腰椎术后行动恢复指南（英文）

The Road To Recovery AFTER LUMBAR SPINE SURGERY A DETAILED GUIDE TO YOUR SURGERY AND THE RECOVERY PROCESS FROM THE JOHNS HOPKINS SPINE SERVICE The Road To Recovery after Spine Surgery 2 TABLE OF CONTENTS Introduction 3 Type of Surgery 6 Preparing for Surgery 7 Day of Surgery 11 Days after Surgery 12 Exercises in the Hospital 13 Going Home after Surgery 14 Ways to Avoid Twisting and Bending after Surgery 17 Proper Lifting Technique 18 Proper Ways to Push and Pull after Surgery 20 Sleeping after Surgery 21 Sitting after Surgery 22 Sitting at Your Desk after Surgery 23 6 Week Follow-Up Appointment 24 Exercises at 6 Weeks after Surgery 25 What if My Expectations of Surgery are Not Met? 27 Additional Resources and Phone Numbers 28 Benefits of Quitting Smoking 29 Hotel Accommodations 31 Johns Hopkins Medical Campus Map 35 The Road To Recovery after Spine Surgery 3 This book will: - Prepare you for surgery - Explain what to expect during and after surgery - Guide you through the recovery process The most important thing to remember is the sooner you return to being active – the sooner you will be on the road to recovery. The Johns Hopkins Spine Service is dedicated to returning you to an active lifestyle. Each member of the spine team has contributed to this book and is here to answer any question. You can also access the book on our website at http://www.hopkinsortho.org/surgery_guide.html. Thank you for choosing us! Johns Hopkins Outpatient Center Johns Hopkins at Greenspring Station Department of Orthopaedic Surgery 10753 Falls Road, Suite 215 601 N. Caroline Street Lutherville, MD 21093 Baltimore, MD 21287 410-583-2850 410-955-6930 The Road To Recovery after Spine Surgery 4 The first step on the road to recovery is learning how to play an active role in your care. Before proceeding with surgery, it is important to become an advocate for yourself. Make sure you understand the surgery and what to expect in the weeks and months following. So the idea is for you to be Pro-Active. This means you should seek out information and help from the health care providers around you. It is a good idea to take control, make decisions, and find your best road to recovery. To not be pro-active means you run the risk of having others make decisions for you. These decisions may not be in the best interests of you and your family. Success at being pro-active depends on knowing your rights as a patient. These rights are: • The right to considerate and respectful care • The right to obtain complete and current information concerning your surgery • The right to receive information necessary to give informed consent prior to your surgery • The right to be informed of the medical consequences of surgery • The right to every consideration of privacy concerning care And the most important right: The right to ask questions! The Road To Recovery after Spine Surgery 5 We know the idea of surgery can cause anxiety and leave you with many unanswered questions. Your questions are extremely important to us and we hope that we can make you feel more at ease in the days prior to and after your surgery. Our intention in constructing this booklet is to allow you to become as involved in your surgery and recovery as your surgeon and the staff. We approach surgery as a team with you being the most valuable player. Each surgery is quite different than the next and it is important that you and your surgeon know what to expect of each other. The Road To Recovery after Spine Surgery 6 What Is a Lumbar (Low Back) Fusion? A fusion stabilizes the vertebrae of the spine creating less chance for slippage of the discs. Bone from the iliac crest (hip), local bone from the operative site, allograft bone and other bone may be used as a bone graft. The graft is inserted between the vertebrae and then rods and screws are placed. The bone from the hip often is removed through the same incision leaving the patient with only one incision postoperatively. Surgery will last approximately 4 to 8 hours. You will be in the hospital approximately 5 days and may go to a rehabilitation unit after the 5 days in the hospital. Some people will undergo a staged surgery. This will entail a posterior fusion as well as an anterior fusion. The anterior surgery is done through an incision in the abdomen. The posterior fusion is done first and approximately 5 days later, the patient undergoes the anterior fusion. You will be in the hospital approximately 12-14 days and may go to a rehabilitation unit after the 12-14 days in the hospital. What Is a Lumbar (Low Back) Laminectomy? A laminectomy