Recovery After Surgery for Degenerative Lumbar Disk Disease in Children

Postoperative Orders 

• 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.

Postoperative Morbidity

• 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.