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Lumbar Discectomy
Table of Contents
Lumbar Discectomy
You have been recommended an operation to relieve the pressure on a nerve passing from you back to your leg. This pressure on the nerve passing from your back to your leg(s) may cause you pain, numbness or weakness and sometimes a disturbance in bladder function. The diagnosis of a prolapsed disc is confirmed by magnetic resonance imaging (MRI) scan. Not all patients who have this condition need surgery; symptoms may improve spontaneously without surgery.
Before your procedure
- You will be seen in our pre-admission clinic by our nurse practitioner and by the Consultant Neurosurgeon and his Specialist Registrar
- At this clinic, we shall ask you for your medical history and carry out any necessary clinical examination and investigations. This is a good opportunity for you to ask us any questions about the procedure, but please feel free to discuss any concerns you might have at any time
- You will be asked if you are taking any tablets or other types of medication - these might be ones prescribed by a doctor or bought over the counter in a health food shop. It helps us if you bring details with you of anything you are taking (eg bring the packaging with you)
- This procedure involves the use of general anaesthetic. See below for further details about the types of anaesthesia/sedation we shall use. The anaesthetist will see you before the procedure to assess your general state of health and discuss the details of the anaesthetic with you
- Most people who have this type of procedure will need to stay in hospital overnight in preparation for the operation the next day
During the procedure
- A small incision will be made in the skin of your back overlying the affected area. The part of the prolapsed (slipped) disc that is putting pressure on the nerve is removed, but most of the disc material is left in place
After the procedure
- You will wake up in the recovery room after your operation. You might have an oxygen mask on your face to help you breathe. You might also wake up feeling sleepy. Both of these are normal
- After this procedure, most people will have a small, plastic tube in one of the veins in their arm. This might be attached to a bag of fluid (called a drip), which supplies your body with fluid until you are well enough to eat and drink by yourself
- While you are in the recovery room, a nurse will check your pulse, blood pressure and limb movements regularly. When you are well enough to be moved, you will be taken to a ward
- Sometimes people feel sick after an operation during which a general anaesthetic has been administered and might vomit. If you feel sick, please tell a nurse and you will be offered medicine to make you more comfortable
- Eating and drinking: After this procedure, you should not have anything to eat or drink until you medical team considers it to be safe - this is usually about 4-6 hours
- Getting around and about: After this procedure, we will try to get you mobile (up and about) as soon as we can to help prevent complications from lying in bed. You will be encouraged to get out of bed on the day of the operation. A physiotherapist will see you and advise you on some important exercises for you to continue at home
- When you can leave hospital: Most people who have had this type of procedure under general anaesthetic will be able to go home 1 to 2 days after surgery. A longer stay might be necessary if you are elderly or have major disability before surgery
- When you can resume normal activities including work: Once you are home, you should gradually increase your activity towards normal levels. After the operation any pain you were experiencing in your leg should get better quickly. Many patients who have this operation have discomfort in their back
- You can resume driving when you feel comfortable; this is provided that you were considered safe to drive by a doctor before the operation
- Check-ups and results: Your condition will be reviewed three months following the operation to make sure that progress is satisfactory
Intended benefits of the procedure
- The aim of the surgery is to relieve the pressure on a nerve passing from your back to your leg. The success rate for this operation is very high. About 90 to 95% of patients get relief from their leg pain and are able to return to work and a full range of normal social and sporting activities
Who will perform my procedure?
- This procedure will be performed or supervised by a Consultant Neurosurgeon
Alternative procedures that are available
- The alternative to this surgery is to decide not to have surgery
- It can be an option to wait and see if your symptoms improve spontaneously
Serious or frequently occurring risks
- Risks of surgery. Operation to treat a prolapsed lumbar (back) disc has been widely practised since the 1930s. It is a very safe procedure and serious complications are extremely rare
- At the time of surgery there is a small risk of damage to the nerve root at the time of surgery. This risk is less than 1%. If it does occur, you might notice increased numbness in part of your leg and/or some weakness of movement at the ankle
- If weakness develops, it might result in a ‘foot drop’; this is permanent in very few people
- Sometimes during the operation we find that the waterproof membrane surrounding the nerves is very adherent (sticky) to the surrounding structures. If it is torn during the operation, there is a risk of leakage of fluid from the wound. This is rare and usually settles down spontaneously without causing you problems
- There is a small risk of wound infection (less than 1%) and this can sometimes need prolonged (long) treatment with antibiotics
- There is a very small risk of damage to the nerves that supply the bladder and bowel
General Anaesthesia
During general anaesthesia you are put into a state of unconsciousness and you will be unaware of anything during the time of your operation. Your anaesthetist achieves this by giving you a combination of drugs. Usually the first step is to inject medication intravenously (i.e. into a vein) through a small plastic tube, placed usually in your arm or hand. This is known as induction of anaesthesia. An example of a commonly used drug is Propofol. Induction is occasionally achieved by breathing gases. To maintain you in this state of unconsciousness, you will breathe a mixture of anaesthetic gases or vapours with oxygen. If the surgery or other factors require your muscles to be relaxed, e.g. in surgery on the abdomen, then a muscle relaxant drug is given and a tube is inserted into your throat and down your windpipe to help you to breathe. While you are unconscious and unaware your anaesthetist remains with you at all times, monitoring your condition and controlling your anaesthetic, replacing fluid or blood. At the end of the operation, your anaesthetist will reverse the anaesthetic and you will regain awareness and consciousness in the recovery room, or as you leave the operating theatre.