is a procedure which involves removing bone of the vertebrae to allow for more space for the nerves. It relieves pressure on the nerves and decreases symptoms such as numbness, tingling, pain and weakness. Surgery will last approximately 3 hours. You will be in the hospital 3 days. What is a Lumbar (Low Back) Discectomy? Pain radiation down the legs may be due to a disc bulge or disc herniation. A discectomy is the removal of the piece of disc or the entire disc that is putting pressure on the nerves and causing your leg numbness, tingling, pain or weakness. Surgery will last approximately 2 to 3 hours. You will be in the hospital 1 night. You will go home the next day. The Road To Recovery after Spine Surgery 7 PREPARING FOR SURGERY No matter what surgical procedure you are getting ready to undergo, there are general guidelines that will help you prepare for your upcoming surgery. Your cooperation is greatly appreciated in this joint effort. Make sure you understand what to expect from the surgery Many people will suffer from back pain as well as leg pain. Make sure you discuss the goals of surgery with your surgeon. If you are suffering from both back and leg pain, the chances of surgery resolving your leg pain are very high compared to relieving your back pain. Complete the on-line patient survey As part of our continuing effort to provide the best care to our patients, we routinely collect information through a web-based survey on all patients both before and after surgery. This survey assesses current pain level, functional ability, and beliefs about healthcare and wellness. The information is provided to your surgeon to help improve surgical care and management of your recovery. The survey also collects outcome information that is essential to the ongoing research efforts of The Johns Hopkins Spine Service. If you haven’t already completed the survey on your first visit, please go to http://sorc.jhmi.edu/ Survey.html and click on the lumbar survey link. You will need your Medical record number to access the survey. This can be found on the orange card or checkout form that you received at one of your clinic visits to the Johns Hopkins Spine Service. If you cannot locate your record number, please contact your surgeon’s office for help. The Road To Recovery after Spine Surgery 8 Stop smoking If you are a current smoker, we advise that you quit smoking tobacco products at least 1 month prior to surgery. Nicotine, in any form, is a hindrance to bone fusion and healing. Because Nicotine is the source of the problem when it comes to healing and bone fusion, smoking cessation products such as Nicorette® gum or nicotine patches must be discontinued as well. Please discuss smoking cessation plans with your medical doctor. There are new medications available to help with this. Obtain medical clearance • You will be expected to see your medical doctor or visit the Johns Hopkins Preoperative Evaluation Center for a physical examination, medical history and other testing. Please call your surgeon’s office to discuss this. • If you have heart disease, diabetes or any other diseases and are following by a specialist, you will be expected to receive clearance from them prior to surgery. This clearance must be in writing and sent to your surgeon’s office. • Your surgeon will discuss whether is it necessary for you to meet with one of our anesthesiologists prior to your surgery based on your health history and age. • If you are suffering from extreme stress or anxiety or have signs of depression, make sure you address this with your surgeon before surgery. • If you see a pain management specialist, make sure to share the news of your surgery. The Road To Recovery after Spine Surgery 9 Perform the required testing: WITHIN 30 DAYS OF YOUR SURGERY DATE A comprehensive history and physical will be required that will include: • CBC with differential, Chem 7, ESR, PT/PTT • Urinalysis • EKG • Chest x-ray If you choose to have your testing done at Johns Hopkins, please call your surgeon’s office and they will make an appointment for you in our Preoperative Evaluation Center. Avoid these medications prior to surgery • You will be required to STOP any nonsteroidal anti-inflammatories such as Ibuprofen (Advil, Motrin), Naprosyn (Aleve), Celebrex, Mobic, Indocin, and Lodine 7-10 days prior to your surgery. • You will need to STOP taking aspirin and any anticoagulants including coumadin and Plavix®, Lovenox®. Please check with your medical doctor about when and how this should be done. • Please STOP taking any herbal supplements and certain vitamins 7-10 