Recovery After Minimally Invasive Lumbar Decompression
Getting You Back to Life
Minimally invasive lumbar decompression is designed to relieve pressure on the nerves in your lower back while minimizing disruption of the surrounding muscles and tissues.
Depending on your condition, I may perform your decompression endoscopically or through a small tubular approach.Procedures in this category may include a laminotomy, foraminotomy, microdiscectomy or other minimally invasive nerve decompression.
Unlike a lumbar fusion, there is no fusion that needs to become solid.
That changes the way I approach recovery.
My goal is to get you up, walking and progressively returning to normal activities as your body allows.
My Approach to Recovery
Get Up and Walk
Walking is one of the most important things I want you doing after surgery.
For most patients, walking begins the day of surgery.
Start with shorter, frequent walks. As you become more comfortable, gradually increase your distance and duration.
You don't need to walk a certain number of miles.
You don't need to hit 10,000 steps.
Just keep moving.
Don't Be Afraid of Your Back
A common concern after spine surgery is:
“Am I going to hurt something if I move?”
After an uncomplicated minimally invasive decompression, I don't want you spending your recovery afraid to move your back.
You will have some soreness. Your muscles may feel tight. Certain movements may initially be uncomfortable.
That's different from damaging your spine.
Use common sense, listen to your body and gradually increase what you're doing.
What to Expect During the First Few Days
Even though the surgery is minimally invasive, it is still surgery.
During the first several days you may experience:
Soreness around the incision
Low back muscle discomfort
Tightness or spasms
Fatigue
Some difficulty getting comfortable when sitting or sleeping
Residual numbness or tingling in the leg
Temporary changes in your preoperative nerve symptoms
Many patients notice improvement in their leg pain relatively quickly.
Other symptoms—particularly numbness, tingling or weakness—may take longer to recover.
Your Nerve May Need Time to Recover
This is one of the most important things to understand after decompression surgery.
Decompressing a nerve and healing a nerve are two different things.
The purpose of surgery is to remove the physical pressure from the nerve.
Once that pressure is removed, the nerve still has to recover.
Some patients wake up and notice that their leg pain is dramatically better.
Others improve more gradually.
And occasionally, a patient may initially feel much better and then experience some temporary return of leg pain, numbness or tingling during the early recovery period.
This does not automatically mean something has gone wrong.
A nerve that has been compressed or irritated for months—or sometimes years—may remain sensitive as it recovers.
The overall direction of your recovery is more important than how you feel during one particular day.
Your First 24–72 Hours
Your priorities are simple:
Walk. Move. Recover.
Take several short walks throughout the day.
Change positions periodically rather than spending the entire day sitting or lying down.
Take your medications as directed.
Protect your incision and dressing.
Rest when your body tells you that you need to rest.
You don't need to test your limits during the first few days.
Your First Week
During the first week, gradually increase your walking and normal daily activities.
You may notice that you can do a little more each day.
Some days will be better than others.
If you have a particularly active day and feel more sore the next morning, that doesn't necessarily mean you've hurt something. It may simply mean that your body wasn't quite ready for that much activity.
Back off slightly, recover and continue progressing.
Weeks 2–6
Many patients are becoming substantially more active during this period.
Walking distances increase, surgical soreness decreases and normal activities progressively return.
Because there is no fusion that needs to heal, activity can generally progress according to your symptoms and recovery.
That doesn't mean you should immediately test how much weight you can lift or jump back into strenuous exercise.
The goal is a progressive return to activity.
Getting Back to Life
One of the reasons patients choose minimally invasive spine surgery is the possibility of returning to normal life relatively quickly.
Here are some of the questions I hear most often.
When Can I Walk?
Right away.
Walking is encouraged from the beginning.
Start with shorter walks several times throughout the day and gradually increase your distance.
If you get tired or your back becomes significantly sore, take a break.
Then get moving again later.
When Can I Drive?
I don't use an arbitrary postoperative day for every patient.
