So you need a back operation?

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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