days prior to surgery including but not limited to St. John’s Wart, Garlic, Ginseng, Gingko Biloba, Vitamin E and Vitamin C, as these tend to thin your blood. • Diabetic patients should not take any oral hypoglycemic agents and insulin products the morning of surgery. Metformin (Glucophage) is the most vital to make sure to avoid. • You should not take any diuretics the morning of surgery (i.e. Lasix, HCTZ) (Unless you have congestive heart failure) • You should not take any ACE/ARB the morning of surgery. These are classes of antihypertensive medications. Examples include Lisinopril, Lotrel, Captopril, Lotensin, Monopril, Prinzide, Atacand, Benicar, Diovan and Avalide. If you have congestive heart failure, you should take these medications the morning of surgery. The Road To Recovery after Spine Surgery 10 Perform the following tasks before surgery • Make sure you review the postoperative exercises and restrictions which include no bending, twisting, and lifting. • Arrange for a family member or friend to check on you in your home and help you through the first couple of weeks after your surgery. The type of surgery you have will determine the length of time you will need help. • If you are coming from out of town, you may want to stay in a hotel the night before surgery. The morning surgery begins at 7:30am and you are expected to arrive at the pre-op area 2 hours prior to your surgery. It is not required that you stay in town after your surgery. However, if you would feel more comfortable staying in the Baltimore area 1-2 days postoperatively, we can help you find accommodations at a discounted rate. Please see the list of hotels that offer the discounted Johns Hopkins rate at the end of the book. • Arrange to have someone drop you off the morning of surgery and pick you up after discharge. You will not be able to drive yourself home on the day of discharge. • Your surgeon and staff will send you a list of medications to avoid prior to your surgery. Please pay special attention to this information as you will have to stop some of the medications 1 week prior to surgery. • You will be required to fast the night before surgery. You should not have anything to drink or eat after midnight the night before surgery. • Please bathe and wash your hair prior to your surgery. Some surgeons will ask that you use Hibiclens®, which is an antiseptic skin cleanser. • Pack lightly for your hospital stay. Please do not bring any valuables to the hospital. It is a good idea to bring sneakers and comfortable clothes with an elastic waistband. The Road To Recovery after Spine Surgery 11 DAY OF SURGERY What are your responsibilities the day of surgery? Please arrive 2 hours prior to your scheduled surgery time (i.e. if your surgery is 7:30am, please arrive at 5:30am) and report to Osler 7 (pre-op area) the morning of surgery. It is essential that you bring your MRI and x-rays to your surgery if you have not given them to your surgeon already. If you have brought a copy of your advance directive or living will, please provide the pre-operative nurse with a copy What happens in the pre-op area? You will meet with a provider from the spine team who will complete the surgical consent forms with you. This person will also confirm the type of surgery and initial the surgery site. You will also meet with the anesthesiologist prior to your surgery. He or she will begin an IV as well as place TED stockings on your legs. You will wear TED stockings throughout your hospital stay as well as 1 to 2 weeks after you are discharged from the hospital. These stockings help avoid leg swelling and clots. Once you are anesthetized (put to sleep), a foley catheter will be inserted which will empty your bladder during surgery. Shortly following the surgery and once you are mobile, this catheter will be removed. Where will you go immediately after surgery? Once your surgery is over, you will be transferred to the recovery room. Once you are deemed stable, you will be transferred either to the surgical intensive care unit (SICU) or to Nelson 8, an orthopaedic unit, on the same day of surgery. If you are moved to the SICU, you will spend approximately 1 night until you are stable to be transferred to Nelson 8 The Road To Recovery after Spine Surgery 12 DAYS AFTER SURGERY After surgery, you will be advised not to twist or bend. Most people will not need to wear a brace after surgery. However, your surgeon will inform you if a brace is required and one will be ordered in the hospital. During the days following your surgery, physical and occupational therapists will work