount of work. The swelling of the soft tissues will disappear, the function of the nerve formations will improve, and the defect in the fibrous ring of the operated disc will close. But the main thing is that in this period the work begins and, basically, ends on achieving the optimal configuration of the spinal column through a change in the tone of its muscles. After all, the height of the operated disc has become significantly smaller. The entire spinal column seems to have “sagged” a little; the relationship of its components has changed, often not for the better. Simply, the load carried by the disc could fall on other discs, on spinal joints - both nearby and distant, on muscles and ligaments. Then all these structures, having resignedly shouldered an unusual burden, may find themselves in a rather difficult position. If a person has excessive physical activity, they will not cope with the increased load and will get sick. Neither one nor the other, you understand, can go on another vacation or resign of their own free will. Therefore, your efforts should be aimed at strengthening the weak spots in the spine that have appeared.
And if the patient behaves carelessly, there may be complications in the disease. For example, instability may develop - a temporary displacement of the overlying vertebra in relation to the underlying one. Or even spondylolisthesis - an irreversible and progressive form of instability.
Another common complication during this period of the disease may be a recurrence of a herniated disc. After all, if you remember, the surgeon does not remove all of the nucleus pulposus. Due to the difficult access to the anterior part of the intervertebral disc, part of the nucleus located there remains in place. In case of gross violations of the motor activity regime, it is possible to move unremoved fragments of the nucleus towards the spinal canal through a still poorly healed crack in the fibrous ring. Everything repeats itself again. Moreover, the source of the hernia may well be the disc adjacent to the operated one - the load on it immediately increased after the operation. You see how many dangers await an unwary person.
But you shouldn’t flatter yourself with the thought that if you follow discipline, absolutely nothing will bother you. You can easily compile a fairly detailed list of the patient's main complaints in the early recovery period. This may be a feeling of discomfort, heaviness, mild pain in the area of the operated area of the spine or even in its other parts.
Similar sensations can appear when standing, sitting, and after a long stay in a lying position. If the pain that appears in a vertical position is determined mainly by excessive tension of the muscular-ligamentous apparatus, then morning pain in the spine is mostly due to insufficient blood outflow from the operated area and the load experienced by the intervertebral joints.
All these considerations are somewhat general. The conclusion will be as follows: during the period described, it is extremely important not to overload yourself. Any ailment in any part of the spine should be considered as a strict order from the body: “Comrade patient, reduce the load on the spinal column. Change your body position!”
And you, as a self-conscious person, must obey immediately. Otherwise, the body, even having turned on all its compensatory capabilities, will not be able to more or less evenly distribute, “scatter” the extra “kilograms” throughout the spine - muscles, ligaments, discs and joints. Then it will be difficult for him.
Of course, it will be difficult for you too. Remember a few practical tips: don't pace, don't stop, and don't sit too long. A bit of everything. If the pain appears while standing, and it is not possible to lie down now, then it is better to walk around. As a rule, the pain calms down for some time.
If discomfort occurs while you are sitting, place a small pillow between your lower back and the back of the chair. In the end, you can just lend your hand.
If you need to lift something, lift the load while keeping your back straight. Use orthopedic products prescribed by your doctor (you have already read about them in chapter seven). And most importantly, whatever you do, change your position often.
Having remembered these simple recommendations, let us now try to divide into two groups the sensations most often experienced by the patient in the early postoperative period. As in the previous chapter, they will be divided into those that should not be given serious importance, and those that should attract the close attention of the patient and his attending physician.
The first group is the appearance or slight increase in heaviness in the lower back and (or) sacrum in a sitting or standing position; the appearance or slight increase in cerebral irritation in the affected leg(s) during a relatively long stay in a sitting or standing position; morning heaviness in the lower back, disappearing after a light warm-up; the appearance of mild pain in the thoracic or cervical spine (or both) while sitting or standing.
The second group is a significant increase or appearance of heaviness in the lower back and (or) in the sacrum after a short stay in a sitting, standing, or lying position; the appearance or significant increase in pain in the affected leg(s) after short physical exertion or while lying down; lumbago in the lower back; the appearance of new, still unfamiliar pain in the spine and/or lower extremities.
