Lumbar Spine Surgery

Overview

The majority of lower back discomfort may be addressed without surgery. Nonetheless, back surgery is sometimes a realistic or essential choice for treating major musculoskeletal problems or nerve compression.

 

How is the spine constructed?

The spine is made up of two parts: the spinal column, which is made up of bones (your back bone), and the spinal cord, which is made up of nerves that carry information from your brain to your body and back again.

• The spinal column

The spine is made up of tiny bones called vertebrae that are stacked on top of each other to form the spinal column. The vertebrae become bigger as they progress down the spinal column, with the lumbar (lower back) region having the largest.

Intervertebral discs prevent these bones from rubbing against one other. These are soft tissue cushions that sit between each of the bones in your spinal column and function as shock absorbers, preventing the bones from grinding against each other.

The ligamentum flavum is a strong band of elasticated tissue that connects the bones in the spine and serves to stabilize them. The dura mater, a thin layer of tissue that protects the spinal cord and nerves, contains the fluid that surrounds the nerves and spinal cord.

The spinal column is extremely strong and flexible, and it is maintained in place by a number of structures. The cervical (neck) and Lumbar (lower back) regions are more prone to issues since they move the most to allow us to move our heads and bend and stretch in the lower spine.

The spinal cord is made up of millions of nerve fibers that pass through the center of your spinal column. Your spinal cord and the nerves that comprise it function similarly to a telephone exchange, transmitting information from your brain to your body and back. Your spinal cord sends out one nerve on the right side and one on the left side at the level of each bone (vertebra). Hundreds of nerve fibers in these nerves convey data between your body and brain.

 

Why do we perform spinal surgery?

Surgery for spinal column, spinal cord, and/or nerve issues can be performed for a variety of reasons. In general, you will have been advised to:

1.  Give you relief from pain
2. Stop any further deterioration in the feeling and/or function from below your waist and more often in your legs.
3. Give you a chance of making some recovery from any symptoms.

The major goal of surgery is to remove whatever is putting pressure on the nerves (e.g., bone overgrowth, thicker ligaments) and to help you relieve your pain and leg symptoms (70-80% likelihood of recovery). It is also critical that you realize that spinal surgery is frequently undertaken in order to treat your leg problems and avoid further worsening in mobility or feeling. Movement and sensation cannot always be improved.

If nerves and/or the spinal cord have been damaged, frequently over a lengthy period of time, the damage to the nerves or spinal cord may be irreversible, even surgery to correct the condition. This is why weakness, numbness, and other symptoms may persist. Any symptom recovery will often take time, and can take several months to manifest.

The surgery is not for your back discomfort, but rather for your leg issues. The information below will assist you comprehend what we are giving you and why. Please keep in mind that agreeing to surgery is entirely your choice. You have the right to alter your mind at any time; if you need more information, please ask a member of the staff.

 

What is Lumbar Spine surgery?

Lumbar surgery encompasses any procedure performed on the lumbar spine, or lower back, between one or more of the L1-S1 levels. The most common surgical procedures for the lower back are divided into two types of lumbar spine surgery:

 

Lumbar Decompression

Decompression is a surgical treatment used to relieve discomfort caused by pinched nerves (neural impingement). A tiny amount of the bone above the nerve root and/or disc material from under the nerve root are removed during lumbar decompression back surgery to offer the nerve root more room and a better healing environment.

There are two common types of spine surgery decompression procedures:

• Microdiscectomy

A microdiscectomy (microdecompression) is commonly used to treat lumbar herniated disc discomfort. The procedure is regarded trustworthy for leg discomfort produced by a herniated disc, which is frequently referred to as sciatica by patients and radiculopathy by medical practitioners.

• Lumbar Laminectomy

A lumbar laminectomy (open decompression) is commonly used to treat discomfort caused by lumbar spinal stenosis. The surgery's purpose is to provide more room for the nerve root, relieving discomfort (and maybe any limb weakness or neurological symptoms) and restoring the patient's ability to engage in daily activities.

Aside from the disorders listed above, a number of lumbar spine issues can induce nerve pinching, which can be corrected by lumbar decompression surgery. These include situations like:

• Isthmic or degenerative spondylolisthesis
• A synovial cyst or a fracture with bone filling the spinal canal
• A spinal tumor (rarely)

 

Alternatives to Microdiscectomy and Laminectomy

While the aforementioned two techniques are regarded the gold standard for surgical spine decompression, there are a few variants and/or alternatives available. As an example:

• Corpectomy - To decompress a canal, the vertebral body might be removed by an anterior incision. The procedure entails removing a portion of a vertebra in order to decompress or alleviate pressure on the spinal cord and/or spinal nerves. This operation is most usually utilized in cervical surgery, however it can also be performed in the thoracic spine on occasion. Except in situations of malignancies or fractures, it is nearly never required in the lumbar spine.
• Laminotomy - This procedure is similar to a laminectomy, with the difference that a hole is cut in the lamina (as opposed to removing the entire lamina).
• Interspinous process spacer - The purpose of interspinous process spacer surgery, a less invasive alternative to laminectomy, is to ease spinal stenosis symptoms.

