- ICU versus standard care unit: Most patients can go to a regular unit postoperatively, but some medically complex patients may benefit from ICU care. In older teenagers with simple MIS diskectomies, same-day discharge may also be reasonable.
- VS: Routine
- Diet and fluids: Routine
- HOB, activities: Positioning and activity as tolerated. Patients should minimize flexion of the lumbar spine and bend at the knees. Bathing depends on the closure used and surgeon preference.
- Medications and dosages, including PRN drugs: A regular schedule of medications, escalating as needed, can help to control postoperative pain. A combination of acetaminophen, muscle relaxants (i.e. methocarbamol or diazepam), ketorolac, and narcotics may be required.
- Laboratory studies: For diskectomies and small surgeries, no laboratory studies are typically needed.
- Radiology studies: No postoperative imaging is routine, unless persistent or recurrent pain is present.
- Physical therapy and orthotics: Therapy is an important part of the recovery for many of these patients. It helps postoperative mobility and can decrease pain.
- CSF leaks: When CSF leaks occur, they may be addressed by oversewing the incision, flat bed rest, placement of a lumbar drain, re-exploration and revision, or some combination of these. If a durotomy is noted at the time of surgery and repaired, then 48 hours of flat bed rest is usually adequate to prevent CSF leakage.
- Persistent radicular pain: After a diskectomy, radicular symptoms should improve markedly almost immediately, although they rarely resolve completely in the immediate postoperative period. Persistence of radicular symptoms without abatement warrants reimaging and consideration for re-exploration.
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