Lumbar Decompression and Fusion
Lumbar decompression and fusion is indicated for patients with spinal stenosis - a condition in which spinal nerves are compressed commonly by age related 'degenerative' changes in the lumbar spine. When the nerves are under compression pain is experienced typically in the buttock and posterior legs (thigh and calf). Often it is made worse with standing and walking distances and relieved by sitting or leaning over a bench or supermarket trolley.
Lumbar 'decompression' involves removing the structures that are compressing the nerves, typically thickened spinal ligaments, enlarged spinal joints and disc bulges. 'Fusion' involves inserting screws and rods to prevent abnormal movement at these operated areas.
Answers to common questions pertaining to lumbar decompression and fusion surgery are outlined below. It should be made clear that not all lumbar decompressions and fusions are the same. There is a wide range of surgical tactics and often the procedure needs to be performed on multiple adjacent regions increasing the surgical complexity. The recovery and expected outcomes are more variable with these more extensive cases.
Where will my surgery be performed?
The operation will be performed at St Georges Hospital. We will send out a preadmission pack for you to complete prior to your scheduled date.
Do I need to stop any medications prior to surgery?
If you are taking medications that affect your bleeding tendency like aspirin, warfarin, clopidogrel or dabigatran these may need to be discontinued at least 5 day prior to surgery. Please advise my personal assistant (Amanda) if this pertains to you. Other medications should be taken as normal.
The Day of Surgery
How long prior to surgery do I need to avoid food or drink?
You will need to stop eating and drinking (other than water) 6 hours prior to your surgery. You should stop drinking water and chewing gum 2 hours prior to your surgery.
What type of Anaesthetic is given?
In all patients a general anaesthetic is given meaning you will be completely asleep for the duration and will have no memory of the procedure.
How long will the operation take?
The surgery typically takes between 3 to 4hrs but more extensive cases may take longer.
You will be looked after in the recovery area for a further 60 - 90 minutes after the surgery has finished until the effects of the anaesthetic wear off before you return to the ward.
How long will my scar be?
It depends entirely on the extent of surgery planned. In almost all cases there is a single wound located in the middle of your back around the belt line.
How long will I stay in hospital?
On average a 3 to 5 night stay in hospital is anticipated but gain this is dependent on a number of factors including the extent of surgery.
What are the risks of surgery?
While surgery has an excellent ability to improve your symptoms some risks exist.
- Wound infection (<3%)
Which may require antibiotics or if severe further surgery to irrigate the area.
In rare circumstances a haematoma may develop that causes pressure on the nerves. Surgery may be required to evacuate this in <1% of cases.
- Nerve damage
During decompression the spinal nerves are retracted to allow the bone and ligaments compressing the nerves to be safely removed. Infrequently this aggravates the nerve and results in worsening pain (<3%). Typically this quickly resolves. In <3% of cases a leak of spinal fluid may result from a hole in the nerve coverings. This is patched or stitched closed and other than a 24hr period when you are asked to lay flat in bed and a short term headache the remainder of your recovery should be as expected.
- Recurrent buttock and leg symptoms
After a particular area of the spine has been decompressed stabilisation with rods and screws ('fusion') of that part of the spine is perform. This protects the region from abnormal movement and prevents recurrent nerve compression in that specific area. While this is protective stopping movement in one area of the spine puts the remaining adjacent mobile areas of the spine under more stress. These areas may deteriorate over time and nerve compression may result. This can result in recurrent buttock and leg symptoms many years later and is a common reason why further surgery is needed in subsequent years.
NOTE: DECOMPRESSION AND FUSION SURGERY IS PARTICULARLY RELIABLE AT RELIEVING PAIN LOCALISED TO THE BUTTOCK AND LEG REGIONS (ESPECIALLY THE THIGH AND CALF AREAS). CENTRAL LOW BACK PAIN MAY ALSO BE IMPROVED POST SURGERY BUT THE CHANCE OF THIS IS LESS PREDICTABLE AND SOME DEGREE OF PERSISTENT LOW BACK PAIN CAN GENERALLY BE EXPECTED. THIS IS BECAUSE THE SOURCE OF THE LOW BACK PAIN CAN NOT EASILY BE LOCALISED AND MAY INCLUDE OTHER PARTS OF THE SPINE NOT INCLUDED IN THE SURGERY. ALSO FUSION MAY TRANSMIT STRESS TO ADJACENT PARTS OF THE SPINE WHICH MAY BECOME UNCOMFORTABLE UNDER THE EXTRA LOAD.
How fast will my symptoms recover?
Often buttock and leg pain/cramp/sensory changes improve quickly - in the days and weeks after surgery. Pain at the surgical site tends to take 4 weeks to settle. Thereafter things tend to steadily improve with full recovery taking 6 to 12 months.
When will I be assessed following surgery?
The first post-operative appointment will be 2 weeks after your surgery. The aims of this visit are to check on your progress, assess the wound, discuss your rehabilitation strategy. On occasion a second visit is planned 8 to 12 weeks following surgery to ensure your recovery remains on track.
Typically a further appointment is scheduled 1 year after your surgery to reassess and also check x-ray appearances.
What should I be doing in the first few weeks following the operation?
Walking is encouraged and can be started immediately. Aim to increase your walking distance and time steadily over the first few weeks. You should avoid heavy lifting and often long car rides can be uncomfortable.
For the first 2 weeks it is advise that you do not soak the wound - in a pool, bath or spa for example. It is OK to get it wet in a shower but pat it dry following this and replace any wet dressings.
When can I expect to return to work?
Most people with office jobs can expect to return to work 6 weeks post surgery, while a 3 month time frame is expected for those with more manual work that involves heavy lifting.
What else can I do to optimize my recovery?
Efforts to reduce weight are crucial to your recovery and the future health of your spine. Diet may need to be the focus of weight reduction efforts until your exercise tolerance improves.
Smoking is also associated with inferior outcomes after discectomy.
What are the chances this will happen again?
See comment above under 'recurrent buttock and leg symptoms'.