I. Post-operative care
1.Day 1 (the day after surgery)
Return to the room after surgery: When returning to the ward after surgery, the patient should be carried to the hospital bed and not get off the floor. Do not get out of bed on the same day, and can leave bed under the protection of lumbar brace on the next day. Except for basic living needs, bed rest should be the main focus during hospitalization.
Postoperative position and monitoring: 4-6 hours in the flat position, monitor vital signs, keep the stability of the spine when turning, prevent spinal torsion, may take the method of lying flat on the left 45° and 45° on the right, turn for the first time in 2 hours, observe whether there is any abnormality in sensation, movement and diaphoresis of both lower limbs. If the patient moves too much in the lumbar region after surgery, it is easy to make the operating area bleed. Spinal endoscopic surgery usually only closes one or two stitches and does not leave a drainage tube, and the hematoma accumulates in the spinal canal easily leading to nerve compression and nerve adhesions.
Postoperative pain: Most patients may feel a certain degree of soreness and swelling in the lumbar region on the day of surgery, which is significantly relieved the next day. Non-steroidal anti-inflammatory and analgesic drugs can be given the same night.
Postoperative medication: antibiotics need to be continued for 3-5 days after surgery. Postoperative adjunctive neurotrophic drugs as well as appropriate anti-inflammatory and analgesic drugs and dehydrating drugs are generally required. Generally apply cephalosporin antibiotics, allergic patients can use other classes of antibiotics.
2.Postoperative day 2-3
On the 2nd postoperative day, after there is no obvious pain in the back, start various exercises in bed, which should follow the principle of gradual progress as well as the combination of safety and self-capacity. The main purpose is to avoid postoperative nerve adhesions by straightening the leg and foot elevation and pulling the sciatic nerve under the resting state of the lumbar spine.
The time to start rehabilitation exercises varies from person to person. If there is no pain after the exercise, the exercise can be started from the second day. Otherwise, the start of exercise is delayed later.
Straight leg raising exercises are performed and the patient is encouraged to get out of bed as soon as possible (under the protection of a lumbar brace). The initial straight leg raising exercise starts at 30° and gradually increases the amplitude of the leg raising and the isometric contraction of the quadriceps, twice a day.
Diet should be light, soupy and nutritious. Avoid greasy and fried food.
3.Day 4-6
Strengthen the above exercises, increase the time to get out of bed, consolidate the effect of exercises and increase the confidence of recovery.
Eat a clear diet with high protein content and vitamin foods, such as lean meat, eggs and dairy products.
4.Day 7-14
Start lumbar back muscle exercise to improve the strength of the lumbar back muscle and enhance spinal stability.
Rehabilitation exercise starts with supine exercise method. Start with 5-point exercise method with head, both elbows, both feet on the bed and hips off the bed. To begin, the knee can be flexed and a relatively small amount of exercise and hip elevation to leave the bed is sufficient. Note: Hold for 1 minute. Three sets of 20 reps per day are appropriate. Gradually increase the intensity in patients whose pain does not increase during and after exercise. Otherwise cancel, or do not increase. Increase by gradually straightening the knee and elevating the hips, or by changing to the 3-point position, which is performed with the head and feet on the bed. There is another way to exercise in supine position, which is the method of empty pedaling bicycle, as long as it is not painful. 200 times a day.
Prone exercise method, the most common “small swallow fly” exercise method. Start with the chest or lower limbs out of bed can be. 3 sets of 20 reps per day. Increase the intensity of the method: raise the height of the chest or lower limbs off the bed, or chest and lower limbs off the bed at the same time.
The next step is the method of getting off the floor to exercise. This can be slow walking, brisk walking, jogging, etc., all to the extent that it is not painful.
The stitches are usually removed two weeks after surgery. Some patients may not be stitched up, i.e., no stitches need to be removed.
5.After the 14th day
The post-operative recovery process varies from person to person. After spinal endoscopic disc surgery, bed rest is generally recommended for 4-6 weeks for rehabilitation. Some patients can go to work, swim, etc. 2 weeks after surgery. Some patients are not able to complete these movements until 3 months. Therefore, the symptom relief or recovery after spinal endoscopic lumbar disc herniation varies from person to person, and the rehabilitation process also varies from person to person.
Second, the correct treatment of the recurrent period after spinal endoscopy (recovery period or edema period)
On the third day after surgery, the so-called “postoperative reaction” will begin to appear, which is characterized by the reappearance or even aggravation of preoperative symptoms, as well as the appearance of new symptoms, such as numbness, pain, soreness and weakness. The duration can be very short or very long, ranging from a few days to 3 months or even longer, and about 30% of patients will have various symptoms in the “recurrent period” after surgery.
Clinical manifestations of the recurrent period after spinal endoscopy
The symptoms of the recurrent period after spinal endoscopy are diverse, but generally manifest as: low back pain, hip pain, numbness, swelling, or soreness at the incision site, etc. There are also a few symptoms on the opposite side, most of which appear or are obvious when standing or sitting, and most of which can be relieved by themselves. If bed rest does not provide relief or if symptoms continue to worsen progressively, the MRI should be reviewed to see if endplate inflammation is present, at which point the treatment plan should be changed and the treatment period will be extended. It is important to communicate to patients undergoing spinal endoscopy that the “recurrent phase” is not a relapse or a poor outcome, but that these can recover on their own.
