Discectomy

The operation you are going to have is called a discectomy and is designed to relieve the pressure from the nerve. The part of the disc that is pressing the nerve will  be removed.

During the operation you will be asleep and  lying on your tummy supported by a frame. Under x-ray control the level of surgery will be confirmed. A small incision about 2" long is made in the skin. After retracting the muscles a small window is made in the spinal canal. The nerve root is retracted and part of the disc is removed.
The nerves are washed and the wound is closed.

The operation takes about 40-60 minutes.

Following surgery you should experience relief of leg pain quite quickly.

The chances that surgery will help your leg pain are around 90%. The chances that it will relieve your back pain are about 50%. Following successful surgery you may still have some residual symptoms in your leg and back. Surgery is better at relieving your leg pain than your back pain.

Risk of Surgery

There are risks of surgery that you need to understand. Very rarely you could die from an anesthetic and be paralysed from spinal surgery. It's similar to driving a car and dying in a car crash. It happens very rarely, but if you never want the risk of dying in a car crash then you would not drive a car.

The nerve root could be damaged during surgery; you could have a leakage of spinal fluid or have a wound infection after surgery. The chances of these complications are between 2 and 4%.

If you do have a major complication there is chance that you may be worse off than you are now and you need to understand this before making a decision to go ahead with surgery.

The benefits of having surgery

Your age, your general health and the severity of the damage to your spinal nerve as well as your attitude and your willingness to work at recovery will determine your level and speed  of recovery.

When you consider your options, keep in mind the impact your condition has on your way of life and carefully weigh the risks and benefits of having surgery against the risks and benefits of not having surgery. The decision is yours.

If you decide to have surgery approach it with a positive mental attitude and with full confidence that you have made the right decision. While the surgical team concentrates on finding and removing the cause of your pinched nerve, you must concentrate on the recovery process. Co-operate fully with him and focus on the improvements you will make in the future, not on the problems on the past.

Post operative care

You will get up and walk after a few hours and be able to walk home after surgery.

You will have various IV lines "drips" in and you will be offered some form of post operative pain relief.

This may take the form of patient controlled analgesia (PCA). With this system you in control of the amount of relief you get and when you get it. You can press a button and a machine will automatically inject the painkiller into your blood stream. It is computer controlled so you are unable to receive an overdose.

A small percentage of patients do develop increasing back pain after disc surgery in the long term.
It is difficult to predict initially whether you will fall into this category. Taking part in a post operative rehabilitation program and working at it conscientiously will reduce the chances of this happening.
If it does happen you may need further surgery to stabilise your lumbar spine.

The scar on your back should heal and initially it will be quite red, but gradually it will become quite pale.

During the recovery process you may get occasional cramping pain in the leg and this is normal.
Taking part in a self - help exercise regime following surgery will greatly improve and hasten your
recovery process.

Alternatives to Surgery:

This will be discussed with you by your surgical team. Doing nothing is an option if you have no buttock numbness or bladder problems. 50% of patients  improve on their own in 3 months.

An epidural injection or nerve root block may provide temporary relief.

Evidence suggests that   the best results are obtained from surgery within 6 months of onset of symptoms.

Surgery is now generally quite safe and the outcomes predictable .

Preparing for surgery

If you are taking any drugs like Warfarin which can increase bleeding during surgery you need to let us know so we can make provision.

If you are on the oral contraceptive pill please talk to us because it does increase the risk of a blood clot in the leg and we may advise you to stop taking it about 3 - 4 weeks prior to surgery.

You must stop smoking  before surgery and up to 6 months afterwards.
Surgery is known to reduce the rate of bony fusion and also has a role to play in developing chronic back pain.

Smoking also increases the risk of getting a lung infection after surgery.

It is also important that you be relaxed and have a positive attitude to recovery.
The more motivated you are the better and faster will be your recovery after surgery.

Discharge Care

You should probably not drive for the first 1  week following surgery. The important thing is to keep active and mobile and not be in one position for too long a time. Certainly prolonged bed rest is not recommended.

The healing and recovery process

Recovery is the process during which you work at becoming well. You must commit yourself to staying good health (exercising, maintaining a positive mental attitude and following your surgeons instructions).

Recognise that healing and recovery will not happen overnight. It is a process. Be patient and persistent. During the recovery period in the hospital and at home, try to rebuild your strength
gradually. Rest when you fell fatigued, but be persistent in your efforts.

It is important for you to recognise that we all heal at a different rate. The speed at which you will recover depends in part on your age, your general level of health, your overall physical fitness and your mental attitude. Generally, you will heal more slowly if you are overweight, out of shape or smoke or if you are a Diabetic or have other pre-existing medical problems.

About 6 weeks post surgery you should begin a program of spinal exercises. The aim is to improve your aerobic fitness and the strength of your muscles around your spine. Because these muscles have not worked for a long time you will find that your back aches following these exercises. This is quite normal and is
similar to muscles aching after say a long run. You should not let this muscle pain stop you from exercising.
As you gradually improve your exercise quota you will find that the pain does resolve. Some patients who do not follow this advice do not achieve all the potential benefits following this surgery.

It is also important to plan to resume activities you enjoy doing post surgery. If you are working it is important to plan try and return to some form of employment after surgery. Setting yourself goals and then trying to achieve them is an important part of the recovery process.

WORK

You should be able to return to work 2-4 weeks after surgery.

Medication

You should also try and reduce the amount of painkillers you use after surgery. It is quite common to have developed some form of addiction to taking painkillers because you have had pain for so long.
This may be habitual or activity caused by the drugs themselves. It is important to recognise this and try and gradually reduce the amount of painkillers you require with the aim of actually stop taking them altogether. You may experience some mood swings in the first few weeks following surgery and this is also
quite normal and is only a temporary phenomena.