“How do you manage a discectomy at home?”
I am a 40 year old male. I can't see my orthopedist because of covid-19. How do you manage a discectomy at home?
3 Answers
The question is not clear. If you already had a discectomy then you should have follow-up doctors visits with your surgeon. Usually the first evaluation is done in person to check the wound for proper healing. After that, telehealth visits are acceptable. If you have not had surgery then evaluations are very easy through telehealth and you should consult your physician.
Generally post discectomy we recommend avoidance of strenuous activities for 2 months and encourage walking as tolerated several times a day. Try to gradually wean off postoperative medications. If you have access to a swimming pool at home or a stationary bicycle, those are beneficial ways to start your home rehabilitation process.
Generally post discectomy we recommend avoidance of strenuous activities for 2 months and encourage walking as tolerated several times a day. Try to gradually wean off postoperative medications. If you have access to a swimming pool at home or a stationary bicycle, those are beneficial ways to start your home rehabilitation process.
If you had discectomy, your surgeon should have given you post-operative instructions. There are many ways discectomies are done and the post-operative care depends on the technique used. Please, check with your surgeon.
Hello,
I am an orthopedic spine surgeon in Minnesota that specializes in endoscopic spine surgery to treat disc herniations. I have personally had 3 disk herniations and surgery to treat one of them. Fortunately, non surgical management should result in a 80-90 percent resolution in symptoms without surgery. That said, dealing with pain and neurologic symptoms can be very persuasive to get some help. Here is what I’d suggest:
1. Start with short-term use of over the counter medications that you tolerate such as acetaminophen and ibuprofen. It is generally okay to combine the two medications unless you have a medical condition preventing the use of these medications. Make sure to use less than 4000mg per day of acetaminophen.
2. Look online for exercises to treat a lumbar or cervical disk herniation. (We have some of these on my website)
3. Consider a telemedicine or primary care visit. These are generally a great first step in initiating treatment and provides the opportunity of obtaining prescription medication and documenting the onset of treatment for your insurance company. Make sure the provider recommends several things including the use of #1. and provides a home exercise plan. This is very important to help you and meet some insurance requirements to obtain an MRI scan. We provide these through my clinic and have been a great way to help people especially during the Covid-19 pandemic.
4. Consider starting oral steroids such as a medrol dose pack. This isn’t such a good idea if you are an insulin dependent diabetic, but for other people, this medication might significantly reduce your pain. This requires a prescription and can be had during #3.
5. A referral to physical therapy or a chiropractor.
6. Depending on the severity of symptoms and whether you’ve already completed #1-5 an MRI scan might be needed.
7. An epidural steroid injection has been shown to be effective in up to 70% of people to avoid surgery.
8. Surgery. This might involve some research on your part to identify how you want the surgery performed.
A. I am partial to an endoscopic microdiscectomy because it is the least invasive method to remove the disc herniation. It can be performed through the foramen along the side of the spine or from the back (posterior) side. Typically, the surgery is done with a 7mm diameter tube. This means there is less injury to the muscle and a small incision (8mm) is used to perform the surgery. Theoretically, minimal scar tissue is formed around the nerves after this type of surgery. If a transforaminal approach is used then this avoids the type of injury to the multifidus muscles that occurs during an MIS or open approach.
B. “MIS” or minimally invasive microdiscectomy. This is done through a posterior approach and is performed through an 18 or 22mm tube. Between the lamina or Interlaminar window and the bottom of the access tube, some muscle and bone are usually removed to access the disc herniation. Bone removal refers to a laminotomy or hemilaminectomy that is usually performed. Generally, this requires a longer period of time to heal the muscles and skin. The incision is usually between 20-30mm. Scar tissue typically forms along the nerves after this type of surgery.
C. Open microdiscectomy. This is done through a posterior approach and involves cutting the muscle off the spine and placing a retractor so that the interlaminar window and lamina is seen. A laminotomy or hemilaminectomy with removal of bone is usually performed except at L5-S1. This may take the muscles and skin the longest to heal depending on the incision size and retractor used. Scar tissue typically forms along the nerves after this type of surgery. The incision size can vary. I’ve seen 25mm (1 inch) to 152mm (6 inch) incisions to treat one level disc herniations.
