LUMBAR (BACK) SPINAL SURGERY

What is a lumbar laminectomy and discectomy?
Discectomy is surgery to remove lumbar (low back) herniated disc material that is pressing on a nerve root or the spinal cord.

It tends to be done as a microdiscectomy, which uses a special microscope to view the disc and nerves. This larger view allows the surgeon to use a smaller cut (incision). And this causes less damage to surrounding tissue.

Before the disc material is removed, a small piece of bone (the lamina) from the affected vertebra may be removed. This is called a laminotomy or laminectomy. It allows the surgeon to better see the herniated disc.

What is a lumbar instrumented fusion?
Spinal fusion is a surgical procedure used to correct problems with the small bones of the spine (vertebrae). It is essentially a "welding" process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.

Spinal fusion eliminates motion between vertebrae. It also prevents the stretching of nerves and surrounding ligaments and muscles. It is an option when motion is the source of pain, such as movement that occurs in a part of the spine that is arthritic. The theory is that if the painful vertebrae do not move, they should not hurt.

If you have leg pain in addition to back pain, your surgeon may also perform a decompression (laminectomy). This procedure involves removing bone and diseased tissues that can put pressure on spinal nerves.

Fusion will take away some spinal flexibility, but most spinal fusions involve only small segments of the spine and do not limit motion very much.

Preparing for surgery
Understand exactly what surgery is planned, along with the risks, benefits, and other options.

Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anaesthesia.

If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin/dispirin/grandpa be sure to talk to your doctor. We will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.

Your doctor will tell you which medicines to take or stop before your surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.

Inform your doctor/anaesthetist regarding if you are willing to receive blood transfusions if required.

Important to make your anaesthetist aware of any allergies/ previous anaesthesia reactions as well as habits such as smoking and alcohol intake.

Regarding any major surgery, you will be admitted the day prior to surgery for a full workup that includes routine blood, ordering blood for the procedure, starting pre-operative steroids and meeting the team, including physiotherapists/occupational therapists and nursing staff.

A steri-scrub will be provided for you to wash on the day of surgery.

Please do not shave your hair, as I usually attempt hair-sparing techniques if possible.

I often have a neuropsychologist examine you prior to surgery for a baseline report.

If you have an advance care plan, let your doctor know. Bring a copy to the hospital. If you don't have one, you may want to prepare one. It lets your doctor and loved ones know your health care wishes. Doctors advise that everyone prepare these papers before any type of surgery or procedure.

What happens after surgery?
All patients will be admitted post-surgery to ICU. For discectomy procedures usually involves an overnight stay for observations.

You may mobilise in bed overnight with limited periods in the upright position.

The following day the physiotherapist will assist with mobilising out of bed, and please avoid sitting for extended periods of time (2 hours) as this may risk re-herniation.

Post lumbar fusion patients recover slower and may require an extra day in ICU. Mobilising with the physiotherapist daily and encouraging muscle strengthening.

It is not uncommon to find it difficult to mobilise post lumbar fusion within the first few days, and the usual hospital stay ranges 3-10 days for adequate pain control and assistance

Surgical clips will be removed in the ward or by the wound sister day 10-14. Subcutaneous stitches may be used in certain cases. We will provide you with dressings that can be used daily at home. You may shower with the dressing as they are waterproof.

Patients are encouraged to follow up with the physiotherapist two weeks post-surgery for back strengthening and massage, and it is common to still have back pain/stiffness post-surgery as trigger point areas require intensive physiotherapy.

Patients are booked off from work. Usually, 3-4 weeks with a follow-up visit.

Please avoid any heavy exertion during the first few weeks and back straining activities.

I encourage to cut down on smoking/drinking alcohol as this retards healing, risks failed fusion and may lead to scarring around the nerve root, which will cause pain

What happens if I have a problem during the post-operative period before my follow up?
-All wound-related issues should be directed with the wound sister at the hospital as they are qualified to hand any minor issues. The wound sister will inform the doctor if this needs medical attention.

- Worsening pain not responding to medication must either be directed at your GP or to the emergency department at the hospital as this will speed up communication to the neurosurgeon with regards to an urgent consult.

- Repeat medication within the first month may be directed to my consulting rooms

- Any new neurological deficit or weakness must be urgently directed to the emergency department at the hospital at which the surgery occurred

- Any administrative/financial related questions may be sent to my consulting rooms via email/fax or telephone.

FAQ:

How long does lumbar spinal surgery take? How long does recovery take? Is lumbar spine surgery painful?