Patients
who have severe back and leg pains due to arthritis of the spine may be offered
back operation. Spine operations are more commonly used to treat lower back
pain resulting from a damaged or degenerate intervertebral disc (the shock
absorber between the bones), or spondylolisthesis (slip of one bone on the
other). The goal here is to stabilise the spine so that pain (and sometimes
deformity) is reduced. Operations are also used to treat lower leg pain
resulting from pressure on a nerve or nerves in the back. The goal then is to
free the nerves from pressure and so stop pain, numbness and weakness in the
legs.
Surgery is usually recommended when all
reasonable conservative measures (pain medications, nerve injections, physical
therapies, braces etc.) have failed. It is often the last resort unless there
are special circumstances like severe nerve injury that makes it the number one
priority. Operations on the spine can be performed from the back or the front.
We more commonly do it from the back. Operations from the front entails going
through the abdomen and may be required in some special circumstances. More
often than not, it is combined with a second operation from the back as well.
The
goals:
Reduction
of back pain
Stabilisation
of an unstable spine
Reduction
in amount of drugs used for pain
Prevention
of deterioration in your condition
Improved
lower back and leg function
Improved
work, walking and recreational capacity
Improved
quality of life
There are
risks in back surgery as with any operation. The chance of a minor complication
is around 4 or 5%, and the risk of a major complication is 2 or 3%. Generally,
surgery is fairly safe and major complications are uncommon. Over 90% of
patients should come through their surgery without complications. Our review in
2012 demonstrated good outcome in the majority of patients.
The
specific risks:
Failure to
benefit or to prevent deterioration
Worsening
of pain
Infection
Bleeding
and a need for Blood transfusion
Nerve
damage (weakness, numbness, pain) occurs in less than 1%
Cerebrospinal
fluid (brain fluid) leak: this risk is much higher in revision (re-operation)
surgery
Surgery at
incorrect level (this is rare, as X-rays are used during surgery to confirm the
level)
Major
neurological problems are very rare, but include paralysis, damage to a nerve,
problems passing urine or stool and loss of erection.
Chronic
pain (may require further surgery)
You
must tell your surgeon:
About
blood clotting or bleeding problems
If you have
ever had blood clots in your legs (DVT or deep venous thrombosis) or lungs
(pulmonary emboli)
Are taking
aspirin, clopidogrel, warfarin, or anything else (even some herbal supplements)
that might thin your blood
About high
blood pressure
About any
allergies to drugs or following previous operations
Any other
health problems even if it seems unimportant
Before
Surgery:
Please
bring all your regular medications with you to hospital.
Consult
with your surgeon if you are taking blood-thinning medications.
You may
continue to take your routine medications (for example, heart and blood
pressure medications), on the morning of surgery with a sip of water (unless
otherwise directed).
You may
not eat anything after midnight, the night before surgery and must cease
drinking clear fluids (water, apple juice, black tea) 2 hours prior to your
admission time (unless otherwise instructed.)
Please
shower on the morning of admission. Do not use powder, apply perfume, makeup or
nail polish and wear cotton underwear if possible.
Please be
sure to take the following to the hospital for the operation; MRI/Xray/C.T
Scans and all previous medical reports and results. Before your surgery it is
imperative that you stop smoking, and you should not smoke for at least 12
months after. Smoking impairs the healing process and leads to worse outcomes
following spinal surgery.
The
operation:
A general anaesthetic will be administered
to put you to sleep. A breathing tube (‘endotracheal tube’) will be inserted
into your throat and antibiotics and steroids given (to prevent infection and
post-operative nausea). A catheter will be inserted into your bladder to
prevent bladder distension during surgery and to monitor urine output. You will
be placed face-up or face-down on the operating table depending on the type of
surgery you are having. An x-ray is often performed to confirm that the surgeon
is at the correct level for your operation. The team then performs the
operation and finish when the surgeon is happy the aims of the operation have
been achieved. A final X-ray is taken and the wound is closed with sutures or
with staples.
You are then transferred back to the ward to commence your recovery from the anaesthesia and the operation. Once you are fully awake and well, we start making plans for your discharge home within a few days and subsequent visits to the clinic for post operative care.
So
if you need a back operation:
The operations are being performed safely in
Nigeria, everyday, and many patients are benefiting from the procedures. Be
clear in your mind that you have exhausted all other reasonable treatments such
as weight loss, regular exercise, medication and even meditation. Be prayerful
and trust in your surgeon for a successful outcome. Have no fear and trust in
God to heal you.
1, Nice normal MRI scan, 2, MRI with pressure on the nerves, 3, MRI showing destruction of the bones and prolapsed disc causing pressure on the nerves.
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