Microsoft word - lumbar laminectomy.docx
Lumbar Laminectomy (Decompression)
DO NOT TAKE ANY ASPIRIN PRODUCTS OR NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (ie NSAIDs, Advil, Celebrex, Ibuprofen, Motrin, Naprosyn, Aleve, etc) FOR 2 WEEKS BEFORE SURGERY. These medications can increase bleeding during surgery. If you absolutely need to be on these medications until the date of surgery, check with Dr. Park.
Your problem spine
You have spinal stenosis, a condition in which the spinal nerve roots are compressed by
degenerated (“worn out”) portions of the lumbar spine. The compression of the nerve
roots can cause symptoms such as pain, numbness, tingling or weakness of the buttocks
and legs. Your surgery
Your surgery is done to treat spinal stenosis. During this procedure, Dr. Park will remove
the portions of the lumbar spine that are causing the compression. The entire spine is not
removed – only the areas compressing the nerve roots are removed. The decompression
helps to free up space for the nerve roots.
The goal of the operation is to help improve the buttock and/or leg pain. Low back pain
may or may not improve after surgery. Incision
An incision will be made down the middle of you lower back in order to access your
spine. The size of the incision depends on many factors including the number of levels
requiring decompression and your body weight. There will generally not be any stitches
There may be a small plastic drain that comes out near the wound. Its purpose is to keep
blood clots from pooling in the wound. Usually, Dr. Park’s team will remove the drain on
day 1-2 after surgery, but it may be pulled out earlier or later depending on how much
comes out of it. If the surgery is 1 level decompression, a drain usually is not needed. Recovery
As you prepare yourself mentally to undergo spinal surgery, you also need to prepare
yourself for the recovery period that will follow your operation. While the surgery entails
work on the part of the surgeon, after that, the brunt of the work is in your hands. To
ensure a smooth and healthy recovery, it is important that, as a patient, you closely follow
the set of instructions that Dr. Park gives you.
Your Hospital Stay
After the operation, you will be brought to the recovery room for observation. When you
wake up from the anesthesia, you may be slightly disoriented, and not know where you
are. The nurses and doctors around you will tell you where you are, and remind you that
you have undergone surgery. As the effects of the anesthesia wear off, you will feel very tired, and, at this point, will be encouraged to rest.
Members of your surgical team may ask you to respond to some simple commands, such as "Wiggle your fingers and toes" and "Take deep breaths." When you awaken, you will be lying on your back, which may seem surprising, if you have had surgery through an incision in the back; however, lying on your back is not harmful to the surgical area.
When you have satisfactorily awakened from anesthesia (usually about 2 hours later), you will then go to your hospital room. There, your family and friends will be able to see you. If the plan is for you to go home the same day, your family and friends will come and see you in the anesthesia recovery unit.
Proper nutrition is an important factor in your recovery. Initially, you will only be given
ice chips to eat. This is because it is common for your GI tract not to function normally
immediately after surgery. Once you can tolerate ice chips, typically you will be given
clear liquids. If you are able to keep the liquids done without feeling sick, you are then
progressed to more normal food. Physical Therapy
If you go home the same day of surgery, you will not need physical therapy. However,
you should walk as much as you can within reason when you get home. Walking is extremely
important to your overall recovery from surgery for a number of reasons.
Getting out of bed is good for your lungs; it prevents blood clots form forming in your
legs, and speeds your recovery.
If you are admitted to the hospital for observation, it is typically because more than 1
level of decompression took place. In this case, you will participate in physical therapy as
early as the first day after surgery. This is extremely
important to your overall recovery
from surgery for a number of reasons. Getting out of bed is good for your lungs; it
prevents blood clots form forming in your legs, and speeds your recovery.
The only physical therapy you should do is walking. No strengthening or stretching is
necessary – these may actually be harmful unless prescribed to you later at an appropriate
time by Dr. Park. Some people will need to use a walker during their initial recovery
period, others may not. Pain Medications
If you are admitted to the hospital, you will be given a PCA pump for pain control after
surgery. The PCA is a machine that allows you to push a button to receive pain
medication (usually morphine) when you feel pain. You can push the button as often as
you wish – it is rare to overdose because the machine limits the amount of medication
you get every hour. Use the machine to make yourself feel comfortable.
However, because using the PCA for long periods of time can have side effects, it is best
to switch to oral pain medicine as soon as possible, usually the day after surgery. Dr. Park
will do this for you in the hospital at the appropriate time.