Furthermore, fresh techniques are always being developed. Patients should carefully examine novel treatments because there is less data available on their efficacy and long-term effects.

 

Lumbar Fusion

Spinal fusion is a surgical treatment used to treat abnormalities with the spine's tiny bones (vertebrae). It is, in essence, a welding process. The main concept is to fuse two or more vertebrae together such that they recover into a single, solid bone. This is done to eliminate uncomfortable movements or to restore spine stability.

Only when your doctor can establish the source of your discomfort is spine surgery typically indicated. Your doctor may employ imaging tests such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans to do this.

Spinal fusion may help relieve symptoms of many back problems, including:

• Degenerative disk disease
• Spondylolisthesis
• Spinal stenosis
• Scoliosis
• Fractured vertebra
• Infection
• Herniated disk
• Tumor

Spinal fusion removes mobility between the vertebrae. It also keeps nerves, ligaments, and muscles from being stretched. It is a possibility when mobility causes discomfort, such as movement in an arthritic or unstable portion of the spine caused by accident, illness, or the natural aging process. if the troublesome vertebrae do not move, they should not cause pain.

If you suffer leg or arm discomfort in addition to back pain, your surgeon may recommend a decompression procedure (laminectomy). This treatment involves the removal of bone and sick tissues that are pressing on the spinal nerves.

Fusion will reduce spinal flexibility; however most spinal fusions involve relatively minor parts of the spine and do not significantly impede mobility. The vast majority of patients will not experience a reduction in range of motion. Your surgeon will discuss with you if your specific treatment may affect your spine's flexibility or range of motion.

 

Pre-operative assessment

If your pain or symptoms change, or if you develop new medical issues or become ill, it is critical that you contact spinal nurses or your consultant's office as soon as possible, but certainly before you arrive for your admission.

To get the information, we must assure your safety during your operation; thus, once you have agreed to surgery, you will be needed to complete an online pre-operative evaluation. You will be given all of the information you need to finish this. One of the pre-op nurses will evaluate the information you give. After this, you will be called to discuss the following stages that will apply to you and the surgery you are having.

Some people will simply need to come in to have blood drawn for testing and regular swabs done. Some patients will need to be called to confirm medical data, while others will need to come into the clinic to be seen and evaluated.

It is critical that you fill out your pre-operative questionnaire completely and precisely, since incorrect information may cause your operation to be delayed.

If you do have to attend for an assessment it may include:

1. A member of the team will go through your medical history with you (including previous procedures and any medical issues you may have) and evaluate you.
2. An Anesthetist may examine you; he or she will speak with you, discuss any relevant medical history, and explain what getting an anaesthetic entails.
3. Some blood tests will be done on you.
4. If any x-rays or a heart trace (ECG) are required these will also be done.
5. Your medicine may be recommended; please bring any medications you are taking or a list of your medications and doses with you. It is critical that you inform us about all of your medications, including prescriptions, over-the-counter medications, and herbal therapies. It is critical that you inform us of any medications that may cause your blood to thin.

An appointment will be organized for you and sent to you if you are required to attend for this.

Some patients may not have any form of pre-operative assessment. This can happen for a variety of reasons, such as being hospitalized hurriedly or as an emergency and not having the time to complete all of this. This is not an issue because everything you require will be completed the day you are accepted. In this case, your procedure is usually scheduled for the next day. You will not be able to return home overnight.

Please be patient as we complete all of our evaluations. It is critical that we finish everything to assure your safety. We may need to postpone surgery if your pre-operative examination reveals that more tests or assessments are required before proceeding with your operation. 

 

Recovery

• Pain Management

You will have some discomfort following surgery. This is a normal component of the recovery process. Your doctor and nurses will attempt to lessen your discomfort, which will allow you to recuperate from surgery more quickly.

Medications are frequently recommended for short-term pain management following surgery. Opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics are among the medications available to assist control pain. Your doctor may prescribe a combination of these drugs to alleviate pain and reduce the need for opioids.

Although opioids can aid with pain relief after surgery, they are a narcotic and can be addicted. Opioid addiction and overdose have emerged as important public health concerns in the United States. It is critical to only use opioids as prescribed by your doctor and to discontinue them as soon as your pain begins to improve. Consult your doctor if your pain does not improve within a few days following your procedure. If you are currently taking narcotics prior to surgery, discuss your postoperative pain regimen with your physician before your treatment.

• Rehabilitation

The fusing process is time-consuming. Although it may take many months for the bone to solidify, your comfort level will usually improve considerably sooner. The fused spine must be kept in perfect alignment during this healing period. You will learn how to move appropriately, adjust yourself, sit, stand, and walk.

