Red flag to remember
New or worsening weakness, numbness, or loss of bladder or bowel control can mean a hematoma compressing the cord or nerve roots — notify the surgeon immediately.
What is laminectomy?
Nursing care centers on protecting the spine while it heals, comparing nerve function with the preoperative baseline, and watching for complications that depend on the level of the surgery. The rule behind most questions: log roll and keep the spine aligned.
Key points to remember
- Turn by log rolling, moving the spine as one unit; a pillow between the knees keeps the hips aligned when lying on the side.
- Check movement, sensation and strength of the arms or legs against the preoperative baseline; new weakness or numbness suggests swelling or a hematoma pressing on nerves.
- Cervical level: watch the airway, swallowing and voice for swelling or a hematoma, and check arm strength.
- Lumbar level: watch for urinary retention and leg weakness; opioids and limited movement also slow the bowels.
- Check the dressing for bleeding and for clear drainage, which can be cerebrospinal fluid.
- Sitting strains a lumbar repair, so early on the patient sits only for short periods (often 30 minutes or less) per the surgeon's orders; standing, walking and lying are preferred.
Nursing priorities
- Do neurovascular checks of the extremities frequently in the first 24 hours and compare them with baseline.
- Log roll about every 2 hours with enough staff, keeping the spine straight.
- Monitor urine output and check for bladder distention; use a bladder scan if the patient cannot void.
- Keep pain controlled with scheduled analgesia and help the patient walk early, as ordered, using good body mechanics.
- Inspect the incision for bleeding, hematoma, drainage and signs of infection.
Patient teaching
- Avoid bending at the waist, twisting and heavy lifting until the surgeon says it is safe.
- Lift by bending the knees with the back straight, holding objects close to the body; after cervical surgery, do not lift anything overhead.
- Get out of bed by rolling to the side and pushing up with the arms, and walk a little more each day.
- Report fever, wound drainage, or new numbness, weakness or trouble urinating.
Red flags: report now
- New or worsening weakness, numbness, or loss of bladder or bowel control can mean a hematoma compressing the cord or nerve roots — notify the surgeon immediately.
- Clear drainage on the dressing or a headache that worsens when sitting up may be a cerebrospinal fluid leak — report it.
- After cervical surgery, trouble breathing or swallowing, stridor or a swelling neck is an airway emergency.
References
Clinical references for this topic
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