LOW BACK PAIN

SURGERY
Presented by:

Jill Diane C. Balena

Jilly M. Baloncio

BSN-3B
LOW BACK PAIN ( LBP)
 The lower back—where most back pain occurs—includes the
five vertebrae ( L1-L5) in the lumbar region, which supports
much of the weight of the upper body.

 The lumbar spine, or low back, is a remarkably well-

engineered structure of interconnecting bones, joints, nerves,
ligaments, and muscles all working together to provide
support, strength, and flexibility.

 LBP is usually due to repeated stress on the lumbar spine

over many years (“degeneration”), although an acute injury
may cause the initiation of pain.
Causes of Low Back Pain
Strains
The muscles and ligaments in the back can stretch or tear due to
excess activity.

Disc injury
The discs in the back are prone to injury. This risk increases with
age. The outside of the disc can tear or herniate.
A herniated disc, which is also known as a slipped or ruptured
disc, occurs when the cartilage surrounding the disc pushes
against the spinal cord or nerve roots. The cushion that sits
between the spinal vertebrae extends outside its normal position.
Sciatica
Sciatica can occur with a herniated disc if the disc presses on the
sciatic nerve. The sciatic nerve connects the spine to the legs. As a
result, sciatica can cause pain in the legs and feet. This pain usually
feels like burning, or pins and needles.

Spinal stenosis
Spinal stenosis is when the spinal column narrows, putting pressure
on the spinal cord and spinal nerves.
OW BACK PAIN SURGERIES
DISCECTOMY: relieves pressure from a nerve root pressed on
by a bulging disc or bone spur. The surgeon will remove a small
piece of the lamina, a bony part of the spinal canal.

FORAMINOTOMY: a surgical procedure that opens up the

foramen, the bony hole in the spinal canal where the nerve root
exits.

Intradiscal Electrothermal Therapy (IDET) involves

inserting a needle through a catheter into the disc and heating it up
for 20 minutes. This makes the disc wall thicker and cuts down on
the inner disc’s bulging and irritation of the nerve.
NUCLEOPLASTY: uses a wand-like device inserted through a
needle into the disc. It can then remove inner disc material. The
device then uses radio waves to heat and shrink the tissue.

RADIOFREQUENCY LESIONING OR ABLATION: is a way to

use radio waves to interrupt the way the nerves communicate with
each other. A surgeon inserts a special needle into the nerves and
heats it, which destroys the nerves.

SPINAL INFUSION: makes the spine stronger and cuts down on

painful motion. The procedure removes discs between two or more
of the vertebrae. The surgeon then fuses the vertebrae next to each
other with bone grafts or special metal screws.
SPINAL LAMINECTOMY: also known as spinal
decompression, removes the lamina to make the size of the spinal
canal bigger. This relieves pressure on the spinal cord and nerves.
 SURGICAL
PREPARATION
 Pre-Operative
NURSING MANAGEMENT
HISTORY AND PHYSICAL EXAMINAT
1. General observation of the patient
2. Back examination
3. Neurologic Testing :
- reflexes
- sensory impairment
- straight-leg raising
- muscle strength
- muscle atrophy
ERATIVE ASSESSMENT CONSIDER
Preoperative Checkup
- Depending on your age and general medical fitness, surgeon may
ask to have a checkup by family doctor and any other doctor that
seeing regularly, such as a cardiologist (heart doctor).

Smoking
- should quit several months before surgery
- Nicotine users : at greater risk for serious complications after
surgery, including wound infections and a delay in the bone
healing needed for successful fusion surgeries.
- inform your surgeon about nicotine usage in advance of
procedure so that, together, patient can determine a plan to quit
Medications
- Some medications can affect the surgery by causing bleeding or
interfering with anesthesia (aspirin and other nonsteroidal anti-
inflammatory drugs (NSAIDs), such as ibuprofen and naproxen)
- Certain over-the-counter dietary supplements and herbal
remedies can also interfere with surgery.

- The surgeon will tell which supplements and medications should

be stop taking in preparation for the procedure.

Donating Blood
- It is not usually necessary to donate blood for low back surgery.
However, there is always a chance that some blood loss will occur
during the procedure. The surgeon will talk with about the
advantages and disadvantages of donating the patient’s own blood
versus using
FORMED CONSENT
- The surgeon will explain the procedure and make sure patient
understood its risks and advantages. Nurse serves as a witness as
surgeon explains and patients signs the consent

Content of the INFORMED CONSENT:

 Patient’s full name
 Surgeon’s name and signature
 Specific procedure
 The witness name and signature
 Date of signature
someone else's blood. If patient decide to donate his/her own blood,
the surgeon may prescribe an iron supplement to help build up
blood before surgery.

Previous Surgery
- Patient should tell the asked about any past or current health
issues and about any previous surgeries he/she have had. In
addition, let the anesthesiologist know if the or anyone in the
family has had problems with anesthesia in the past.

BEFORE THE OPERATION:

-Patients are usually admitted to the hospital on the day of
surgery.
- After admission, the patient will be taken to the preoperative
preparation area where the patient will be interviewed by a
doctor from the anesthesia department. The anesthesiologist
will review the medical history and physical examination
reports.

- Together, the patient and anesthesiologist will determine the

type of anesthesia to be use.
 Intraoperative
OSITIONING
- Patient is in a prone- position which will be returned to the
supine position gradually and slowly once surgery is over.