Your symptoms will progressively improve, as will your level of activity. Your doctor may advise you to undertake only mild activities, such as walking, immediately following your procedure. You will be able to gradually raise your activity level as you regain strength. Physical therapy is usually begun six weeks to three months after surgery. Your surgeon will discuss with you whether physical therapy is required in your case.

Maintaining a healthy lifestyle and following your doctor's orders can considerably improve your chances of success.

 

Minimally Invasive Spine Surgery

The purpose of minimally invasive spine (MIS) surgery is to stabilize the vertebral bones and spinal joints and/or alleviate pressure on the spinal nerves, which is typically caused by problems such as spinal instability, bone spurs, ruptured discs, scoliosis, or spinal malignancies.

Minimally invasive spine surgery can be quicker, safer, and require less recovery time than open spine surgery. Because there is less stress to the muscles and soft tissues (in comparison to open treatments), the possible advantages are as follows:

• Better cosmetic results from smaller skin incisions (sometimes as small as several millimeters)
• Less blood loss from surgery
• Reduced risk of muscle damage, since less or no cutting of the muscle is required
• Reduced risk of infection and postoperative pain
• Faster recovery from surgery and less rehabilitation required
• Diminished reliance on pain medications after surgery

Furthermore, certain MIS operations are conducted as outpatient procedures with just local anaesthetic, reducing the risk of an unfavorable reaction to general anesthesia. As with every surgical operation, no matter how minor, there are dangers involved. These hazards include, but are not limited to:

• Possible adverse reaction to the anesthetic
• Unexpected blood loss during the procedure
• Localized infections, no matter how small the incision area

And, while it is unusual, there is always a potential that the initial MIS surgery would fail, necessitating either a second treatment or full open surgery.

 

What are the major differences between traditional spine surgery and minimally invasive spine surgery?

The anatomy is completely exposed in traditional open spine surgery. Surgeons expose less of the anatomy during minimally invasive spine surgery, which means an earlier recovery in the first few weeks following surgery in many circumstances. Extra surgical tools are frequently employed, such as intraoperative spinal navigation, in minimally invasive spine surgery. This allows the surgeon to see more clearly into surgical regions with less exposure.

Patients often recover faster after minimally invasive surgery; however, not every patient or surgical condition is acceptable for minimally invasive surgery. It is critical that you collaborate with your spine surgeon to choose the optimal treatment choice for your problem.

 

What are the risks?

All of the risks will be addressed with you before to your operation, and while they are uncommon, you should be aware that they are possible.

1. Risk from anesthesia (being put asleep for your surgery)
2. Skin damage, eye issues, and, in extreme cases, blindness might result from placement during surgery and the instruments utilized. During surgery, special gel pads/protection are utilized to reduce the likelihood of these problems. Diathermy pads, which are adhesive pads put on the skin, commonly on the thigh area, are used to minimize heat build up, which can cause skin irritation and, in extreme circumstances, skin burn.
3. Small risk of increased pain in back or leg, or no improvement in leg pain/symptoms.
4. Nerve damage is rare (less than 1%), however it is more likely in individuals undergoing recurrent surgery (10%). This can result in limb weakness or numbness, as well as issues with bladder, bowel, and sex organ function. In severe cases, this might result in paralysis from the waist down, but this is extremely unusual.
5. A rupture in the lining that protects the nerve roots causes a leak of spinal fluid, which happens in less than one in every 100 individuals. Stitches, a patch, or special adhesive are used to fix this. The worst-case situation is that additional surgery is necessary to correct the leak, which is exceedingly rare (0.05%) and more prevalent in repeat surgery. This can result in headaches and illness, as well as infection in the CSF fluid in very rare circumstances (meningitis). A leak may need further surgery to correct with sutures, glue, or a patch.
6. Infections, such as superficial wound infections, can occur in around four out of every hundred patients and are readily treated with medications. Deep wound infections occur in less than one out of every 100 patients, but they might necessitate further surgery and lengthy antibiotic regimens. MRSA bacterium infection is a danger of infection (infection with MRSA is very rare). Any infection can lead to Sepsis, however this is extremely rare. Those with compromised immune systems, diabetes, or using steroid medication are especially vulnerable to surgical infections.
7. Wound drain issues necessitating removal in theatre while under anesthesia, which is quite unusual.
8. Bleeding or hematoma (blood collecting) may necessitate a second procedure in very rare cases.
9. Deep vein thrombosis (DVT) or pulmonary embolus risk (PE), To lessen the danger, we utilize special surgical stockings and blood thinning injections when necessary.
10. Worsening of symptoms

 

Conclusion 

If you’ve struggled with back pain for any length of time, you may be wondering if lumber spine surgery is your only treatment option. Sometimes, surgery is the only treatment. Spine surgery may be recommended if non-surgical treatment such as medications and physical therapy fails to relieve symptoms.