Following any surgery or injury, healing occurs. This process involves an infiltration of cells and blood vessels and conversion of initial healing granulation tissues in to mature tissues or scar.
The initial phase is attended by swelling.
In Endoscopic Minimally Invasive Spine Surgery (EMISS) this swelling involves the nerve and the surrounding tissue. The limited resection that typifies EMISS results in limitation of unnecessary excavation so that during healing the nerve will abut surrounding boundaries and become irritated. The resulting effect is a recurrence of the predominant presenting symptoms in a Flare which occurs about 5 days following surgery and peaks at 10 days and last about 2 weeks and thereafter gradually subsides.
The danger with EMISS is that patients feel so well for the first few days following surgery that they feel a sense of release and become fully or overactive and thus aggravate the subsequent Flare.
The flare symptoms are minimised by Medication and Activity Control:
Medication
- Day 1 – 5: Ibruprofen / Dicofenac & Omeprazole / Lanzaprazole
- Day 5 – Decrease of Flare: Emflex (Acemethacin) & Omeprazole / Lanzaprazole.
- Decrease – end of Flare: Ibruprofen / Dicofenac & Omeprazole / Lanzaprazole.
Curtailing activity
- 1 – 3 hours post-operative phase:
Mobilise from bed to reduce back spasm and local inflammation.
- Day 1 – 5:
Restrict activity to pottering around the house, No driving, Driven out for 5 minute limit, No Lifting. No visiting friends – Friends may visit the patient for short periods, Sitting for 20 minutes, Walking for 20 minutes about the house, Physiotherapy exercises level 1 – 4 for 20 minutes, Walking out of the house for 5 minutes. Limited computer work with correct posture and ergonomics for 20 minutes, Cooking split into short phases
- Day 5 – Decrease of Flare:
Restrict activity to pottering around the house, No driving, No Lifting. No visiting friends – Limit friends visits to short periods, Sitting for 20 minutes, Limited walking for 20 minutes about the house, Physiotherapy exercises level 1 – 4 for 20 minutes, No Walking out of the house. Limited computer work with correct posture and ergonomics for 5 - 10 minutes, Very limited cooking split into short phases
- Decrease – end of Flare:
Progressively restore activity to pottering around the house and light house work, Recommence driving starting with short shop visits at 5 minutes radius, Light lifting after 6 weeks. Visiting friends for short periods initially, Sitting for 20 minutes, Walking for 20 minutes about the house, Physiotherapy exercises level 1 – 6 for 20 minutes, Progressively walking out of the house beyond 5 minutes on even ground. Limited computer work with correct posture and ergonomics for 20 minutes and extending this after 6 weeks, Cooking in increasingly normal fashion. Returning to work on a progressive basis after 4 – 6 weeks following surgery.