Tarlov / Meningeal Cyst Post-Operative Instructions

The following guidelines are recommended after your surgery to ensure the best possible recovery. You may be given additional instructions upon discharge. If you have any questions or problems please contact our office at (214) 351-8450.

Activity Restrictions and Guidelines

Daily activities for personal needs are permitted but avoid any strenuous activity. Do not lift anything heavier than a gallon of milk (about 8 pounds or 4 kilograms) for the first 4 weeks after surgery. At four weeks after surgery you may gradually increase to no more than 20 pounds. At three months after surgery you may gradually increase to 50 pounds. Avoid pushing and pulling activity for three months. Minimize bending and twisting for the first 4 to 8 weeks after the surgery. Note: bending and twisting could put strain on the incision and/or increase your pain level.

Take precautions to prevent falls and use assistance if unsure. Stairs are permissible, however use handrails and take one step at a time until comfortable. It is recommended to limit sitting to 45 minutes to one hour at a time and take a break for a few minutes to get up and move around or lie down. Sitting longer will not harm your surgery but may increase your pain and discomfort.

Walk daily as tolerated gradually increasing the distance you walk. As you increase your activity level you may experience an increase in discomfort. This is normal and to be expected. Remember this is a slow and long recovery process. There is nothing you can do to hurry the nerve healing process. Nerves heal on their own schedule! It is okay to be active but rest in small bouts and alternate as you tolerate. Modify your activity level to enhance your comfort as needed.

TED hose

If you were given TED hose stockings you may discontinue use once you are routinely up and walking daily.

Incision care

Your incision will have steri strips, small adhesive strips along the incision line, or dermabond, a surgical glue. Do not be concerned if the strips roll up or fall off. It is ideal for the strips to stay on for a week to ten days. If the strips remain after ten days you should remove them. There will not be any stitches that need to be removed. All of the stitches are from the inside of your incision and will absorb over time. It is normal for the incision site to itch. Call if there is any drainage or excessive swelling from your incision. It is not necessary to put any ointments on your incision but if you feel you must, wait until after all the scab is gone around three to four weeks after surgery.

Bathing

You may shower and get the incision wet 48 hours after the surgery. Do not soak the incision and avoid scrubbing the incision site. No tub baths until one month after the surgery. (All scab must be sloughed off with no open areas along the incision line before soaking the incision area.)

Driving

It is recommended to avoid driving for three weeks after the surgery. If you are doing well and feeling well and not taking narcotic medication you may start driving short distances as early as two weeks. At any time you may ride in an automobile for short distances as tolerated. If riding for extended periods of time (such as to get back to your home state) include stretch breaks at 45- 60 minute intervals and you may have to lie down in the car. For very long travel distances by car, such as eight hours or more, it is recommended the trip be taken in two days or more.

Traveling home by plane

Pre-arranging for assistance when you land at the gate is highly recommended. During the plane ride get up frequently each hour to walk around and stretch. Tell your flight attendant you have recently had surgery and will need to move about at times. Bring a cushion to sit on if needed.

Pain medication

Prescriptions will be given at discharge from the hospital. Please fill them in Dallas. If your primary care or pain management physician was prescribing your pain medications before surgery, please see if they will continue to do this for you once you return home from Dallas. Please do not try to get prescriptions from more than one physician. Narcotics are monitored by the state, our office, pharmacies, and insurance companies. This could result in loss of pain management by your providers. Once you return home and are in need of a refill, these prescriptions will need to be mailed to you. Please call our office at least 5 days prior to ensure the script will arrive in time. We can only refill scripts for a limited time from your last appointment. Please begin to find someone locally who can continue pain medication refills.

Other medications

You may be given a prescription for Flomax. This is to help initiate a urinary stream and empty your bladder. Once you have finished the prescription you do not need to get it refilled unless you are having trouble emptying your bladder. You may discontinue this if you are urinating too often or without difficulty.

Constipation

You may be constipated after your surgery. It is normal for surgery and narcotics to slow down your ability to have a regular bowel movement. It is best to take a pro-active approach and increase your fiber and fluid intake. Take stool softeners and laxatives as needed or daily. You may use your choice of over-the-counter laxatives as needed. We recommend to our patients to take Miralax and/or Senokot S. If you are having trouble having a bowel movement use a Fleets enema.