In conclusion:
If the symptoms are bad enough, don’t wait 3 months to be in the 90% group that get better with conservative treatment. Steps 1-8 can be done to get better so you can have relief from the pain.
If constant numbness, weakness, and severe pain are present then get evaluated urgently. If loss of bowel or bladder control occurs or significant weakness develops then this becomes an emergency and needs evaluation immediately.
Hope this information is helpful,
Daniel W. Hanson, MD
I am an orthopedic spine surgeon in Minnesota that specializes in endoscopic spine surgery to treat disc herniations. I have personally had 3 disk herniations and surgery to treat one of them. Fortunately, non surgical management should result in a 80-90 percent resolution in symptoms without surgery. That said, dealing with pain and neurologic symptoms can be very persuasive to get some help. Here is what I’d suggest:
1. Start with short-term use of over the counter medications that you tolerate such as acetaminophen and ibuprofen. It is generally okay to combine the two medications unless you have a medical condition preventing the use of these medications. Make sure to use less than 4000mg per day of acetaminophen.
2. Look online for exercises to treat a lumbar or cervical disk herniation. (We have some of these on my website)
3. Consider a telemedicine or primary care visit. These are generally a great first step in initiating treatment and provides the opportunity of obtaining prescription medication and documenting the onset of treatment for your insurance company. Make sure the provider recommends several things including the use of #1. and provides a home exercise plan. This is very important to help you and meet some insurance requirements to obtain an MRI scan. We provide these through my clinic and have been a great way to help people especially during the Covid-19 pandemic.
4. Consider starting oral steroids such as a medrol dose pack. This isn’t such a good idea if you are an insulin dependent diabetic, but for other people, this medication might significantly reduce your pain. This requires a prescription and can be had during #3.
5. A referral to physical therapy or a chiropractor.
6. Depending on the severity of symptoms and whether you’ve already completed #1-5 an MRI scan might be needed.
7. An epidural steroid injection has been shown to be effective in up to 70% of people to avoid surgery.
8. Surgery. This might involve some research on your part to identify how you want the surgery performed.
A. I am partial to an endoscopic microdiscectomy because it is the least invasive method to remove the disc herniation. It can be performed through the foramen along the side of the spine or from the back (posterior) side. Typically, the surgery is done with a 7mm diameter tube. This means there is less injury to the muscle and a small incision (8mm) is used to perform the surgery. Theoretically, minimal scar tissue is formed around the nerves after this type of surgery. If a transforaminal approach is used then this avoids the type of injury to the multifidus muscles that occurs during an MIS or open approach.
B. “MIS” or minimally invasive microdiscectomy. This is done through a posterior approach and is performed through an 18 or 22mm tube. Between the lamina or Interlaminar window and the bottom of the access tube, some muscle and bone are usually removed to access the disc herniation. Bone removal refers to a laminotomy or hemilaminectomy that is usually performed. Generally, this requires a longer period of time to heal the muscles and skin. The incision is usually between 20-30mm. Scar tissue typically forms along the nerves after this type of surgery.
C. Open microdiscectomy. This is done through a posterior approach and involves cutting the muscle off the spine and placing a retractor so that the interlaminar window and lamina is seen. A laminotomy or hemilaminectomy with removal of bone is usually performed except at L5-S1. This may take the muscles and skin the longest to heal depending on the incision size and retractor used. Scar tissue typically forms along the nerves after this type of surgery. The incision size can vary. I’ve seen 25mm (1 inch) to 152mm (6 inch) incisions to treat one level disc herniations.
In conclusion:
If the symptoms are bad enough, don’t wait 3 months to be in the 90% group that get better with conservative treatment. Steps 1-8 can be done to get better so you can have relief from the pain.
If constant numbness, weakness, and severe pain are present then get evaluated urgently. If loss of bowel or bladder control occurs or significant weakness develops then this becomes an emergency and needs evaluation immediately.
Hope this information is helpful,
Daniel W. Hanson, MD
