Surgery :: Anterior lumbar interbody fusion :: Anterior Cervical Decompression Fusion
Lumbar Disc Replacement :: Posterior Cervical Spine Surgery :: Spinal Deformity Surgery
Lumbar Decompression and Fusion :: Surgical Risks :: FAQ
Anatomy of the Spine
The spine consists of 33 bony blocks called vertebrae stacked one above the other with a soft intervertebral disc between each pair of vertebrae. The intervertebral disc consists of a soft jelly-like substance called the nucleus pulposus in the center, which is surrounded by multiple layers of collagen called the annulus fibrosis (like an onion). The disc connects and allows movement between vertebrae and acts as a shock absorber for the spine. The vertebrae surround and protect the spinal cord and nerve roots.
What is a disc prolapse?
This is also referred to as a slipped disc or disc herniation. The soft central portion of the disc (nucleus pulposus) tears through the surrounding layers (annulus pulposus) and compress nerves extending from the spinal cord. This compression on the nerves causes pain in the legs (sciatica), which increases on bending forwards, coughing and sneezing. Numbness, pins and needles, and muscular weakness in the legs may also be present. Rarely, there can be difficulty in passing urine and stools. The presence and severity of these symptoms vary from person to person.
About the surgery
Anaesthesia: The surgery is usually performed under a general anaesthetic, with the patient lying face down.
Procedure: The surgeon makes a 2.5-5cm incision in the skin over the affected area of the spine. The muscle is detached from the bone to reveal the laminae, which are the portion of the bony vertebrae that lies behind the spinal cord. A portion of the lamina is removed (laminotomy) along with the surrounding ligaments to expose the prolapsed disc. Occasionally, the whole lamina has to be removed (laminectomy) to access the disc. The bulging parts of the intervertebral disc, along with adjacent loose disc fragments, are removed. The resultant space is not filled with any material but is eventually filled with scar (fibrous) tissue. A drain tube removes the blood that collects at the surgical site.
Skin sutures: Dissolvable sutures are used to close the skin. These will dissolve as your wound heals, however, the ends of the suture on either end of the incision will need to be cut on your first visit to the surgeon's office (7-10 days after surgery).
In the recovery room: Following surgery, you will be transferred to the recovery room and may feel some pain at the operated site when you wake up. A patient controlled analgesia (PCA) pump will be provided which releases a small dose of pain medication every time you press the button thereby putting you in control of your pain. You will be given intravenous fluids to keep you hydrated and a urinary catheter will empty your bladder. When the medical staff in the recovery room are confident that you are comfortable, you will be transferred to your room.
In the ward: You will be allowed to drink sips of fluids after surgery and gradually progress to a full diet. The day after surgery, the drain tube, urinary catheter and pain pump will be removed and you will be encouraged to walk wearing a brace to support your spine. You will stay in the hospital for 1-3 days and your surgeon will decide when you can go home.
Pain relief: Medications will be provided to reduce your pain after surgery and at home for the first 1-2 weeks. However, if you have excessive pain while you are in the hospital, the attending nurses should be informed.
Results after surgery
Eighty to eighty-five per cent of patients have a good outcome after a lumbar disc surgery. While there is considerable relief of the leg pain after surgery, the pins and needles, numbness and weakness in the legs may take 3-6 months to resolve, depending on the duration and severity of nerve compression. If the compression has occurred for a long period, complete resolution of the abnormal sensations and weakness may not occur. There is also a 5-10 % incidence of recurrent disc herniation at the same level after surgery.
Are there any risks involved in disc surgery?
All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. The risks may be associated with the anaesthesia given or the surgical procedure. Surgical complications can include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine or injury to the nerve tissue or its surrounding protective layer.
Injury to the nerves may occur during surgery resulting in paralysis of certain muscles in the legs and loss of sensations. Loss of bowel and bladder control can also occur following nerve injury. An injury to the covering layers of the nerves (dura) can result in leakage of spinal fluid and may occasionally require a repeat surgery to control the leak.
Although antibiotics are given before and after surgery, there is a 1-5% incidence of wound infection. Superficial infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other region (urinary bladder, chest and skin) immediately prior to surgery, you may be at a higher risk of post-operative infection in the spine, so let your surgeon know.
Venous thrombosis (DVT: clotting of blood in your calf muscles) and pulmonary embolism are uncommon after an elective spine surgery, particularly when you are out of bed and walking within 24 hours after surgery. We use calf compressors and TED stockings to prevent the clotting of blood in legs; we do not routinely use medications. However, if you have had an episode of DVT in the past, let your surgeon know.
There are certain warning signs you should look for after surgery that may indicate a problem, such as excessive bleeding, redness or discharge from the wound, fever, weakness or numbness of the legs or problems urinating. If you notice any worrisome symptoms, notify your surgeon at once.
Talk to your surgeon
This is a brief overview and does not contain all the known facts about your condition and the surgery. Feel free to seek any clarifications from your surgeon and his or her team. It is important for you to obtain a clear understanding of the surgery and potential risks and benefits before you sign the consent form.