Sexual Intercourse

Sexual intercourse may be resumed at any time as tolerated. Go slowly and avoid painful positions. It is not unusual for nerve pain to increase after intercourse as with any increased activity.

Smoking

You should not smoke after surgery. Smoking decreases the rate of skin and bone healing. Smoking also may interfere with the effectiveness of your pain medication. Reminder: the hospital campus is entirely smoke free.

Fever / Meningitis

If you have fever or chills, take your temperature with a thermometer. If you have a temperature of 101degrees Fahrenheit or 38.3 degrees Celsius or higher contact our office. Call if you experience signs/symptoms of meningitis: fever, headache, neck stiffness, and eye sensitivity to bright lights.

Numbness

It is not unusual for some patients to experience numbness in the buttocks or the areas between your legs after the surgery. This is generally temporary but it is also possible some of this numbness may not completely go away. Allow weeks or months for the numbness to improve. Generally, you can expect the area of numbness to get smaller and smaller over time.

Other

Like any other recovery period you must take good care of yourself. That means stay hydrated, get plenty of rest, eat properly, minimize stress and get up and move around periodically.

Office Follow-up

Your post-operative appointment has been made for you.

What to expect at your post-operative appointment

Your appointment will last for approximately 15 -20 minutes depending on how many questions you have. You will be asked to compare your symptoms from before surgery to after. Communicate what is better, same, or worse and what is different. You will also be asked about your symptoms and medications. An exam is done to check incision site and your strength. A spine model may be utilized to explain what surgery was performed. Activity limitations, recovery, and follow up will be discussed. Towards the end of your appointment, you will have the opportunity to ask questions.

Going home packet

If you are from out of town you will be given a packet at your post-operative appointment with your post-operative questionnaires, a letter for your primary care physician informing them of planned MRI follow up, and a copy of your surgical operative note.

Follow up

As part of your follow up from surgery, you will need to obtain an MRI at 3 months and 1 year. In addition, you will need to complete questionnaires at 3 months, 6 months, 1 year, and 2 years after surgery. The MRI must be a closed MRI and, if necessary, you may lie on your stomach. Please note, some facilities may not allow this option. Make sure you send all post-operative materials to our Dallas office. We prefer to receive the MRI on disc, MRI report and questionnaire together. Please allow two weeks to process your follow up items into your medical records.

To check on the arrival status of both the MRI and questionnaire, contact Soledad at (214) 351-8450.

Once all items have been received, Dr. Feigenbaum will review the information and you will be contacted with the results. Allow up to four weeks to receive the MRI results.

MRI Results

Please keep in mind the report of your post-operative MRI from the imaging center may not be accurate. This is not uncommon as the radiologist may not fully understand your surgery and how your images should look. It is highly recommended to first allow Dr. Feigenbaum to review your MRI and give his opinion before assuming the accuracy of the report. It is very rare for a post-operative MRI to be abnormal upon Dr. Feigenbaum’s review.

Preparation of your living space before surgery

It is recommended to prepare in advance for your return home after surgery. Here are some suggestions to consider: Remember it is okay to ask friends, family, neighbors, and church members for help!

  • Remove throw rugs to prevent falls.
  • Place non-slip tape on the bottom of shower/tub floors.
  • Place frequently used bathroom and kitchen items at waist level for easy reach.
  • Have plenty of prepared or frozen food/meals stocked in your freezer.
  • Make sure there are clear pathways in your home, especially to the bathrooms and remove any extra items that could be a tripping hazard.
  • If you will be alone, consider a hand gripping device to pick up things off the floor.
  • Invite someone to call and check on you daily and perhaps help you with errands.
  • You may want to consider home delivery for groceries and pharmacy items.

Disability or Activity/Work Restriction Paperwork

If activity/work restriction paperwork needs to be addressed, please notify someone when you check in at your follow-up visit. Otherwise, please call the office at (214) 351-8450, and ask for Peg, our medical assistant. Allow at least a week for paperwork to be completed. If short-term disability/FMLA paperwork needs to be addressed, please fax your form with your name, date of birth, contact information, and release of authorization to (214) 351-8451. There is a $10 pre-pay fee. Please allow 5-10 business days. If you have any questions, please call the office. We do not address long-term disability or functional capacity evaluations. Please have a local physician address these concerns. Thank you.