You can consider returning to driving when you:
Are no longer taking narcotic or other medications that could impair your ability to drive
Can comfortably get into and out of the vehicle
Can sit comfortably enough to concentrate on driving
Can safely operate the pedals
Have enough mobility to see your surroundings
Can react quickly enough to safely perform an emergency maneuver
For some patients following a small minimally invasive decompression, this may happen relatively quickly.
The important question isn't “How many days has it been?”
It's “Can I safely control the vehicle?”
When Can I Return to Work?
This depends primarily on what you do for work and how you're feeling.
Someone who works from home or performs primarily desk work may be able to return relatively quickly.
A patient whose job requires repetitive bending, heavy lifting, climbing, pushing or pulling will usually need a more gradual return.
If possible, returning with lighter duties before immediately resuming heavy physical work can sometimes make the transition easier.
We'll consider both your recovery and the physical demands of your occupation.
When Can I Bend and Twist?
Normal life requires you to bend and twist.
I don't want you permanently afraid of these movements.
During the first several days, move deliberately and avoid aggressively testing your back.
As your surgical soreness improves, gradually return to more normal movement.
If a particular movement causes significant pain, back off and give yourself more time.
When Can I Lift?
Start light.
Everyday objects can be progressively reintroduced as you become more comfortable.
Avoid immediately testing your maximum lifting ability simply because your leg feels better.
Remember that the small muscles and tissues involved in the surgical approach still need time to recover even though there is no fusion.
Increase your lifting gradually.
When Can I Exercise?
Walking starts immediately.
From there, exercise can be progressively reintroduced as your surgical soreness improves.
Start with lower-impact activities and gradually increase duration and intensity.
More strenuous resistance training should be added progressively rather than jumping immediately back to your preoperative routine.
The goal isn't to protect your back forever.
The goal is to rebuild it.
When Can I Go Back to the Gym?
Your return to the gym should be gradual.
Initially, walking and light cardiovascular activity are usually more appropriate than heavy resistance training.
As your soreness improves, you can begin adding exercises progressively.
Don't make your first day back the day you find out whether you can still deadlift your previous maximum.
Start lighter than you think you need to and build from there.
When Can I Swim or Get in a Pool?
Your physical recovery may progress faster than your incision heals.
Do not submerge the incision until it has healed appropriately and you have been cleared to do so.
This includes:
Swimming pools
Hot tubs
Bathtubs
Lakes
Oceans
Once the incision is healed, swimming and pool exercise can be progressively reintroduced.
When Can I Travel?
Travel can often be resumed relatively early when you are comfortable.
For longer car trips, I recommend stopping periodically so you can get out, stand and walk rather than remaining seated for hours.
The same principle applies to longer flights when you're able to safely get up and move.
If you're planning significant travel shortly after surgery, discuss it with me beforehand.
When Can I Have Sex?
Sexual activity can generally be resumed when you feel physically comfortable enough to participate without significant pain.
Start gradually and choose positions that don't place unnecessary strain on your back.
If something hurts significantly, stop and give yourself more time.
When Can I Golf or Return to Sports?
Return to golf and other recreational activities depends on how you're recovering and the physical demands of the activity.
Walking a golf course is different from repeatedly taking a full driver swing.
Likewise, riding a stationary bike is different from running, heavy weightlifting or participating in a contact sport.
I prefer a progressive return:
Start easy. See how your body responds. Then increase.
Caring for Your Bandage
When Can I Remove My Bandage?
Keep your surgical bandage in place for the first 4–5 days after surgery, unless you are given different instructions.
After 4–5 days, remove the original bandage and replace it with a clean, new bandage.
Continue to keep the incision covered until your postoperative follow-up.
If the bandage becomes wet or soaked with drainage at any time, replace it with a clean, dry bandage and contact your surgical team.
Do not leave a wet or saturated dressing over the incision.
Your individual wound-care instructions may vary depending on your incision and how it was closed.
What Is Normal During Recovery?