The significance of routine medication after spinal endoscopy
The purpose of medication and rehabilitation within 3 months after surgery is to reduce or shorten the recurrent period, but there is no way to make all patients free from the “recurrent period”.
E. There is no need to rush to do imaging monitoring after spinal endoscopy
The symptoms improve first after spinal endoscopic surgery, and then the imaging changes such as MRI and CT are seen, which is known as the “imaging change lag. Imaging changes are usually seen after six months and are influenced by age, length of medical history, whether other excessive treatment has been received, degree of prominence, and severity of the disease.
VI. Contraindications after spinal endoscopy
The implementation of the following measures will help the patient’s recovery, which may be delayed if the patient does not follow medical advice
1, no alcohol, no overwork, and preferably no “hairy” food, such as mutton and seafood, for 3 months after surgery.
2, within six months, do not engage in long-term bending or prolonged squatting work or activities, such as long meetings, grass pulling, etc..
3, do not lie in bed for a long time during the day after surgery, preferably for no more than 10 hours continuously, otherwise the symptoms will be relieved slowly.
4, within six months shall not play computer games for a long time, surf the Internet or play cards for a long time.
Seven, the spinal endoscopy patient’s clothing, food, housing and transportation
1, clothing: dress to be comfortable.
2, food: dietary attention: to strengthen nutrition, to not increase weight limit. Many patients have increased their weight in the process of recuperating from illness, which is wrong. Excess weight will increase the clinical symptoms of the lower back.
3, live: bed to hard board bed is good, spring bed, soft Simmons are not the choice of patients with disc herniation. It is not advisable to sit on a small bench, should not be strong bending, such as long squatting action. Use a sitting commode, not a squatting commode. Wear a long posterior support of the peri-waist, the time to at least 3 months is appropriate.
4, line: lumbar disc herniation treatment to rehabilitation, relying on a minimally invasive surgery to achieve a permanent cure and no recurrence, is unattainable. Self-maintenance and rehabilitation of lumbar intervertebral disc disease is very important. As the saying goes: three points of treatment, seven points of maintenance is the truth. The line should be appropriate and moderate!
5, sex: sexual life: to not produce and increase clinical symptoms as a limit.
Eight, the follow-up of patients after spinal endoscopy
1, 3 months after surgery should be maintained with your treating physician in order to guide the medication and rehabilitation exercises.
2.Medication: neurotrophic drugs, blood-activating drugs, anti-inflammatory and analgesic drugs are recommended for 3 months after surgery to facilitate the smooth passage of the “recurrent period”.
3.Regular follow-up: After surgery, you should come back for follow-up in the third month, six months and one year. The content of the follow-up visit includes inquiry, physical examination, imaging examination, etc. The content of each visit varies, and is specific to each patient’s situation.
4.After the surgery, the patient should not be absolutely bedridden without any exercise, otherwise the postoperative effect will be poor.
5.Post-operative rehabilitation training should be carried out gradually and according to medical advice, and if conditions permit it should be transferred to rehabilitation department or rehabilitation hospital. As an exercise program, but it should be moderate.
IX. Functional exercise after discharge from hospital after surgery
1.The purpose of functional exercise
Through exercise, the lumbar back muscles are strengthened and flexibility is enhanced, which can protect the ligaments, joints and intervertebral discs of the lumbar spine. This is like the principle of the cable-stayed bridge, whose load-bearing is not the cement and steel plates of the bridge, but the main force-bearing part is the steel wire on the bridge. This wire is like the lumbar muscles on both sides of the lumbar vertebrae, the lumbar muscles mainly exercise the lumbar back muscles, can make it strengthen and sensitive, when the lumbar vertebrae most need protection immediately.
Through the process of lumbar back muscle exercise, the sciatic nerve can be stretched, extended and stretched. Whether conservative treatment or surgical treatment, it is necessary to do the sciatic nerve stretching exercise.
2, functional exercise methods are as follows
Deep squat training. Feet such as shoulder width, as far as possible, as horse stance, the difference is, than the horse stance but also deep squat down until the thighs against the calf belly, at the same time, must be straight back, feel the back muscles are very tight, is the so-called “pull back”. Then repeat several times.
Straighten the affected leg and lift it up, you can rest it on a higher bar or similar object. This will stretch the nerve directly.
Crawling. Straighten your legs, do not bend your knees, and then crawl with your hands on the ground, both to stretch the nerves and exercise the low back muscles.
Little swallow fly. Lie on the bed, abdomen on the bed, hands and feet as far as possible to both ends of the stretch, while cocked upward, at this time feel the low back muscle is very tight, feel the lumbar vertebrae want to be two people pulled in the opposite direction. This method also both strains the nerves and exercises the lumbar back muscles.
It takes at least 3 weeks for the lumbar disc annulus fibrosus to heal. It is recommended to wait for the disc annulus fibrosus to heal initially and then begin rehabilitation exercises with a greater amount of movement.
X. Tips for spinal endoscopic surgery patients
If a recurrence is caused by a variety of factors such as poor rehabilitation or improper force, the patient can undergo a second minimally invasive surgery because minimally invasive surgery, unlike open surgery, leaves a lot of scarring that can prevent a second surgery or make a second surgery more difficult. The second minimally invasive surgery will be as smooth as the first minimally invasive surgery.