Using the proposed classification, carefully understand your feelings and, if they are worth it, immediately report your discomfort to your doctor!
Late recovery period
This period includes the time period from the second to the sixth month from the date of surgery and is characterized by the following features.
By the beginning of the third month, in the absence of complications (and if you strictly follow all medical instructions, there should be no complications), the crack in the fibrous ring of the operated disc will be firmly overgrown with connective tissue, that is, it will heal. In the spine, adaptation processes of a compensatory nature will generally be completed, and it will be able to function normally under conditions of changed loads. Pain in the spine ceases to be felt when doing housework, or during relatively long periods of standing or sitting. The person is quite ready to return to normal work activities.
Like those treated conservatively, patients after surgery in the late recovery period require a light work schedule, at least for two months. If the work involves physical activity, then release from heavy physical labor and, if possible, a shorter working day are necessary. If work involves constant sitting or standing on your feet for a long time, then a shortened working day is also desirable.
You already know how to lie down, get up, sit, lift a load correctly if you carefully read the previous chapters
The rehabilitation period for patients who have undergone surgery for a herniated disc takes approximately 6 months. Restorative measures include the use of medications, physiotherapeutic procedures, special therapeutic exercises, mechanical unloading of the spinal column, manual therapy, acupuncture, as well as spa treatment.
In the first 3 months of the postoperative period, the patient must follow the following set of rules:
- it is forbidden to sit for 3 weeks after surgery;
- avoid deep and sudden movements in the spine (bending forward, to the sides, twisting movements for 1 month);
- do not drive a car or ride in a vehicle in a sitting position for 2 months after surgery;
- do not lift more than 4-5 kg for 3 months;
- You should not engage in sports such as football, volleyball, tennis, cycling for 3 months.
In the long-term postoperative period (3-6 months):
— it is not recommended to lift more than 6-8 kg, especially without warming up and warming up the back muscles, jumping from heights, or long car trips;
— it is recommended to avoid hypothermia, heavy lifting, monotonous long-term work in a forced position, and the appearance of excess body weight.
Surgery for intervertebral hernias does not mean that in a few days a person will feel healthy, mobile and ready to do any work. Rehabilitation after spinal hernia surgery lasts up to several months and the complete restoration of functions lost during the illness depends not only on the professionalism of the doctor, but also on the patience and perseverance of the patient. During the recovery period, the patient must follow all the doctor’s recommendations; compliance with them will prevent a possible relapse and allow you to quickly cope with the limitation of mobility.
Conventionally, the entire rehabilitation period can be divided into three stages of different duration:
The early rehabilitation period is up to two weeks after surgery or another type of intervention on the spine. During this period, the postoperative suture heals, lost sensitivity is restored and pain is reduced. Not all patients experience pain and limitation of movements completely stop immediately after surgery - swelling and inflammation of nerve fibers and tissues disappear within a few days, after this period it will be possible to evaluate the results of surgery.
In the early rehabilitation period, non-steroidal anti-inflammatory and painkillers are prescribed. Patients with depression are prescribed sedatives. Neurosurgeons do not advise lying in bed for a long time after surgery; after a day or two you can already perform simple movements and move around, the only condition for this is the use of a corset.
Orthopedic corsets will be required not only in the first days and hours after surgery, but also for several months, that is, during the recovery period when performing physical work or exercises. Rigid bandages prevent displacement of the vertebrae, prevent sudden movements, and promote rapid healing of internal and external sutures.
In the early rehabilitation period, the doctor evaluates the appearance of sensitivity in the limbs, restoration of pelvic organ function, and prescribes tests and repeat images. The selection of drug treatment will depend on the data obtained and the patient’s well-being.
Depending on the type of surgical intervention, the patient’s general well-being, and the presence of complications, discharge home can be made on the third or tenth day after the operation. Before discharge, the doctor must give the operated patient detailed and complete recommendations, on compliance with which the restoration of health and all functions of the spinal column in the future depends.
