The first six weeks is the immediate recovery phase. Your incision heals within the first two weeks. You are also recovering from the affects of surgery. You will be fatigued. It is like the fatigue felt the day after running a marathon and may last from one day to 2 weeks. Pain medication is used and can be fatiguing by itself. Constipation occurs from these medications and use of tricks for regular bowel movements is important. You learn how to handle yourself in small maneuvers such as getting into and out of bed and how to take a shower comfortably.
Driving can be started as soon as the 3 point test is passed (see section on when to start driving).
Walking is the cornerstone exercise during the first six to promote healing and is encouraged. Walking short distances and repeating laps in the beginning is a preferable. If you walk away from your home soon after surgery let’s say ½ mile and then are too fatigued to walk the ½ mile return, this creates a dilemma. I use to encourage walking as much as tolerated but when one patient walked 8 miles the day upon discharge from the hospital; I had to revise my advice to use more common sense and moderation
Self-regulated exercise during the first 6 weeks is helpful to speed recovery. You can get on a stationary bike as long as it is mostly upright (you don’t want to be on a trainer bent too forward so move the handlebar to the upright position). You can get on a treadmill to walk or even an elliptical as long as your arms are stationary
After having a microdiscectomy or decompression lumbar surgery, understanding of the symptoms that may be residual after the surgery is important. The three main symptoms that can remain are numbness, weakness and pain.
The nerve or nerves have been decompressed and recovery starts immediately. Pain should be reduced significantly. An interesting phenomena that some patients complain about is “new” reported onset of “numbness” in the area where the pain is now gone.
Numbness as reported by patients is not really numbness by definition. Numbness is a decreased sensation of the skin. A check of skin sensation is typically intact and normal in the area of reported numbness. What this complaint most likely stems from is really altered proprioception. Proprioception is the important sensation of position sense of your body in space. When you close your eyes, you automatically know where your right leg is. This is not magic but a series of sensors in your bone, tendon, muscle and ligament that respond to stretch and weight that tell your brain where your body is positioned.
If the nerve that conveys this sensation is not compressed and functioning properly, bizarre altered sensations occur such as “pins and needles” or a hot or cold sensation on the skin occur. Before surgery, the pain covers up these feelings and only after surgery when the pain is resolved do these sensations come to the attention of the patient.
If there was weakness of any muscle group, this weakness may take time to recover. Most of the time, within 6 months, the weakness will significantly improve but there are instances when the weakness can be permanent.
Recovery is based upon allowing the nerve to heal, the surgical incision to recover and the disc to accommodate to the biomechanics of the new situation. Motion of the back or the leg actually stretches the nerve which is both a positive and a negative. Motion prevents scar formation which can bind the nerve down. Motion however also stretches a healing nerve which is swollen which can contribute to further swelling. There is a happy medium or balance where nerve recovery is helped by motion but too much motion can inflame the nerve.
This is where a good physical therapist comes into play. Although occasionally even a great therapist can cause a freshly decompressed nerve root to become irritated. The physical therapist will advance your activities with each visit and council you as to activities that can be added and those that need to be curtailed. In addition, ergonomics (body position and techniques of lifting) will be drilled into your head (I hope). You hopefully will repeat the mantra “no BLT- no BLT- no BLT (no bending, twisting and lifting at the same time)!
For incision care, please see that specific section in this web site.
For being capable of driving, see that specific section in this web site.