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Lumbar Spine Surgery

Lumbar Spine Surgery

Lumbar spine refers to the lower back area. It is a very strong and flexible part of our body helping us to bend and tilt to reach objects. It is the most common area of spine problems. Common causes of lumbar spine problems include age related wear and tear (degeneration/lumbar spondylosis), slip disc (prolapsed intervertebral disc), injuries to the lumbar spine, and infections.

Common surgeries for the lumbar spine include:

  • Lumbar discectomy / Microdiscectomy
  • Lumbar decompression
  • Lumbar fusion surgery

Lumbar Discectomy / Microdiscectomy

It is the procedure during which a piece of the prolapsed/damaged disc is removed from the back which is causing irritation of the nerves around it. This is done from the back and under general anaesthesia. Patients undergoing lumbar discectomy start walking on the same day itself and are normally discharged after only 2 days of hospital stay.

  • Common indications include
    • Herniated disc / disc prolapse / slip disc : When there is a tear in the outer portion of the disc, the central jelly like material of the disc leaks out and causes irritation of the surrounding nerves. It can cause radiating pain in the leg along the course of a nerve (sciatica), felling of pins and needles in the legs, numbness or even weakness of specific group of muscles supplied by the nerve.
    • Cauda Equina Syndrome : It is a dangerous medical condition involving the spine which happens when a group of nerves are severely compressed in the spine (lower back) and causes loss of bowel and bladder functions and also weakness of legs. It’s a surgical emergency and requires urgent surgery to release the compression
    • Patient showing progressive weakness and numbness in the legs when under observation
    • Persistent sciatica not responding to a reasonable period of conservative treatment
  • What to expect after the surgery?
    In 80 to 85 percent of patients there is a good to excellent outcome. There is significant improvement in the leg pain and feeling of pins and needles immediately after the surgery. However the numbness and weakness in legs takes time to recover and can even take as long as 6 months but there is progressive improvement. In 5 to 10 percent of patients there is a chance of recurrent slip disc after the surgery.
  • Risks and Complications
    • Risks of anaesthesia : Since all spine surgeries are done under general anaesthesia there could be some soreness of voice after the surgery. Very rarely there could be an allergic reaction to the anaesthetic agent. Please speak to your doctor in detail about any allergies you have before planning the surgery.
    • Risks of surgery : Overall there is a minor risk of superficial skin infection, excessive bleeding, or injury to the nerve roots causing weakness of specific group of muscles. Very rarely one of the outer layers of the nerve might be injured during the surgery which can cause leakage of spinal fluid. All surgeries are done under the cover of antibiotics but still there is a very rare possibility of an infection after the surgery. (There is a 5-10% risk of recurrent disc herniation after the surgery)
    • Postoperative period : After the surgery there is a minor risk of temporary worsening of any pre-existing medical conditions like diabetes, asthma or hypertension (BP). But we always involve a physician both before and after the surgery to take care of these medical conditions.
    • Rare possibility bladder infections, DVT (clotting of blood in the calves) or serious medical conditions like stroke, pneumonia or kidney failure.

Lumbar Decompression

It involves relieving the pressure on the spinal cord and it’s exiting nerves by removing part of bone (lamina) and ligaments from the back. This procedure is done under general anaesthesia.