NESTHESIA
The most common types of anesthesia used for low back surgery
are:

- General (you are asleep for the entire operation)

- Spinal (you may be awake, but you will have no feeling from
the waist down)
he PROCEDURE:
- Low back surgery usually takes from 1 to 3 hours, depending
upon the procedure.
- When surgery is over, patient is moved to the recovery room,
where for observation and monitoring until patient is awaken
from the anesthesia.
- An intravenous (IV) line inserted into a vein in the arm.
- May also have a catheter inserted into the bladder to make
urination easier.
- When you are fully awake and alert, you will be taken to your
hospital room.
 Postoperative
NURSING MANAGEMENT
The recovery period after low back surgery depends on a number
of factors, including patient’s condition before surgery, the
extensiveness of the surgery, and the surgeon’s skills and
experience.

Physical Therapy:
- Typically prescribed to rebuild strength, range of motion, and
encourage healing.
TOPERATIVE INTRUCTIONS:
Movement Limitations
- The spine must be kept in proper alignment. Teach patient how to
move properly, reposition, sit, stand, and walk.
- While in bed, patient should be taught to turn frequently using a
"log rolling" technique. This maneuver allows patient’s entire
body to move as a unit, avoiding twisting of the spine.

- Patient may be discharged from the hospital with a back brace or

cast. The family will be taught how to provide care at home.

Medications
- Monitor and instruct patient to take medications as prescribed to
ease pain and muscle spasms after surgery.
Hygiene and Wound care
- To promote comfort and prevent infection especially on the surgical
site.
LABORATORY
TEST
PERFOMED
BEFORE
SURGERY
> X-ray:
- Shows the alignment of the bones and whether there is arthritis or broken
bones. These images won’t show problems with the spinal cord, muscles,
nerves or disks.
> MRI or CT scans:
- These scans generate images that can reveal herniated dirks or problems with
bones, muscles, tissues, tendons, nerves, ligaments and blood vessels.

> Blood tests:

- These can help determine whether you have an infection or other condition
that might be causing your pain.
> Bone scan:
-In rare cases, doctor might use a bone scan to look for bone tumors or
compression fractures caused by osteoporosis.
> Nerve Studies:
- Electromyography (EMG) measures the electrical impulses produced by the
nerves and the responses of muscles. This test can confirm nerve compression
caused by herniated disks or narrowing of spinal canal (spinal stenosis).
 SURGICAL
INSTRUMENTS
NEEDED
> Forceps > Calipers and Gauges

> Gouges, Osteotomes, and > Curettes

Rongeurs
> Dissectors and Probes
> Hooks
> Elevators and Spreaders
> Instrument Handles
> Knives

> Needle Holders

> Retractors, hand-held and self-

retaining

> Scissors

> Suction Tubes

 PAIN
MANAGEMENT
Limit bed rest; keep knees flexed to decrease strain
on the back

 Nonpharmacological approaches:
- distraction
- relaxation
- imagery
- thermal intervention (eg. Ice or heat)
- stress reduction

 Pharmacological approaches:
- nonsteroidal anti-inflammatory drugs
- analgesics
- muscle relaxants
 POSSIBLE
COMPLICATIONS:
 Reaction to anesthesia or other drugs
 Bleeding
 Infection
 Blood clots
Heart attack
 Stroke
 Herniated disk
Nerve damage, which can lead to weakness,
paralysis, pain, sexual dysfunction, or loss of
bowel or bladder control
DISCHARGE
PLANNING
 Low back surgery recovery can depends to many factors. Other
surgery can recover for just weeks and others takes months.
Health teaching to patient is important for faster recovery and
prevent patient from infection. Teach patient as follows:

Wound Care:
- The bandages ( or tape ) may fall within 7 to 10 days. If not,
teach that he/she can remove it on your own if surgeon says its
okay.
- To check wound everyday to see if it:
> is more red, swollen, or draining extra fluid
> feels warm
> begins to open up
- To check with surgeon if patient can shower again. The
surgeon may instruct the following:
> make sure the bathroom is safe
> keep the incision dry for the first 5 to 7 days
> for the first time of shower, ask for someone‘s help
> cover incision with incision wrap
> DO NOT allow water from the shower head to spray the
incision.

- DO NOT SMOKE OR USE TOBACCO RPODUCTS : slows

the healing process
Activity:
- Try not to sit for longer that 20 to 30 minutes at one time.

- Sleep in any position that does not cause back pain

- Patient may be fitted with a back brace or corset to help support

back:
> Wear the brace when sitting or walking
> Need not to wear it when sitting on the side of the bed for a
short time or to use bathroom

- Do not bend waist, instead bend knees and squat down to pick up
something

- DO NOT lift or carry anything heavier that around 10 pounds or

4.5 kilograms.
- The surgeon may prescribe physical therapy to learn how to move
and do activities in a way that prevents pain and keeps the back in
a safe position. These may include the following:
> Get out of bed or up from chair safely
> Get dressed and undressed
> Keep the back safe during other activities, including during
lifting and carrying items
> Do exercises that strengthens back muscles to keep the back
stable and safe
hen to call the DOCTOR
- If the following is present, call for immediate help from the
doctor:
 Chills or a fever of 38.3 degree Celsius
 More pain in the incision area
 Drainage from the wound, or the drainage is green or yellow
 Loose feeling or have a change in feeling in the legs and feet
 Chest pain, shortness of breath
 Swelling
 Calf Pain
 If back pain worsens and is not relieved by rest and medications
 Difficulty urination and controlling bowel movements
THANK YOU!