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Postop Orders for Lumbar Disc

- See
       - Hemilaminectomy and Decompression L3-4, L4-5

- Diskectomy:
    - diet: liquids as tolerated on the day of surgery, resume preoperative diet on the day following surgery;
    - pt may be up to void on the night of surgery (unless dura was opened)
    - patient may roll side to side in bed prn;
    - narcotics (morphine and demerol) are not to be withheld from pts with routine lumbar disc disease;
    - all patients with lumbar disc surgery get a lumbrosacral corset from brace shop before discharge;
    - w/ intra dural procedures: patient is to remain in bed w/ head of bed flat for 5 days;
          - it is desirable to have patient on his side;
          - w/ hold major analgesics until pt is alert & awake & cooperative;
    - physical therapy:
          - note that the nucleus excised may have the effect of increasing segmental motion;
          - extension exercises should be encouraged since this is the most stable loading position;
          - patients should avoid lateral bending and axial rotation;

- Hemilaminectomy
    - may be up as the patient tolerates movement
    - may stand with assistance on the night of surgery to void;
    - may have adequate narcotics;

- Laminectomy:
    - accumulation of epidural blood causing compression of spinal cord w/ resultant quadriplegia or paraplegia is ever present danger w/ 
          cases that have required complete laminectomy;
    - check neurological status frequently to spot epidural hematoma;
          - check neuologic status of legs;
    - if a cervical laminectomy, no narcotics until the pt is awake;
    - following a full laminectomy with dural opening below the mid - thoracic spine, maintain the patient horizontal in bed for several days, 
          depending on the surgeon;
          - however, the patient may be rolled prn;
    - cervical laminectomy: no narcotics until the patient is awake

Kinematics of the whole lumbar spine: Effect of discetomy.