Your personal guide to Disc Replacement (Pro Disc)

 Surgery :: Microdiscectomy :: Anterior Cervical Decompression Fusion
Intra Discal Electro Thermal Annulaplasty (IDETA)
Posterior Lumbar Interbody Fusion (PLIF)

Following your consultation with Dr Diwan it has been decided that an option for you at this time is to under go a disc replacement.  This surgical procedure will take around 2 hours and will require a general anaesthetic.  The PRODISC technique approach’s the vertebra from the front (i.e. your abdomen) which allows for careful exposure and remove of the disc material at the level to be replaced.  The placement of PRODISC lumbar prosthesis is based on a ball and socket joint that is designed to restores disc function, the geometry and motion of the lumbar disc.

Preoperative instructions

• Smoking is prohibited for 4 leeks before your operation and 12 weeks after surgery.  Research suggests that smoking decreases bony ingrowth into the metal plates of the prosthesis.
• Alcohol should be limited as much as possible 1 week before your surgery.
• Make sure you have been fitted properly with a back brace.

2 weeks before

• The following medications should be discontinued 2 weeks before your surgery as the blood thinning agents in them can accentuate swelling and discomfort.  The following non steroidal anti inflammatory drugs such as: Disprin  Naprogesic, Feldine, Voltaren, Tagamet, Neurofen. If you have any questions regarding medications please ask Dr Diwan or your anaesthetist.

Discontinue the use of natural remedies such as: Vitamin E, Evening primrose oil, Herbal tea, Green tea,

If you need pain relief in this period use either Panadol, Panadine or Panadine Forte

1 week before  

• Plan, cook and freeze meals for a week so you do not have to cook following your surgery.
• Arrange a support person to be with you on your first 2 days at home.  If this is not possible you will need to organise transport home from the hospital.
• Co ordinate with the hospital admission office your admission status for your stay.  St Luke’s Hospital 02 93560200, St George Private Hospital 02 95985581 and St George Public Hospital 02 93503032

2 days before

• Cut finger nails and toe nails, remove any nail polish.
• Pay any bills that are due in the next week or 2, as well as any banking matters.
• Establish a comfort zone including items such as phone, TV guide, tissues and phone book. In preparation for the first few days post surgery.
• Call hospital to confirm booking, fasting time and hospital costs.
• Call Dr Diwan’s office to confirm post operative appointment.
• Pack for hospital, include: comfortable cloths that do not have a tight waist band, slip on shoes if possible, reading material to help pass the time before your operation.

1 day before

• Fast from specified time given to you by the hospital.
• Ensure you have all your relevant phone numbers
• Remove any obstacles in your home that you could fall over.
• Remember any X-Rays and CT scans that Dr Diwan does not already have.

Day of surgery

• Do not eat anything unless you have been instructed by the hospital.
• When you have a shower pay special attention to your stomach and groin area.  You may wish to wash your hair as it may be a few days before you feel up to washing it again.
• Leave home in plenty of time
• Take phone numbers of your support person.
• Remember to take your Medicare card as well as your private insurance details if applicable.
• If you are allergic to anything please remember to tell the anaesthetist.

What to expect following your surgery

Pain- From the time you wake up from the anaesthetic you should feel relief from your back / leg / arm pain.  You will however experience pain associated with the operation itself.  The recovery staff will watch you closely and ensure that pain relief is available to you if you need it.

Calf stimulators- You will wake up with compression (massage) devices on your calves.  These will stay on your legs until you are up walking to reduce the risk of deep vein thrombosis (DVT).

Urinary Catheter- It is necessary for you to have a catheter while you are asleep.  This will be removed once you are up and about.  Removal is not painful and takes about 2 seconds.

Drains- You will have a wound drain that will be removed within 36 hours.

Coping with the blues- It is not uncommon for patients to feel a little low 1-2 days after the surgery.  This phenomenon is due to the drugs used in the anaesthetic as well as the natural let down feeling that people experience after meeting a long term goal, for example, your back surgery. 

Length of stay-  Expect< /font> to be in hospital for 3-4 days.  This can vary a little depending on the how you feel and the extensive nature of the operation.

Ileus- During the operation the bowel is retracted to the side.  This can cause the bowel to become a little sluggish for a few days following surgery.

Postoperative instructions

Week 1

• Do not arch your back, if you have to bend make sure it is from the hips and knees.
• Rest and eat well to regain your strength.
• Try to maintain good posture
• It is very important to wear your brace as instructed. You may remove it to bathe.
• Do not lift anything heavier than a 3 kg bag of sugar.
• If you experience significant pain along with a high temperature and the shivers you should contact the hospital or Dr Diwan.
• Take your pain medication as directed.
• Begin mobilizing gently.
• Begin gentle walking for up to 20 minutes at a time.

 Week 2

• Continue to wear your brace as instructed.
• Ensure you keep your first appointment with Dr Diwan on day 10. At this appointment you will be given further instructions as to your rehabilitation.

Commonly asked questions

When do I see Dr Diwan?

You will be seen in Dr Diwan’s  rooms on day 10 following your surgery and again at week 6 to make sure every thing is going well.

When can I have a Shower?

You can have a shower the day following your surgery with the help of a nurse.

If your dressing gets very wet just gently pat it dry with a towel do not rub it.

Do I have Stitches to come out?

You will have a drain in your stomach over night that will be removed the following day.  The stitches are under your skin so removal is not necessary.  When you are seen in Dr Diwan’s rooms on day 10 your dressing will be removed and the incision line cleaned.

Is there a certain position that I should be in to sleep at night?

The most important thing is for you to be comfortable.  The ideal position is lying on your back with a pillow under your knees.  This however is not compulsory, if lying on your side is more comfortable do so.  Avoid extending (arching) your lumbar spine backwards.

How long is it before I can drive a car?

The recommendation is to wait 6 weeks before driving a car.  At first only for short periods at a time then as you feel more comfortable you can increase the driving time.

When can I go back to work?

This is assessed on an individual bases.  To generalize a physically demanding job may take 3-4 months, where a less physically demanding job will take less time.

When is it safe to engage in sexual relations following the surgery?

This is a very personal issue and is up to you and your partner as to when you feel ready.  Clinically a 3 week period is recommended before you resume sexual activity providing you are the less active partner.  There after such activity has to be in keeping with the above guide lines. NB it is very important that you do not arch your back for the first 4 months. 

When is it safe to lift / bend / twist at the waist?

Bending from the waist is not recommended for 6 weeks. Lifting anything greater than 5-7 kg is not recommended for 3 months and twisting is ok as long as it is done in a controlled manner at all times.