Lumbar Spine Surgery

Lumbar Spine Surgery

Introduction

Back pain is very common and most of us will experience it at some point. With the right approach basic back pain can be avoided. This advice booklet will describe some of the basic ways you can prevent back pain.
The spine is made up of 33 small bones called vertebrae stacked on top of each other in an ‘S’ shape. Not all backs are the same ‘S’ shape but they are usually curved at the neck and lowest part of the back. The shape should be kept in mind when you move to maintain the natural curves in your back whatever you are doing. Each of the vertebrae has a disc in between them which acts like a shock absorber. Spinal nerves pass between each vertebra next to the disc and travel to the legs. These nerves allow us to move our muscles and feel things in different parts of our body.
The muscles in the back support the vertebrae and the discs. The most common form of back pain is caused by these muscles going into spasm. This often happens when you have been doing something strenuous such as gardening or heavy lifting.
Back pain often occurs in the lumbar region of the spine. This section bears the most weight of the body and is capable of bending and twisting more than any other part so suffers more wear and tear.

 

What is a disc?

Discs are tough yet flexible and allow the spine to bend and twist. Discs have a central part filled with a rubbery substance called the nucleus. The outside wall is called the annulus which is made from tough and flexible fibres. The annulus is a very strong substance which is usually able to heal and ‘reseal’ itself after surgery.

 

What has happened to my disc?

If part of the outer wall (annulus) weakens, some of the central part (nucleus) of your disc may herniate / move through it. This can occur in lots of people without them knowing it. This is referred to as disc herniation but can also be called slipped disc, disc bulge, nerve impingement, disc protrusion, or prolapsed disc.
Both the annulus and nucleus may press on the nerve next to it causing pain, pins and needles, numbness or weakness in the leg. Leg pain symptoms are often called sciatica.

 

What is stenosis?

Back and leg pain can sometimes be caused by a condition called stenosis, instead of a problem with the disc. Spinal stenosis is when the spinal canal is too narrow/nerves become compressed in the narrowed space.

 

What happens during surgery?

Your surgery will take place in an operating theatre, where you will be put to sleep by an anaesthetist. In the operating theatre you lie on your front, over an arched operating table. The surgeon makes an incision, usually about 3-5 cm long, down the centre of your back. Different types of surgery include:

Discectomy
A small amount of bone and ligament from the back of the spine are removed so the disc and nerve can be seen; this will not make your spine weaker. The part of the nucleus pressing on the nerve is trimmed.
Once the surgical procedure is completed the incision is closed with either stiches or clips, and a sterile bandaged applied.
Decompression
A small section of bone and ligament from the back of the spine are removed so the nerves have more space. This is called a laminectomy and will not make your spine weaker. The surgeon may also remove the osteophytes, this is called a foraminotomy.
Once the surgical procedure is completed the incision is closed with either stiches or clips, and a sterile bandaged applied.

 

Expectations of surgery

After surgery, there is a 65 to 90% chance of your leg pain reducing or disappearing altogether. A 25 to 50% chance that you will have back pain that may get worse. However, we hope that your pain will be reduced enough for you to be able to move about well enough to continue with your life, work and social activities.

 

Possible complications following spinal surgery

• Bleeding or haematoma (collection of blood).
• Bladder and or bowel problems - this may lead to incontinence (loss of control), which may be temporary or permanent.
• Dural tears or leaks – this is when the membrane covering the spinal cord (the dura) is damaged. This may lead to nausea, vomiting and headaches. It is usually treated with bed rest.
• Disc-space infection - this is an infection in the disc that was operated on. It is uncommon and is treated with antibiotics.
• Nerve damage - this is damage to the nerves in your back which can lead to foot drop (when you drag your foot while walking), altered feelings which can include pins and needles, temperature changes or no feelings in your back or legs (or both).

 

What to expect after the surgery

Some patients find that their leg symptoms have disappeared straight away; others find that it takes longer for them to subside. Everyone is different. You may experience discomfort around your wound and from spending time in one position. You may also find it difficult to pass urine and may need a catheter for a short time after surgery. It is normal to be in some discomfort, but let the nurse know if your pain stops you from doing normal things like eating, sleeping, walking and going to the toilet.
Soon after your surgery a nurse will come and see you to work on safely getting out of bed and walking. Routinely, you do not need to be seen physiotherapist. Please see post-op advice booklet (in PDF format bellow) for specific details and exercises. Some people go home the same day, others stay in hospital overnight. This may depend on how long your surgery took or whether it took place in the morning or afternoon.
If you have had clips to close your wound, the nurses on the ward will arrange a referral for them to be removed usually between 5-10 days after your surgery. An outpatient appointment will be made for you to see the surgeon’s team about 6 weeks after surgery. It is usually sent to your home address if not given to you in hospital.

If you experience any of the following symptoms you should see a Doctor immediately:
• Numbness around your back passage and genital region
• New onset of bladder or bowel incontinence
• New numbness, pins and needles or weakness in both legs

 

Post-operative advice and exercises

Please see post-op advice booklet (in PDF format bellow) for specific post-operative advice on posture; getting in and out of bed; personal care; domestic activities; travelling / driving; returning to work; and returning to exercise / leisure activities. Post-operative exercises are also included if appropriate, though these may be tailored to individual needs based on your type of surgery.

  

Download Post-op advice booklet Here