Pills are advantageous in that they provide a more constant level of pain control. You will
be given several prescriptions for pain pills to take home after surgery. Going home
Your length of stay in the hospital depends on many factors, including your general
medical condition and the severity of your spine problem. Most patients who have a one
level decompression can go home the same day. If more levels need decompression, your
hospital stay may be longer.
You can go home when:
1) you are taking oral pain pills 2) you can eat and drink enough to sustain yourself (Don't worry – most people
will not feel like eating and drinking too much after surgery, and that is OK
3) you are able to get out of bed and walk around. Having a bowel movement is
not necessary before going home.
Some patients may need to go to a rehabilitation facility first before going home. There
they Wound Care
When you are discharged from the hospital, there are a few things to remember about
your surgical wound.
1. keep your incision clean and dry 2. there are no stitches to remove, unless you have been told otherwise. Special
“glue” was used to seal the wound, and all of the stitches are “inside”
3. if the wound is dry, no further dressings are needed and the incision can be left
open to air. If there is some drainage, the wound can be covered with a clean dressing as needed
4. you may shower on day 5 after surgery if there is no drainage from the wound 5. do not soak the wound in a bathtub or pool 6. gently clean your wound- do not scrub it vigorously until it is completely healed 7. do not put any ointment or antibacterial solutions over the incision 8. if you notice any drainage, redness, swelling, or increased pian at the incision, call
Walking is the best activity. Walk as much as you like. It is good for you and will help
you recover more quickly. Avoid the BLTs: bending, lifting, twisting of your lower back.
However, you may exercise your arms and legs with light weights if you desire as soon
as you feel it-as long as those activities do not cause you to perform BLTs on your lower
back. Do not try to do too much too early. Use your common sense.
You have been given prescriptions for three medications.
1. percocet (oxycodone/acetaminophen) for severe pain 2. lortab (hydrocodone/acetaminophen) for moderate to severe pain 3. ultram for mild to moderate pain
Try to take the appropriate medication for the level of pain you are having. Pain
medications are helpful around the time of surgery, but they can cause problems if taken
for too long. The goal is to try to get you off of the medications by 4-6 weeks or
earlier, if possible.
Some people may need medications for longer than 4-6 weeks, and
If you find that your pain is really mild, try taking plain extra strength Tylenol instead.
You may want to take over the counter pericolace or milk of magnesia to keep your
bowels regular. You may find the pain medication, constipating. Do not take any non-
steroidal anti-inflammatory drugs (ie, NSAIDS, advil, celebrex, ibuprofen, motrin,
naprosyn, etc) or aspirin products for 4 months after surgery. These medicines can
prevent proper healing of the fusion. If you have any questions about whether you can
take a medication or not, call the office. Diet
Eat whatever you like. You may not feel like eating too much for a few days, and that’s
ok. Food high in fiber (fruits and vegetables) are good in that they can help reduce
constipation. Drink plenty of fluids. Follow up
Call Dr. Park’s staff at (248) 663-1900 within the first few days after you get home. Tell
her that you had surgery and need six week follow up appointment. Questions
Feel free to call Dr. Park’s office with any questions (248) 663-1900. If you are having an
emergency, call (248) 663-1900. Tell the operator it is an emergency. During business
hours, you will be connected to Dr. Park’s staff who reports emergencies to Dr. Park.
After business hours, you will be connected to the surgeon on call who can help you or
contact Dr. Park if necessary. Things to be aware of
If any signs of infection are observed while changing the dressing, call your doctor.
These signs include
Fever - a body temperature greater than 101°F (38°C)
Redness or warmth around the incision(s)
In addition, call Dr. Park’s office if you experience chills, nausea/vomiting, or suffer any type of trauma (e.g., a fall, automobile accident).
The Israeli Journal of Aquaculture – Bamidgeh 61(1), 2009, 5-26. Full article available to e-journal subscribers Spawning Induction in the Carp: Past Experience and Future Prospects - A Review Z. Yaron1*, A. Bogomolnaya1, S. Drori1, I. Biton2, J. Aizen3, Z. Kulikovsky2 and B. Levavi-Sivan3 1 Department of Zoology, Tel Aviv University, Tel Aviv 69978, Israel 2 Gan Shmuel Fish
TÉRMINOS Y DEFINICIONES Los siguientes términos tendrán los significados que se indican a continuación para cada uno de ellos, siendo tales significados igualmente aplicables para la forma singular y para la forma plural: “Activos Tangibles Consolidados” significa la totalidad de los activos consolidados del Emisor menos activos intangibles, tales como el exceso del costo sobre el val