According to Dr. Bhandarkar, patients undergoing disc surgery most frequently ask a great deal of questions about recovery and how soon they can resume their active routines and go back to their jobs.
Anatomical explanation for initial restrictions
Dr. Bhandarkar explains recovery in context to the changes that happen in a patient’s anatomy after surgery:
During a disc surgery only a small part of the disc which is protruding is removed. He commonly uses the analogy of jelly and a doughnut for the disc. In patients with disc related pain, the jelly comes out through the tougher annulus (doughnut) and causes compression of the outer neural structures. During surgery a hole is made in the outer structure of the annulus and only the jelly which has herniated (protruded out) is removed.
The hole in the annulus takes about 6 to 8 weeks to heal. During this early post-surgical period, restrictions are placed regarding lifting, bending, twisting and sitting for long periods as it may increase the risk of the remaining jelly to come out through the hole, causing recurrence of symptoms.
Dr. Bhandarkar goes on to say that with the advent of newer microsurgical techniques the size of the hole to be made has decreased and the recovery is much quicker than it used to be in the past with open techniques.
The Healing rates
The human body heals itself by forming fibrous scar tissue. During the initial healing period the scar tissue gradually increases in strength and size and then it contracts and reorganizes. It is little more than half the strength at 6 weeks and almost at 100% at 12 weeks. Bone healing and remodeling takes longer.
Factors affecting the length of recovery.
Dr. Bhandarkar says every individual is different and the recovery period can only be estimated after taking into consideration patient characteristics such as age, weight, life style and other health matters such as obesity, smoking, diabetes and heart disease. Also taken into consideration is the duration of the problem and the intensity of the current problem.
In the postoperative period increased recovery times are usually associated with surgical complications and postoperative surgical site pain, which directly correlates with the amount of anatomy disrupted.
The minimally invasive approach used by Dr. Bhandarkar at Prairie Spine disrupts very little anatomy and uses multimodal analgesia (link to the previous article) which reduces the post-operative pain, cutting recovery time noticeably.
Activities favored in the early postoperative period.
As twisting is not allowed in the early postoperative period it is important to learn ‘log rolling’ which means the torso and extremities roll in one direction while transitioning to various positions while laying down or sleeping.
Dr. Bhandarkar encourages his patients to walk after surgery as being mobile aids in healing and it is very gentle on the operated area. It also prevents any scar formation and allows patients to gain their muscle strength much sooner. He also encourages stretching typically after 4 weeks. This is about the time scarring begins and stretching helps prevent this from happening, which may impair mobility of the nerve roots at the decompressed area.
The role of physical therapy.
Dr. Bhandarkar explains that our spine is surrounded by muscle and they are important structures that impart stability and support to the spine. The decreased mobility caused by the disease and pain results in the muscle decreasing in strength. Getting that strength back is important to recovery and in preventing disease progression and further episodes of discogenic back pain. He recommends exercises guided towards those muscles by an expert physical therapist, as core muscle strengthening is the key for further well-being and endurance. He further states physical therapy is utmost essential for strength recovery in weak muscles due compressed nerve roots. The recovery of these muscles depend on duration and amount of compression.
Using pain as a guide.
Dr. Bhandarkar also outlines the most important principle that dictates progression of activities. He says it is important to understand that all the activities done in the post-operative period should be limited by pain. Pain serves as an important guide what can be done and what cannot be. Having said that he states it is imperative that we try slowly within limit to incrementally increase the recommended activities.
How many people return to work and and when?
Regarding going back to work, Dr. Bhandarkar says people who have relatively sedentary jobs or office work can go back to work within 3 to 4 weeks. People who have jobs that involve doing lots of heavy work can return to work after 6 to 8 weeks. People can return earlier to work with certain restrictions. He says studies have shown more than 80% of people successfully return back to their earlier level of work.
Return to sports.
Dr. Bhandarkar says that patients who return to active professional sports after discectomy are approximately 90%. Some people are able to return to sports as early as 3 months but most people take up to 6 months. He says the return if further influenced by the type of sports. Patient who want to return to sports sooner need to have an early conditioning regime started at 4 weeks with a trained physical therapist and should be progressively, slowly re-conditioned over a period of time.
If you have any additional questions about disc surgery or would simply like to learn more about Prairie Spine Pain Care, please contact us today!