Lumbar Discectomy Surgery
Information about your procedure:
The intervertebral disc is the structure between the vertebrae (bones of the spine), which acts as both a spacer and a shock absorber. The disc is composed of two parts: a soft gel-like middle (nucleus pulposus) surrounded by a tougher fibrous wall (annulus fibrosus).
Following your recent MRI scan and consultation with your spinal surgeon, you have been diagnosed as having a lumbar disc protrusion, resulting in nerve root compression (trapped nerve) and leg pain (sciatica) . Very few people who have a disc problem need surgery. In general, if a patient’s leg pain due to a lumbar disc protrusion is going to get better, it will do so in about 6–12 weeks. However, if the symptoms have not resolved following conservative measures (manipulation, physiotherapy, medication or injections) surgery may be necessary. Immediate spinal surgery is only necessary in cases of bowel or bladder incontinence (cauda equina syndrome) or progressive neurological problems (numbness, weakness).
About the procedure
The operation is carried out under general anaesthetic, through an incision in the midline of the lower back. We are then able to enter the spinal canal by removing a membrane over the nerve roots (ligamentum flavum). Often, a small portion of bone is removed both to enable access to the nerve root and to remove pressure on the nerve. The nerve root is then gently moved to the side and the disc material is removed from under the nerve root. The disc is then entered, to remove any loose fragments of disc material within it . Good relief from leg pain following this type of disc surgery occurs in approximately 85–90% of cases. However, relief from back pain is less reliable.
Risks and complications
Risks are rare but include the following:
Damage to the nerve root and the outer lining which surrounds the nerve roots (dura). This is reported in < 5% of cases. It may occur as a result of the bone being very stuck to the lining and tearing it as the bone is lifted off. Often the hole or tear in the dura is repaired with stitches or a patch. This could result in back or leg pain, weakness or numbness, leaking from the wound, headaches or, very rarely, meningitis.
Ongoing back pain
Recurrent sciatica. This can occur as a result of scarring or further disc protrusion, occurring in approximately 5% of people, up to ten years later
Superficial wound infections may occur in 2 – 4% of cases. These are often easily treated with a course of antibiotics. Deep wound infections may occur in < 1% of cases. These can be more difficult to treat with antibiotics alone and sometimes patients require more surgery to clean out the infected tissue.
Bleeding; you must inform your consultant if you are taking tablets used to thin the blood, such as warfarin, aspirin or clopidogrel.
What to expect in hospital
Immediately after the procedure you will be taken on your bed to the recovery ward where nurses will monitor your blood pressure and pulse. Once back on the ward and when you are fully awake you will be allowed to get out of bed.
You will normally be discharged home with simple analgesia on the same day or the day after your operation, when you and your nurse are happy with your mobility and basic observations. Please arrange for either a friend or relative to collect you from the hospital, as driving yourself or taking public transport is not advised for 48 hours after the anaesthetic. A responsible adult should remain with you overnight.
In general, you may return to work in 3-4 weeks provided that you are comfortable. We will provide a sick note at your request on the day of the procedure, if necessary.
Normally between 2 to 4 weeks