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Back surgery

Published by Bupa's health information team, May 2008.

This factsheet is for people who are planning to have routine back surgery, or who would like information about it.

Back surgery is usually done to relieve pressure on one or more nerves in your spine (backbone).

Your care and the type of treatment you have will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

• About the back
• What puts pressure on the nerves?
• Symptoms
• Diagnosis
• What are the alternatives to back surgery?
• Preparing for your operation
• About the operation
• What to expect afterwards
• Recovering from back surgery
• What are the risks?
• Further information
• Questions and answers
• Related topics
• Related Bupa products and services
• Sources

About the back

The spine (or backbone) is made up of about 29 bones (called vertebrae) which are linked together. Muscles and ligaments provide support for the spine. The spine forms a channel called the spinal canal, through which the spinal cord and spinal nerves run. These nerves branch off in pairs from spaces between the vertebrae to specific parts of the body. Cushions of tissue, called discs, sit between the vertebrae and allow the spine to move.

Back surgery is usually done to relieve pressure on one or more nerves running between the vertebrae.

The different parts of the spine

What puts pressure on the nerves?

Common conditions that lead to nerve compression include:

• disc prolapse/herniation (or "slipped" disc) - this is when a disc bulges out from between two vertebrae
• spinal stenosis - this usually happens when the cartilage in the vertebrae becomes worn or inflamed and the spinal canal becomes narrow
• spondylolisthesis - this is when one of the vertebrae slips forward and out of position

Symptoms

Whatever the cause, pressure on the nerve roots in the spine interferes with the traffic of nerve signals to and from the brain. Nerve compression can lead to sciatica. Sciatica is the name given to a set of symptoms that include:

• pain (this may be felt in the lower back, buttock, and/or various parts of the leg and foot)
• loss of sensation
• pins and needles
• muscle weakness
• muscle wasting

Diagnosis

Back surgery is usually only recommended if your back problem is affecting your mobility and other treatments haven't helped. Your GP will refer you to see an orthopaedic surgeon (a doctor specialising in bone surgery).

Your surgeon may use X-rays and magnetic resonance imaging (MRI) or computerised tomography (CT) scans to check the exact nature of your back problem. X-ray images are good at showing problems with the bone. MRI and CT scans are much better at showing damage or injury to nerves and other soft tissue.

What are the alternatives to back surgery?

Some of the most common treatments for chronic back pain or sciatica are listed here.

• Epidural injections - local anaesthetic and steroids are injected into the epidural space that surrounds the spinal cord. Steroids help reduce inflammation.
• Transcutaneous electrical nerve stimulation (TENS) - a small battery-powered device releases mild electric pulses to block pain signals in the spine.
• Acupuncture - this stimulates certain nerves in the muscle and tissues to change the way pain and other sensations are processed in the spinal cord.
• Spinal mobility exercises - exercises such as pelvic tilt, knee roll and bridging can help improve pain and function by strengthening the muscles and ligaments in your lower back.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

Back surgery usually requires a hospital stay of five days and is done under general anaesthesia. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

You will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the operation

There are different types of back operation and the type of procedure you have depends on the cause of the pain. Your surgeon will explain the procedure that is suitable for you. Sometimes, more than one procedure is done during a single operation.

Your surgeon may do the operation using open or keyhole surgery. Open surgery involves making a large cut on the back. Keyhole surgery involves making several cuts on your back and using a thin long microscope and special instruments to do the operation.

Discectomy

The soft centre of the disc that is damaged or protruding is removed to take the pressure away from a spinal nerve.

Laminectomy

The bony coverings (the lamina) of the spine are removed to widen the entire spinal canal through which the spinal nerves pass.

Foraminotomy

Parts of the lamina and the facet joints are removed to widen the gap in the side of the spine through which spinal nerves pass.

Stabilisation surgery

The lamina is cut away and the spine is fused back together. Screws are fixed into the spine under X-ray guidance. The screws are joined up with rods and wires. Bone from your hip, or metal implants or plates may be used to hold the spine together. This is a major operation and full recovery can take several months.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may have a catheter to drain urine from your bladder into a bag. You may also have tubes running from the wound. These drain fluid into another bag and are usually removed after a day or two.

You can begin to drink and eat, starting with clear fluids, when you feel ready.

You may be given a corset to wear that will support your back. You may also be given a soft collar to help support your head if the operation was performed near your neck.

You will need to spend some time resting in bed. The exact length of time depends on the procedure. You may be able to walk on the day of the operation, or during the next few days depending on your surgeon's advice.

Starting from the day after your operation, a physiotherapist will usually visit you daily to guide you through exercises to help your recovery.

You will stay in hospital until you are able to use stairs and sit comfortably for about 10 minutes. This will usually be around five days after your operation.

Your nurse will give you advice about caring for your back, hygiene and bathing before you go home. You may be given a date for a follow-up appointment with your surgeon.

Recovering from back surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information that comes with the medicine and ask your pharmacist for advice.

The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's essential that you continue to do them. You should gradually increase the amount of walking and sitting you do. You will usually be able to move around your home and manage stairs.

There are certain movements that you shouldn't do in the first six weeks. For example, you shouldn't bend, twist or stretch your back or do any lifting.

Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort.

You can usually return to work after six to eight weeks. But you may need to stay off work for three months if your work involves a lot of standing or lifting.

What are the risks?

Back surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic. You will feel some pain in your back and possibly in your legs. This may last a few weeks.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Complications may require further treatment such as returning to theatre to stop bleeding or antibiotics to deal with an infection.

Complications of back surgery will depend on the exact type of back operation you are having. Possible complications of back surgery are listed here.

• Spinal cord or nerve damage - this is very rare, but if it happens it can lead to numbness, loss of muscle control, impotence, pain or paralysis. You may temporarily lose control of your bladder or bowel movements.
• Persistent pain - you may not be completely free of pain or the pain may be worse.
• Implant failure - the screws or implants may come lose and you may need further surgery.
• Re-occurrence - a "slipped" disc can re-occur.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain the type of complications specific to your procedure and how these risks apply to you.

Further information

• BackCare
  0845 130 2704
  www.backpain.org

Related topics

• Acupuncture
• Compression stockings
• Epidural for back pain
• Physical activity
• General anaesthesia

Sources

• Jayson M (ed). Understanding back pain. The British Medical Association. Family Doctor Publications, 2001
• van Tulder M, Koes B. Low back pain (chronic). ClinicalEvidence. www.clinicalevidence.bmj.com, accessed 26 February 2008
• Epidural and back pain. Backcare - The charity for healthier backs. www.backpain.org, accessed 26 February 2008
• TENS pain relief for back pain. BackCare - The Charity for Healthier Backs. www.backpain.org, accessed 26 February 2008
• Medical acupuncture. BackCare - The Charity for Healthier Backs. www.backpain.org, accessed 26 February 2008
• Exercise for a better back. BackCare - The Charity for Healthier Backs. www.backpain.org, accessed 26 February 2008
• Gibson JNA, Waddell G. Surgical interventions for lumbar disc prolapse. The Cochrane Database of Systematic Reviews. www.cochrane.org, accessed 26 February 2008
• Back surgery. Backcare - The charity for healthier backs. www.backpain.org, accessed 26 February 2008
• Ostelo RWJG, de Vet HCW, Waddell G et al. Rehabilitation after lumbar disc surgery. Cochrane Database of Systematic Reviews 2002, Issue 2. www.cochrane.org, accessed 26 February 2008
• Possible Complications of Spine Surgery. www.allaboutbackandneckpain.com, accessed 27 March 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2008.