I’ve experienced two lumbar back surgeries. At different times two of my lumbar back discs had degenerated and ruptured to the point they were causing pain and muscle weakness (couldn’t use all muscles).
My back surgery procedure is known as a laminectomy. The laminectomy with discectomy procedure decompresses the nerve by removing part of the disc. Laminectomy is the part where some bone (lamina) is removed for easy access to the disc. Discetomy is where the part of the disc causing the impingement is removed.
This page has some general information on my experience with lumbar laminectomies.
You can read more about the L5-S1 Episode and recovery, or you can read more about the L4-L5 Episode. Each was slightly different and had a different path. The one thing I can say for sure is that each back issue will be unique.
All blog Posts on Laminectomy Surgery Recovery
All of the posts for the laminectomy discetomy can be found here.
- Recovery Phases
- Background and Why
- Diagnosis and Process
- Laminectomy Surgery
- Laminectomy Surgery Recovery
Recovery seems to go through some general phases. Each surgery and recovery for me was different, but this is a general outline.
- Immediate relief (day of surgery) – The general anesthesia blocks the pain of the incision and you realize your leg/back pain is much better. There is a good chance you get relief from the decompression.
- Wound healing – Your back muscles were cut and stretched for the procedure. You will get some level of wound pain and swelling. The swelling can influence your perception of the benefits of decompression.
- Depression – This set in pretty quickly during my down period, maybe week 2. This is the hardest part and it lasted well into the physical recovery phase.
- Disc is healed – around 4-6 weeks the disc itself is healed. The healing process means a lot of muscle atrophy, scar tissue and tightness.
- Rebuilding phase – Rebuild strength, get muscle control back and learn how to reuse the muscles. The most important thing is to rebuild your core muscles.
- Re-learning how to do things like walk, pick things up, stand properly… this may induce using muscles that were lost. If you didn’t have bad weakness, this may be minor.
- Mental adjustment – starting to do new things is mentally hard. For me the fear of re-injury was huge. What can I do? Will it hurt? Did it hurt? Did I hurt myself?
- Gain muscle – gaining control of some muscles causes soreness and tightness there. Need to stretch and train the new muscles. Some muscles are “new” from starting to re-use them and some are new because the nerves are healing and re-connecting. Really, the muscles were there, but not connected and atrophied.
- Condition the muscles – I’ve got them, get some endurance.
- Gain confidence in using them.
- Metal Healing – A lot has happened from the initial injury to the challenge of the recovery. It is natural to fear a repeat injury and you will be mentally cautious. It can take a solid year to mentally trust yourself again.
- Repeat the rebuilding phase – I feel like I’ve repeated the rebuild part many, many times. Sometimes it is with simple things, other times is is hard with the full mechanics of how to walk (still working on that). Maybe I start something new in therapy, or just get better use of a muscle. Everything is linked so the process of rebuilding is cyclical.
Background and Why
I wrote a longer blog post on the what and why, but it is good to restate some of it here.
There is no smoking gun that I can point to. I don’t know how I got to the point that my disc herniated the way it did. In the past, I’ve been banged up a bit. If you look at my recovery from microfracture surgery, you will see that I’ve had a few bumps and bruises.
I think a combination of things led to my disc problems and my need for surgery. I think that I likely had degeneration of my discs for a while which is common in males over 35. That is something that happens over time, particularly to those of us who sit for long periods at a time.
Possible Contributing factors
- Sitting at my desk for long hours every day – apparently this is common among males who sit 6+ hours at a time in the 35-40 age bracket.
- Inconsistent exercise – a hard workout bracketed with lots of sitting settles out to a lot of sitting. I read that this may be worse that just sitting as you loosen up the muscles in the workout to make sitting even worse.
- Lack of core strength. I bicycle a lot and have a strong back. That enabled me to cheat through all of my core exercises without knowing it. More poor form like the muscle imbalance.
- Even with some improvements, my disc had degenerated a lot.
- Cycling – this one is hard to admit because I love it. I managed 3,000+ miles per year between surgeries, but the symptoms amplified after a big ride. Was it a cause or was it a contributor? It likely didn’t help.
I likely won’t ever know what caused it. There is a lot of research out there on recovering from disc problems which should help me in preventing more problems in the future.
Diagnosis and Process
Diagnosis will come from a medical professional and may take time. Initially, my physical therapist surmised that I had disc like symptoms. One of those symptoms is feeling like I had a tight hamstring.
These disc like symptoms should lead you to see a doctor who may confirm with an MRI.
An MRI is a fancy way to image the soft tissue of your body similar to the way an x-ray looks at your bones. You lie flat on table that slides into a tube roughly the side of your body. For those that don’t like small spaces, they can be unnerving. After what felt like 30 minutes of loud banging, you are done and they send the results to the doctor.
For me, the MRI proved that the disc was pushing on the nerve.
Once this is established, physical therapy or steroid injections are a common next step.
Epidural Steroid Injections
ESI as they are known are in injection of Cortizone into your back. The goal is to reduce the swelling. Swelling after all (along with the disc bulge) is causing the pressure on the nerve. The question is how much is from swelling. Reducing the swelling can relax the back muscles and set you up for a therapy based recovery.
The first injection helped a bit for a few days. Since there was some help, we scheduled two more.
I got some temporary help from each one. But not enough and the pain came back fast. I was also developing some foot drop in my left foot.
This is where the team preps you, the anesthesiologist puts you to sleep and the doctor works their magic. As a patient, there isn’t much for you to do.
There is an old saying that minor surgery is that which is performed on someone else. Dr. Bawa listed the normal risks; infection, bleeding, a leak in the spinal fluid and re-injuring during recovery while the disc is still weak. It is good to know your risks. It is not worth dwelling on them. A good doctor won’t have you consider surgery if it isn’t worth it.
Cerebral Spinal Fluid (CSF) Leak is a painful risk in the 1-5% category. At 5 weeks, I had some headaches which registered as some of the worst I’ve ever had. They went away and came back at 7 weeks. Instead of getting better, things got worse.
An MRI confirmed fluid around the level of the surgery and I underwent a surgical process to repair it. My repairs included sutures and a blood based patch. 3 days of bed rest and I was able to sit up without a headache.
These fixes have a good history of working which is good because it is an additional surgery with bed rest. Best rest is mentally miserable and you need to physically rehabilitate your whole body.
There are some moments for you to sit around and wait. That is hard if you like to worry. Once you get through the paperwork and wheeled in, you only have a few moments for your are out.
Initial Surgery Report
Once you wake up, the surgeon will let you and who ever is there with you know what they saw. There may be some variability. It is good information to know.
Laminectomy Surgery Recovery
Recover is about managing pain, not stressing the wound and trying to walk.
The Hard Part of Surgery Recovery
Pain comes in as a second place for the hard part of the surgery recovery. First is mental. When things go well, you mentally feel great, but you may still only be at a fraction of your former abilities. On bad days, you are very far behind. There have been many days where I felt like I was fighting a losing battle, and wondered why I should continue. I have no answers about that. The whole process takes time and it is hard.
Pain can vary. Don’t get behind the pain, or try to stay ahead of the pain. This means to take your pain medication on time. As you get better, you can try to reduce it or get onto milder medications. If you get behind it, you can be in a lot of pain. Rest helps healing and healing reduces the pain.
Numbness may come and go. There is pressure from the swelling that can cause numbness. Expect it to come and go a bit over time.
Sleeping may only come in small doses. Rolling may wake you, pain may wake you or any number of things. Just let it come. It can be painful to get in an out of bed. You will see an improvement every day.
The hardest part of sleeping the first few nights was from the pain meds and the associated crazy dreams.