Surgery for Hernia Nuclei Pulposi (HNP) Hernia Nuclei Pulposi, the medical term for herniated disc, is a protrusion of the intervertebral disc. Though there are many types of hernias, treatment of this condition, namely surgery to remove the herniated disc material pressing on the nerve root, is the same in the majority of cases. It is important to note that the nerve root can swell post-surgery;
as a result of which, the radiating pain you felt in your leg prior to surgery may persist or even worsen. You may experience back pain as a result of the surgery itself but also because the intervertebral disc may collapse slightly after removal of the herniated disc material.
Canal stenosis surgery (interarcuate canal widening or laminectomy)
The spinal canal, the hollow space in the centre of the spinal column, extends from the base of the skull (cervical vertebra) to the tail bone (coccyx). The spinal canal contains the nervous system which facilitates signal relay from the brain to the rest of the body and back. Canal stenosis, narrowing of the spinal canal, results in compression of the bundle of nerve roots known as the cauda equina (so named in Latin for its horse-tail like appearance). This compression may have several causes (including intervertebral disc protrusion, accumulation of material in the intervertebral disc and/or arthritis of the facet joints). Interarcuate canal widening (between the vertebral arches) or laminectomy (widening of one or more vertebral arches) may relieve the compression. Like the surgery for Hernia Nuclei Pulposi described above, symptoms may persist or even worsen temporarily because the nerve roots have been pinched for a period of time. You may have more or less pain in your back in comparison with your symptoms before the surgery.
Follow-up treatment is the same for both types of surgery.
You will need to lie flat on your back for up to 3 hours after arriving in the Recovery Room.
And then depending on your level of pain, the ward nurse will help you out of bed. You will be assisted with mobilisation several times, and, if this goes well, you will be permitted to move around independently.
Alternate regularly between walking, sitting and lying down. Be careful not to perform frequent and/or sudden twisting or bending of your back.
Please note: sitting may cause the most pain as it is the most taxing for the back.
A drain will be inserted into the wound to remove excess fluid. This will be removed the following morning if there is not a large collection of fluid.
Before the surgery, you will be given an IV drip so that painkillers and fluid can be administered. Although the IV bag will be removed during the evening, the needle will remain in place until being removed before your discharge.
You may experience difficulty with urination. An ultrasound bladder scan will be taken to determine the amount of urine present in your bladder. At which point the decision may be made to empty the bladder using a catheter which will immediately be removed afterwards.
The radiating pain which you had in one or both legs prior to surgery will not disappear completely after the procedure (see above for surgery descriptions). Pain symptoms can persist for several weeks with varying degrees of severity. This pain can be caused by swelling of the nerve root, which had been pinched, once the compression has been relieved. As a result of the surgery, you may also experience back pain that can persist for several weeks.
If you experience severe pain, do not hesitate to request painkillers.
The day after the surgery, the physiotherapist will visit in the morning to do physical exercises with you.
Upon discharge, you will be given a referral for your own physiotherapist.
You will also be given an exercise regime to perform independently at home a few times per day.
You may remove your own wound closure strips after a week. However if you have had stitches, contact your GP to arrange for their removal after a week.
If the surgery proceded without complications and you are able to move around well, you can go home the day after the surgery. After discussions with the ward doctor and possibly the neurosurgeon and physiotherapist, you will be notified during of the day if this is possible.
Your hospital release is depends upon whether you are getting out of bed regularly and are able to climb stairs. Frequently, sitting for extended periods of time will still be difficult; you are advised to walk around or lie down instead. Approximately 6-8 weeks after being discharged, you will come for a check-up by the neurosurgeon. This appointment will be scheduled for you and you will be given a card with the relevant details as a reminder.
Patients usually return to work between 2-4 weeks after the surgery, depending naturally on their recovery. You can arrange for resumption of work in consultation with your company physician. The neurosurgeon is only able to provide advice on lower back strain. Should the company physician want information on both the surgery and the expected recovery, he or she may request this information in writing, provided that you give your consent.
The muscles in your back may be less stable after the surgery, causing tiredness in your lower back. These symptoms will improve over the course of a few weeks. However, due to the symptoms described above, we strongly recommend that you seek the guidance of a physiotherapist. Your back will require approximately 6 months to regain its full strength.
The risk of developing complications from a hernia surgery is very low but there are a number of complications that can arise from the surgery:
- Wound infection;
- Leakage of cerebrospinal (brain) fluid from the spinal canal;
- Subsequent bleeding;
- Damage to the nerve root, which can cause reduced muscle control or decreased sensitivity in the area of the nerve.
Should any of these symptoms occur, please contact the Neurology Outpatient Department from Monday-Friday between 9:00 and 12:00 hours and between 14:00 and
16:00 hours via telephone number 088 979 44 28. Outside these hours and at weekends, please call HMC Bronovo Hospital’s the Accident & Emergency department on telephone number 088 979 23 80.
Post-surgery home regime
- The physiotherapist will provide you with a webpage on herniation or stenosis in the lower back.
- You are advised to do the exercises 3 times every day.
Please contact your physiotherapist within the first week of being at home.
Avoid postures and movements which tax your back as you were instructed after the operation.
- Avoid working for extended periods in a hunched posture.
- You can resume swimming, cycling and other sports after consulting with your physiotherapist.
- It is advisable to take regular breaks when driving for extended periods during which you should leave the car and go for a walk.
- Continue to monitor your posture; also while in the car.
Should you have any questions, please contact the Neurology Outpatient Department from Monday-Friday between 9:00 and 12:00 hours and between 14:00 and
16:00 hours on telephone number 088 979 44 28.