Before your operation
Before your operation your anaesthetist will visit you in the ward, although occasionally this will happen in a pre-anaesthetic assessment clinic. The anaesthetist who looks after you on the day of your operation is the one who is responsible for making the final decisions about your anaesthetic. He or she will need to understand about your general health, any medication that you are taking and any past health problems that you have had. Your anaesthetist will want to know whether or not you are a smoker, whether you have had any abnormal reactions to any of the drugs or if you have any allergies. They will also want to know about your teeth, whether you wear dentures, have caps or a plate. Your anaesthetist needs to know all these things so that he or she can assess how to look after you in this vital period. Your anaesthetist may examine your heart and lungs and may also prescribe medication that you will be given shortly before your operation, the pre-medication or 'pre-med'.
Pre-medication is the name given to medication (drugs) given to you some hours before your operation. These drugs may be given as tablets, injections or liquids (to children). They relax you and may send you to sleep. They are not always given. Do not worry if you do not have a pre-med, your anaesthetist has to take many factors into account in making this decision and will take account of your views on the topic if possible. Do not be worried about your anaesthetic. When your anaesthetist visits you before your operation, this is the time to ask all the questions that you may have, so that you can forget your fears and worries. Before your operation you will usually be changed into a gown and wheeled to the operating suite into an anaesthetic room. This is an ante-room outside the theatre. The anaesthetist, his or her assistant and nurses are likely to be present. An intravenous line (drip) may be inserted. Monitoring devices may be attached to you, such as a blood pressure cuff or a pulse oximeter. A pulse oximeter is usually a little red light in a small box, which is taped to your finger. It shows how much oxygen you have in your blood and is one of the vital monitors that an anaesthetist uses during your operation to ensure that you remain in the best of health. You may be given some oxygen to breathe. It is common practice nowadays to allow a parent into the anaesthetic room with children: as the child goes unconscious, the parent will usually be asked to leave.
During your operation
While you are unconscious and unaware your anaesthetist remains with you at all times. He or she monitors your condition and administers the right amount of anaesthetic drugs to maintain you in the correct level of unconsciousness for the period of the surgery. Your anaesthetist is constantly aware of your condition and trained to respond. Your anaesthetist will be monitoring such factors as heart rate, blood pressure, heart rhythm, body temperature and breathing. He or she will also constantly watch your need for fluid or blood replacement. If you have any other medical conditions, your anaesthetist will know of these from your pre-operative assessment and be able to treat them during surgery.
After your operation
After your operation your anaesthetist continues to monitor your condition carefully. You will probably be transferred to a recovery ward where specially trained nurses, under the direction of anaesthetists, will look after you. Your anaesthetist and the recovery nurses will ensure that all the anaesthetic effects are reversed and that you are closely monitored as you return to full consciousness. You may be given some oxygen to breathe in the recovery area, and may find that intravenous drips have been inserted whilst you are unconscious in theatre and that these will be replacing fluids that you might require. You will be given medication for any pain that you might feel, and systems, such as Patient Controlled Anaesthesia (PCA) may be set up to continue pain control on the ward. You are likely to feel drowsy and sleepy at this stage. Some patients feel sick, others may have a sore throat related to the insertion of the breathing tube during surgery. During this time it is important that you relax as much as you can, breathe deeply, do not be afraid to cough, and do not hesitate to ask the nursing staff for any pain relief, and about any queries you may have. You are likely to have hazy memories of this time and some patients experience vivid dreams. Once you are fully awake you will be returned to the ward, and if you are a day patient will be allowed to go to the waiting area to fully recover before you are accompanied home. Do not expect to feel completely normal immediately!
What are the risks of general anaesthesia?
In modern anaesthesia, serious problems are uncommon. Risks cannot be removed completely, but modern equipment, training and drugs have made it a much safer procedure in recent years. The risk to you as an individual will depend on; whether you have any other illness, personal factors (such as smoking or being overweight) or surgery which is complicated, long or done in an emergency. Please discuss any pre-existing medical condition with your anaesthetist.
- Very common and common side effects (1 in 10 or 1 in 100 people) Feeling sick and vomiting after surgery, sore throat, dizziness, blurred vision, headache, itching, aches, pains and backache, pain during injection of drugs, bruising and soreness, confusion or memory loss
- Uncommon side effects and complications (1 in 1000 people) Chest infection, bladder problems, muscle pains, slow breathing (depressed respiration), damage to teeth, lips or tongue, an existing medical condition getting worse, awareness (becoming conscious during your operation)
- Rare or very rare complications (1 in 10,000 or 1 in 100,000) Damage to the eyes, serious allergy to drugs, nerve damage, death, equipment failure
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