neurosurg

Lumbar disc surgery

The lumbar disc

Between the bones of the spine (called vertebrae) there is a soft cushion of tissue, in texture like crab meat, which acts like a kind of shock absorber. This disc material is held in place by strong ligaments or sinews which also hold the bones together by encircling them. If the ligaments are damaged by injury or wear-and-tear they may give way and bulge backwards (prolapse).

A Normal Disc
Normal lumbar disc

Disc Prolapse
Lumbar disc prolapse

Sciatica

This prolapse of the disc may cause pressure on nerves that pass from the spine to go to the leg. This causes pain that is typically felt in the leg (sciatica), with accompanying back-ache. Further pressure on the nerve may lead to numbness in the leg with or without weakness in the muscles that nerve normally goes to.

Treatment

Although the majority of patients with this condition improve with bed rest and anti-inflammatory pain killers, a number of patients continue with symptoms. These patients may benefit from surgery to remove the disc.

The operation is carried out through a cut made in the lower back and is always under a general anaesthetic. The disc removal will relieve pressure on the nerve thereby relieving the sciatica. Generally there is a 70 – 80 % chance of relieving the sciatica with this type of surgery. Despite this, taking out the disc is not a good cure for back-ache which is due to wear-and-tear. Surgery cannot reverse the ravages of time !

Most patients after disc removal still have some residual back pain. This may be no more than a stiffness in the lower back first thing in the morning or it can occasionally be more troublesome and require treatment.

Most surgeons would agree that surgery when successful has a 50% chance of reversing numbness or weakness. Unfortunately, some of these symptoms may be due not only to pressure but to damage to the nerve by the disc. Under these circumstances, numbness or weakness may not be reversed even though the pressure has been taken off the nerve successfully. When a nerve recovers after surgery it does so only slowly . Nerves grow at a rate of one millimetre per week and there are thus a lot of weeks between the back and the foot!.

Post-operative care

Following surgery there will be a degree of discomfort in the operation site. This tends to be worst on the first post-operative night, but most patients are able to sleep because of the anaesthetic and also because you will be given strong pain-killing injections which will effectively relieve the discomfort. The second night is also sore and the third night tends to be bearable.

The day after the operation the nurses / physiotherapists will help you to get out of bed for a little walk to ensure that the circulation in your legs is not impaired. Usually by 3-5 days you will be able to get up out of bed unaided and you will be discharged home within a few days depending on progress.

During the post-operative period you will be advised not to sit for long periods of time. You should spend more time lying down or walking rather than sitting. A flexible rule might be to sit for no longer that 20 minutes at a time and then either lie down or walk a little.

You should also be seen and advised by the ward physiotherapist before discharge. If this does not happen please ask the nurse to arrange this – it is important!

Return home

Whatever transport you arrange it is best to avoid long journeys sitting when you go home. If you are going by car, recline the seat as much as possible and have a small cushion in the small of you back to give support.

The same rules apply at home as in hospital at least for the first two weeks after your return home. Do not sit for more than 20 minutes at a time but lie down or walk in between spells of sitting. This is because there may be a tendency to slouch forwards causing stretching of the operation site and the scar tissue in the area may be weakened.

Approximately three weeks after surgery swimming is recommended. Don’t start by doing twenty lengths! The first time only do ten minutes gentle stretching of the back and come out of the pool. The next time (perhaps 2 days later) do the same gentle stretching moving the legs backwards and forwards and from side to side with one width of breast stroke or back stroke. Build gradually on this to aim eventually at 20 minutes of swimming each time you go. This exercise 2-3 times per week will strengthen the back muscles and brace the site of the disc prolapse and surgery. Having achieved this there is no reason to stop – many people swim up to the age of 80!

You will be reviewed in your consultants out-patient clinic , usually within 3-4 months. You should avoid driving for six weeks.

Return to work

Most people if their sciatica has resolved are fit to return to a sedentary occupation from six weeks to three months after surgery.

If your job involves stooping, bending, or heavy lifting it may be unwise to return to this kind of occupation. Surgery will not give you a new back but only relieves the pressure on the nerve in you back. There is therefore no guarantee that you will be any more fit for heavy work after surgery than you were before it. If in doubt do not return to work without discussing this with you own doctor or preferable your consultant. You can have many jobs but you only have one back and it has to last you the rest of your life!

A few tips

When you go home make sure that there is someone who can look after you for the first week or two. You will not be fit for shopping, cooking, cleaning or housework.

If the wound becomes red, sore, swollen or leaks any fluid or other matter consult your G.P. as this could be a sign of wound infection (this is rare but can occur) which could require a course of antibiotics. If in doubt ring the ward staff who will be pleased to advise you.

You should not be in severe pain on your return home. Severe pain means that you should be seen by your G.P. or by the hospital staff. The odd twinge in the leg after this kind of operation is commonplace and if you are doing too much you will get some back soreness which goes with a days rest lying down.