Rehabilitation after removal of an intervertebral hernia is carried out by any patient subject to the following conditions:
During the first weeks after the operation, the postoperative scar heals, the impaired sensitivity of the nerve endings is restored, and the processes of restoration of the functions of the spine occur. Therefore, the patient’s task at this stage is to create the most favorable conditions for his spine. Active restoration of the spine after surgery begins in about a month; rehabilitation measures include:
Restorative gymnastics in the first stages is carried out only under the supervision of a specialist; various sudden movements can lead to an attack of pain. Rehabilitation after removal of a spinal hernia, in addition to exercise therapy and physiotherapy, may also include classes on special simulators, therapeutic massage, and reflexology.
Therapeutic exercise is necessary throughout the entire period of recovery of the body after surgery and in later life. Physical exercise increases joint mobility, strengthens the muscle corset, increases blood supply and nutrition to the spine, and helps eliminate toxins accumulated in the skin and muscles. The doctor is required to select exercises and explain to the patient all the principles of performing gymnastics during the rehabilitation period.
You can begin extensive exercises about a month after surgery, but warm-up movements for the limbs and joints can be practiced already on the second or third day after discectomy. The simplest exercises after surgery include:
General recommendations and rules have been developed for patients who have undergone surgery to remove a herniated disc. Compliance with them allows you not to experience discomfort and pain and have the maximum beneficial effect on the spine.
The exercises given below are indicated for postoperative patients, but it is always necessary to remember that the rehabilitation doctor will be able to draw up an exercise plan competently based on the patient’s well-being, the presence of contraindications and the anatomical features of the spine of a particular patient.
Therapeutic exercise will bring undoubted benefits after surgery and will help prevent recurrence of the hernia after surgery if the patient performs the exercises constantly, moderately increasing the load. Throughout life, the patient is recommended to perform three basic sets of exercises - push-ups, squats and cycling. Allocating 10 minutes in the morning for exercise will allow you to endure all the day's loads without discomfort and pain.
The sets of exercises selected by the doctor must be performed for 6 months or more; during this time, it is believed that a bone callus will form at the site of the hernia removal. After this period, physical therapy expands with exercises on simulators, massage, physiotherapy, and mechanotherapy.
Mechanotherapy is the use of various simulators, with the help of which the physical conditions of influence on the limbs and spine are expanded. In patients with various paresis and paralysis of the limbs, a verticalizer can be used to give the body a vertical position - a device created to prevent complications that develop with prolonged lying down.
The functioning of the cardiac, respiratory and urinary systems improves in a patient placed in a verticalizer. Several types of verticalizers are produced, in some of them the patient can train the lower limbs, in others the back muscles, and others are equipped with a device for independent movement.
Therapeutic massage is recommended to be performed several weeks after surgery. A professionally performed massage relieves tension, swelling, and prevents muscle atrophy. There are several massage techniques, their choice depends on the general health of the patient and the nature of the surgical procedure.
The use of physical methods of influence - ultrasound, laser, magnetic fields, electrical impulses increases blood supply, nutrition and metabolism in the spine.
During the rehabilitation period, diet after hernia surgery is also of great importance. Nutrition should be aimed at preventing constipation and gas formation, which can place excess stress on the operated area. It is recommended to eat often, but in small portions; the daily menu should contain dishes with plant fibers and a sufficient amount of liquids - jelly, compotes, rosehip decoction.
In the first days after the operation, they mainly eat vegetable and milk soups, liquid porridges, then the diet is expanded to include omelettes, steamed dishes from vegetables, cutlets, meatballs, and boiled fish. In the future, it is necessary to minimize products with cocoa, coffee, and alcohol. You constantly need to monitor your weight - excess kilograms create unnecessary stress on the spine, which is categorically not recommended after removal of intervertebral discs.
An intervertebral hernia can cause a lot of suffering to a person, so successful surgical intervention cannot but rejoice. You can maintain the positive effect of the operation and prevent complications and relapses by following the following recommendations.
Rehabilitation after spinal surgery for a hernia lasts at least six months. During this recovery period, it is necessary to follow all the recommendations of the attending physician - restriction of movements, minimal lifting of weights, refusal to drive a car or travel by transport.
Compliance with all the measures suggested by the doctor to restore the body will allow you to lead a normal life, not limit yourself in doing your usual work, and will prevent the development of relapses.