After Lumbar Decompression or Endoscopic Surgery

The big picture

A decompression removes the disc fragment, bone, or thickened ligament that was pressing on a nerve. No bones are fused, so there is nothing that has to "set." Your job in the first six weeks is simple: walk a lot, protect the healing incision, avoid bending and lifting, and let the nerve calm down. Most people are up and walking the day of surgery, home the same day or the next morning, and back to light work within one to three weeks.

The first few days

• Walk. Start with 5 minutes, 6 to 8 times a day, and add a little each day. Walking is the best medicine for your back, your lungs, your bowels, and your mood.
• Do not sit for more than 30 to 45 minutes at a stretch. Get up, walk, then sit again.
• Lie down when you are tired. Any position that is comfortable is fine. A pillow between the knees on your side, or under the knees on your back, helps.
• Keep the incision dry for the first two days. After that you may shower, letting water run over the dressing or the closed incision; pat it dry. No baths, pools, or hot tubs for at least four weeks, and not until the incision is fully sealed.
• Leave the clear glue or paper strips over the incision alone. They fall off on their own in one to two weeks. Do not put ointments or creams on the incision.

Pain and medicine

Expect soreness at the incision and some back muscle ache. The leg pain is usually much better right away, though it can flicker for a few weeks as the nerve recovers. Numbness and tingling often take weeks to months to fade and were the last symptoms to appear, so they are the last to leave.

• Acetaminophen (Tylenol) on a schedule, up to 3,000 mg a day unless told otherwise, is your base.
• Anti-inflammatories (ibuprofen, naproxen) are allowed after a decompression alone once I say so, usually right away, with food.
• An opioid is for breakthrough pain only, in the first days. Take it less each day and stop when you can. Do not drive while taking it.
• A muscle relaxant can help the back spasm in the first week.
• Constipation: start a stool softener on day one while taking opioids, drink fluids, and walk. If no bowel movement by day three, add a gentle laxative such as polyethylene glycol (MiraLAX).
• Nerve pain that returns a few days after surgery, often as a burning leg pain, is usually irritation from the nerve settling, not a new herniation. Call us; a short course of oral steroid or a nerve-calming medicine often settles it.

Activity and restrictions

For the first two to four weeks: no bending at the waist past what you need to brush your teeth, no lifting more than 10 pounds (a gallon of milk), and no twisting. Hinge at the hips and knees to pick things up. Climbing stairs is fine. No brace is needed.

• Driving: when you are off opioid medicine and can turn and brake comfortably, often 7 to 14 days.
• Desk work: usually 1 to 2 weeks. Physical work: usually 4 to 6 weeks, in stages.
• Sex: when comfortable, with positions that keep your back neutral.
• Exercise: walking from day one. A stationary bike and gentle core work at about four weeks. Running, impact, and heavy lifting after six weeks, once I have seen you. Physical therapy is often started around week four to rebuild the core and teach you how to move.

After endoscopic surgery

The incision is about a centimeter, and most people need little or no opioid medicine. The rules above still apply: the disc and the nerve need the same time to heal no matter how small the opening. Many people feel so well that they overdo it in week two. Please do not. The most common cause of a recurrent disc herniation is bending and lifting too early.

Your follow-up

• A photo of the incision sent to the office at 2 weeks, or a wound check visit if you have stitches to remove.
• A visit with me at about 4 to 6 weeks. No X-rays are needed after a decompression alone.
• Physical therapy if needed, usually starting after that visit.

Call the office the same day for

• Redness that is spreading, drainage from the incision, or the edges of the incision opening.
• Fever over 101.5°F.
• Clear fluid leaking from the incision, or a headache that is much worse when you sit or stand up and better lying flat.
• Leg pain that is getting worse instead of better after the first week.
• Calf pain or swelling in one leg, which can mean a blood clot.

Call 911 or go to an emergency room for

• New trouble controlling your bladder or bowels, or numbness in the groin or inner thighs.
• New or rapidly worsening leg weakness.
• Chest pain or sudden shortness of breath.

Learn more

OrthoInfo, Herniated Disk in the Lower Back: orthoinfo.aaos.org (opens in a new tab)

My guide to spine emergency warning signs lists the symptoms that should never wait.

This playbook is general guidance for Dr. Wey's patients. Your own discharge instructions come first. If anything here does not match what you were told, what you were told wins: please ask us.