Incisional soreness
Even a small incision can be sore for several days.
Low back muscle discomfort
The muscles around the surgical area may feel tight, tender or fatigued.
Residual numbness or tingling
These symptoms can take longer to improve than leg pain.
Temporary nerve irritation
Occasional burning, tingling or recurrent nerve-type pain can occur while the nerve recovers.
Fatigue
Your incision may be small, but your body still went through surgery.
Good Days and Bad Days
Recovery isn't always a straight line.
An increase in activity can sometimes lead to temporary soreness afterward.
Pay attention to the overall trend rather than one particular day.
Bending, Twisting & Lifting After Lumbar Decompression
Your activity restrictions depend on the type of decompression you had. A microdiscectomy and a lumbar laminectomy are different procedures, so I do not give every decompression patient the exact same restrictions.
After a Microdiscectomy
If you had a lumbar microdiscectomy, I generally want you to avoid significant bending, twisting and lifting for approximately 2–4 weeks after surgery.
For patients returning to a more strenuous or physically demanding job, I typically use approximately 4 weeks before allowing a return to significant bending, twisting and lifting.
This doesn't mean you need to remain inactive. I still want you walking, changing positions and performing appropriate everyday activities. The goal during this early period is to stay active while avoiding unnecessary stress on the recently treated disc.
As you progress beyond this initial period, bending, twisting and lifting can be gradually reintroduced based on your recovery and the physical demands of the activity.
After a Laminectomy or Unilateral Laminotomy for Bilateral Decompression
If you underwent a lumbar laminectomy or unilateral laminotomy for bilateral decompression without a microdiscectomy, my approach is generally less restrictive.
Some bending, twisting and lifting is acceptable based on your comfort.
You do not need to be afraid of normal movement.
Start gradually. Move deliberately and pay attention to how your back responds. If a particular movement or activity causes significant discomfort, back off and give yourself more time before trying it again.
I don't want you immediately testing your maximum lifting ability or jumping into strenuous physical activity simply because your leg symptoms have improved. Instead, progressively increase what you're doing as your surgical soreness decreases.
The Bottom Line
Microdiscectomy: Avoid significant bending, twisting and lifting for 2–4 weeks, with approximately 4 weeks generally used for patients returning to strenuous work.
Laminectomy / Unilateral Laminotomy for Bilateral Decompression: Some bending, twisting and lifting is generally acceptable as comfort allows, with a gradual return to more demanding activities.
Regardless of the procedure, walking is encouraged from the beginning.
Your specific operation and circumstances may require different restrictions, so always follow the individualized instructions you receive after surgery.
When Should I Call?
Please contact the office if you experience:
Increasing redness, swelling or drainage from your incision
A bandage that becomes soaked with drainage
Opening or separation of the incision
Fever or other signs of infection
Severe or progressively increasing back or leg pain
New or progressive weakness in your leg or foot
Significant new or worsening numbness
A major change in your neurologic symptoms
Any postoperative symptom that concerns you
Seek immediate medical evaluation if you develop new loss of bowel or bladder control, numbness involving the groin or saddle area, severe or rapidly progressive leg weakness, chest pain, difficulty breathing, loss of consciousness or another potentially life-threatening problem.
Decompress the Nerve. Get Moving. Get Back to Life.
Minimally invasive lumbar decompression is designed to treat nerve compression while minimizing disruption of the surrounding tissues.
Whether your procedure was performed endoscopically or through a small tubular approach, my recovery philosophy is similar:
Walk early.
Keep moving.
Gradually increase your activity.
Don't be afraid of your back.
And remember that your nerve may take time to recover even after it has been successfully decompressed.
The goal isn't simply to have a smaller incision.
The goal is to safely get you back to the life you want to live.
These guidelines describe my general approach following an uncomplicated minimally invasive lumbar decompression. Your diagnosis, procedure, neurologic condition and individual circumstances may require different instructions. Always follow the specific postoperative instructions provided to you.