This information is for patients scheduled for surgery to remove a portion of a lumbar spinal disc found to be compressing a nearby nerve. The technical term for the operation is a ‘discectomy’.
Where will my surgery be performed?
The operation will be performed at Forte Health or St Georges Hospital. We will advise you which facility and send out a preadmission pack for you to complete prior to your scheduled date.
Do I need to stop any medications prior to surgery?
Please advise if you are taking medications that affect your bleeding tendency like aspirin, warfarin, clopidogrel or dabigatran. These will need to be discontinued at least 5 day prior to surgery unless otherwise advised. Please contact my personal assistant (Amanda) for further direction. 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 takes between 60-90mins
You will be looked after in recovery until the effects of the anaesthetic wear off meaning you will return to the ward after a total of 2-3 hrs.
How long will my scar be?
It depends on a number of factors but is likely to range between 4-10cms
How long will I stay in hospital?
It is expected you will require a one night overnight stay in hospital.
Prior to discharge a nurse will remove the drain inserted at the time of surgery. A prescription for pain relief and time off work forms will be provided if required.
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 surgery the nerves are retracted to uncover the disc. 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 disc prolapse
The damaged outer layer of the disc (through which the prolapse occurs) cannot be repaired surgically. This will heal naturally. Until this occurs there is a 5-7% chance that another disc prolapse can occur through the same defect. The treatment of this may involve further surgery.
How fast will my symptoms recover?
Your symptoms will improve the most within the first 3 months however further improvement out to 12 months is expected.
Pain tends to improve promptly (mostly within the first 2-6 weeks). Improvements in muscle weakness and ‘numbness’ and ‘pins and needles’ takes longer (months and even years). Even though surgery may relieve all pressure on the nerve ~10-25% of people do not fully recover muscle strength and ~50% of patients are left with residual numbness. This often reflects irreversible damage that has occured prior to surgery.
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 return to work strategy and refer you through to a physiotherapist to assist with this process.
A second and final visit is planned 6 to 8 weeks following surgery to ensure your recovery remains on track.
What should I be doing in the first few weeks following the operation?
As soon as your comfort allows it is safe to return to all normal activities although initially you should avoid heavy lifting or contact sports. Walking is encouraged and can be started immediately. Support from a physiotherapist is suggested and can be arranged for you at the 2-week post-op clinical review.
When can I expect to return to work?
Again, it is not necessary for patients to stay passive after lumbar disc surgery. Most people with office jobs should aim to return to work within 2-3 weeks, while a 4-6 time frame is expected for those with manual work that involves heavy lifting.
When can I return to sporting activities?
Around 80 - 90% of athletes return to sports at competitive levels following lumbar discectomy. Recreational athletes in non-collision sports can aim for a return to competition at 6 to 8 weeks. Rugby/Rugby league and other collision athletes may expect to return to the field between 8-12 weeks.
What else can I do to optimize my recovery?
It is recognised that obesity is associated with worse outcomes after the operative treatment of lumbar disc herniation. 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?
The remaining disc contents have the potential to prolapse through the initial defect in the outer layer of the disc. This is called a ‘recurrent disc herniation’ and can occur in 5-7% of cases. Treatment options include repeat surgery or non-surgical care. Importantly the chances of this happening are unrelated to your activity level following surgery so it is safe for you to return to work and your normal activities as per the timeframes above.
Will I need further surgery in the future?
The most common reason for further surgery is a recurrent disc prolapse (see above).
While a 'lumbar discectomy' is effective at relieving leg pain it is not able to reverse the damage to the disc. Consequently a minority of patients can get low back pain in the years following. In most this is tolerated without too many restrictions. In ~10% of patients the pain is bothersome enough to require further treatment. Only rarely does this involve a spinal fusion procedure.