with you at your bedside. They will provide you with exercises to regain your strength and with equipment to help you resume your normal activities, such as a reacher to pick things off the floor or a cane or walker to assist with safe walking. They will also help you get out of bed and to sit in a chair. Once you are tolerating getting out of bed and to a chair, a physical therapist will work with you to begin walking. This usually occurs the day after your surgery. Once you are tolerating walking in the halls with the physical therapist, you will be reintroduced to stairs. Who are the other people you will meet in the hospital? A social worker and a home care coordinator will discuss your home needs while you are in the hospital and order durable medical equipment which can be delivered to your home. If you feel the need to speak with pastoral counseling, there are chaplains, rabbis, priests or ministers of your faith. Johns Hopkins Hospital does hold mass every Sunday and patients and their family members are welcome to attend. What about pain management and diet advancement after surgery? Immediately following surgery, you will be given pain medications through an IV. The IV medication will be administered through a PCA (Patient-Controlled Analgesia) pump. This form of medication allows patients to control his or her own medication depending on the severity of the pain. You will then be converted to oral pain medications. Once you are tolerating clear liquids, your diet will be advanced slowly until you are ready for a regular meal again. The Road To Recovery after Spine Surgery 13 Please take the time to review some of the exercises you will do in the hospital. The Road To Recovery after Spine Surgery 14 GOING HOME AFTER SURGERY Most people will be discharged home. But for some, rehabilitation may be necessary as a bridge to going home. Johns Hopkins has a rehabilitation floor and your insurance may cover the stay. Depending on availability, you may also go to our sister rehabilitation unit at Good Samaritan Hospital or others depending on your needs. Pain medications You will be discharged with pain medications. Be sure to drink plenty of fluids, take stool softeners prescribed and increase your fiber intake while taking narcotic medications as they tend to cause constipation. You should begin to wean yourself off of the pain medications with a goal of weaning off within 3 months from surgery. If you are still requiring narcotic medications after 3 months, we will be happy to help you find a pain management specialist either here at Johns Hopkins or in your local area. Medication restrictions after a Lumbar (Low Back) Fusion Surgery Please ask your surgeon how long you should refrain from non-steroidal anti- inflammatory medications. Usually patients are asked to avoid these medications for 3 months after surgery but this decision can be made by your surgeon. These medications include, but are not limited to: Ibuprofen (Advil, Motrin), Naprosyn (Aleve), Celebrex, Mobic (Meloxicam), Indocin, Voltaren, and Lodine. Surgical incision care Please Remember: **If you notice any increased drainage, redness, swelling, or have a fever of 101.5 or greater, please call you surgeon’s office immediately or go to the emergency room. Your surgical incision may be closed with dissolvable sutures and steri-strips, staples or sutures. If you have staples or visible sutures, these will need to be removed 14 days after your surgery. Arrangements for a home care nurse can be made in the hospital by our home care coordinators. If you do not qualify for in-home care by your insurance company, you will need to make an appointment for staple/suture removal with your surgeon’s office. The Road To Recovery after Spine Surgery 15 Surgical incision care While you are in the hospital, you will wear a dry gauze dressing. Once your incision is no longer draining, you may take off the dressing and leave the incision open to air. Do not apply any ointments or lotions to the incision while it is healing. YOU MAY NOT BATHE IN A TUB, SWIM OR USE A HOT TUB UNTIL YOUR INCISION IS HEALED. Sexual activity You can resume sexual activity when you are feeling up to it. You may find certain positions will be more comfortable than others. Driving You can drive when you feel up to driving and are not taking narcotic pain medications. This is usually 2 to 3 weeks after a laminectomy and discectomy and 4 to 6 weeks after a lumbar fusion. Narcotic pain medications will delay your reflex time. Begin with short trips first and get out of the car every 30 to 45 minutes to walk a