  • Common indications of this procedure include
    • Spinal stenosis : It is a condition in which due to age related degeneration of the discs (wear and tear) and of the small joints of the back (facet joints) the nerves get compressed causing fatigue symptoms in the legs with numbness on walking for a long distances. Complaints include pain in buttocks, thighs and calves associated with numbness or feeling of pins and needles and in severe cases even weakness of leg muscles. It affects the quality of life as walking gets difficult and progressively worsens if appropriate treatment is not initiated. Surgery is usually indicated when complaints are longstanding and little relief is obtained from reasonable period of conservative treatment.
    • Herniated disc / disc prolapse / slip disc : When there is a tear in the outer portion of the disc, the central jelly like material of the disc leaks out and causes irritation of the surrounding nerves. It can cause radiating pain in the leg along the course of a nerve (sciatica), feeling of pins and needles in the legs, numbness or even weakness of specific group of muscles supplied by the nerve.
    • Metastatic tumors : When tumors around the spine cause compression of the spinal cord and exiting nerves.
  • What to expect after the surgery?
    In most of the patients there is significant improvement in leg pain, feeling of pins and needles in legs and walking capacity immediately after the surgery. Walking progressively improves after the surgery. Numbness and weakness of muscles take more time to recover as they are signs of long standing compression of the nerves. Forward bending and lifting weights is to be avoided for a few weeks after the surgery. On follow up visits the doctor will advise you when to resume all your normal activities.
  • Risks and Complications
    All surgical procedures carry some risk of a complication. They can be minor or major. But overall with the advancement in surgical techniques, equipment and preoperative assessment their incidence is very low.
    • Risks of anaesthesia : Since all spine surgeries are done under general anaesthesia there could be some soreness of voice after the surgery. Very rarely there could be an allergic reaction to the anaesthetic agent. Please speak to your doctor in detail about any allergies you have before planning the surgery.
    • Risks of surgery : Overall there is a minor risk of superficial skin infection, excessive bleeding, or injury to the nerve roots causing weakness of specific group of muscles. Very rarely one of the outer layers of the nerve might be injured during the surgery which can cause leakage of spinal fluid. All surgeries are done under the cover of antibiotics but still there is a very rare possibility of an infection after the surgery. Some patients can develop instability of the spine at that the operative level after the surgery which can cause back pain.
    • Postoperative period : After the surgery there is a minor risk of worsening of any pre-existing medical condition like diabetes, asthma or hypertension (BP). But we always involve a physician both before and after the surgery to take care of these medical conditions.
    • Rare possibility bladder infections, DVT (clotting of blood in the calves) or serious medical conditions like stroke, pneumonia or kidney failure.

Lumbar Fusion Surgery

It is a procedure in which two or more vertebrae of the spine are joined together using implants (screws and rods) to provide stability to the spine and decreasing the pain associated with instability. This surgery is done under general anaesthesia and involves use of screws and rods made up of metal (titanium) and sometimes use of plastic or metal spacers for the disc spaces. In patients who have poor bone quality your doctor might discuss the probability of using bone from the bone bank (allograft).

  • Common indications of this procedure include
    • Spinal stenosis with instability (Spondylolisthesis): It is a condition in which due to age related degeneration of the discs (wear and tear) and of the small joints of the back (facet joints) the nerves get compressed causing fatigue symptoms in the legs with numbness on walking for long distances. Complaints include pain in buttocks, thighs and calves associated with numbness or feeling of pins and needles and in severe cases even weakness of leg muscles. It affects the quality of life as walking gets impaired and progressively worsens if appropriate treatment is not initiated. Surgery is usually indicated when complaints are longstanding and only little relief is obtained from a reasonable period of conservative treatment.
    • Recurrent disc herniation/prolapse
    • Tumors and infections of the spine causing weakening of the bones.
    • Fractures of the spine.
  • What to expect after the surgery?
    In most of the patients there is significant improvement in leg pain, feeling of pins and needles in legs and walking capacity immediately/soon after the surgery. Walking progressively improves after the surgery. Numbness and weakness of muscles take more time to recover as they are signs of long standing compression of the nerves. Forward bending and lifting weights is to be avoided for a few weeks after the surgery. On follow up visits the doctor will advise you when to resume all your normal activities.
  • Risks and Complications
    All surgical procedures carry some risk of a complication. They can be minor or major. But overall with advancement in surgical techniques, equipment and preoperative assessment their incidence is very low.
    • Risks of anaesthesia : Since all spine surgeries are done under general anaesthesia there could be some soreness of voice after the surgery. Very rarely there could be an allergic reaction to the anaesthetic agent. Please speak to your doctor in detail about any allergies you have before planning the surgery.
    • Risks of surgery : Overall there is a minor risk of superficial skin infection, excessive bleeding, or injury to the nerve roots causing weakness of specific group of muscles. Very rarely one of outer layers of the nerve might be injured during the surgery which can cause leakage of spinal fluid. All surgeries are done under the cover of antibiotics but still there is a very rare possibility of an infection after the surgery. Rarely in some patients inspite of all efforts the bones fail to join together after sufficient period of time (pseudoarthrosis) and in such situations patients might require another surgery to supplement the fusion.
    • Postoperative period : After the surgery there is a minor risk of worsening of any medical condition you had before like diabetes, asthma or hypertension (BP). But we always involve a physician both before and after the surgery to take care of these medical conditions.
    • Rare possibility bladder infections, DVT (clotting of blood in the calves) or serious medical conditions like stroke, pneumonia or kidney failure.