Patient information Information for Patients Undergoing Lumbar Disc Surgery Trauma and Orthopaedic Directorate PIF 1359/V3
Your Consultant / Doctor has advised you to have a Lumbar Microdiscectomy. What is a Prolapsed Disc? Your spine is made up of small bones called vertebrae which all sit on top of each other to form your spinal column. To stop these bones from rubbing on each other you have intervertebral discs. These are soft cushions of tissue, which sit in between each of the bones in your spinal column and act as shock absorbers. The spinal cord and nerves run through the middle of your spinal column. This acts as a telephone exchange passing information from your brain to your body and back again. At the level of each bone (vertebra) your spinal cord sends out some nerves to transmit these messages to your body. A prolapsed disc occurs when one of these cushions (discs) rips at the edge and some of the internal tissue pokes out putting pressure on a nerve causing your trapped nerve symptoms.
What does a prolapsed disc cause? Prolapsed discs can cause various symptoms depending on which nerves they press upon. Prolapsed discs in your lower back area cause symptoms in your legs. Usually, the pressure on your nerve causes pain to go down your leg and this is called Sciatica. Occasionally, there may be numbness or weakness in your legs, in a few cases the pressure can affect the nerves that supply your bladder and your bowel and this can affect your ability to pass urine. In this very specific case it would be dealt with as an emergency and immediate attention is required. Treatment Most attacks of sciatica settle themselves after a few weeks and will not require any surgery. The non-surgical option for treatment is to allow your body s natural healing process to relieve the symptoms. This can be helped by including treatment from a physiotherapist, taking painkillers and keeping yourself active. The Spinal specialist may be able to inform you of other alternatives. If the pain does not settle spontaneously and persists with a degree of severity then surgery can be considered. Surgery allows reduction of pain and symptoms in 90% of cases. It will, however, be mainly to try and reduce your leg pain and may not be directed to relieving your back pain, which can be due to various other causes, e.g. muscle, ligaments and joint degeneration (wear and tear). Surgery also allows the relief of symptoms earlier than if you wait for a natural recovery. What does surgery involve? A microdiscectomy allows the part of your disc, which is causing the pressure on your nerve, to be removed with minimal disturbance of bone and tissue. This is achieved with a microscopic surgical technique. Microdiscectomy involves having a small cut on your lower back while under general anaesthetic. A microscope is used for the surgery to give a better picture of your tissues and to minimise the disturbance to the surrounding structures, improving the accuracy. The disc is approached from behind and the bit that is pressing on your nerve is removed, the complete disc is not removed. What are the benefits of having surgery? The advantages of surgery are that there can be up to an 80-90% chance of reduction of pain in acute cases but not chronic cases. However there is no guarantee that there will be any relief from back pain or an improvement in any leg weakness that you may have had prior to surgery. What are the risks of having surgery? All the risks will be discussed with you prior to your surgery and although they are not common you should be aware that there is the potential for them to occur. 1. Risk of anaesthesia. 2. Small risk of increased pain in back or leg. 3. Risk of injury to the nerves causing weakness or numbness in the legs. 4. Leak of spinal fluid. 5. Infection. 6. Haematoma, (Deep Vein Thrombosis, Pulmonary.Embolism).
In six per cent of patients another piece of disc at the same level can move out and cause pressure or a prolapsed (slipped) disc can occur at another level in the spinal column at some time in the future. Admission to Hospital Pre-operative assessment You will be brought in to the hospital for your pre-operative assessment. This may include being assessed by the anaesthetist. He/she will have a chat with you, discuss any relevant medical history and explain what having a general anaesthetic will involve. You may have some blood tests performed, a member of the team will discuss your medical history with you and you will be examined. If any X-rays or a heart trace (ECG) are required these will also be done. This may be done at the pre-operative assessment clinic, an appointment will be sent to you if you are required to attend for this. If you are unable to attend the pre operative assessment clinic you must contact them as soon as possible. If you are on medication that thins the blood you will be asked to omit this medication as follows before your surgery. Asprin seven to ten days. Clopidrogrel seven to ten days. HRT one month. Warfarin four days. This will be explained to you in pre-operative assessment. Patients will usually be admitted on the day of their operation and stay overnight. Operations may be delayed, postponed or cancelled depending on your suitability of anaesthetic or availability of high dependency beds if it is indicated you require one. Everything will be done as quickly as possible but you will appreciate that the medical staff also have to care for the patients on the wards, and will see you as soon as possible. You can eat and drink up to midnight the night before your surgery and in some cases up to 6am on the morning of your surgery. This varies depending on what time you are due to go for your operation. The day of surgery You will be kept fasted (nothing to eat or drink) and need to wear a theatre gown following your morning bath or shower at home. Your details will be checked with you on the ward, before you go to theatre. You will be wearing a wrist band and have to answer a list of questions, for example, your name, your date of birth and confirm that you have removed all jewellery and make up etc. You will be collected for theatre and taken to the theatre reception area where the nurse will check your details again, this can appear repetitive but it is all done to ensure your safety. You will then be taken to the anaesthetic room. Here the anaesthetist will give you your anaesthetic medication through a needle in your hand/arm and once you are asleep you will be taken into theatre.
After surgery you will be taken into the recovery room where you will be monitored whilst you wake up from your anaesthetic, and you will be made comfortable for your transfer back to the ward. You will be transferred back to the ward after spending time in Recovery. In Recovery and on return to the ward your observations, for example blood pressure and pulse will be monitored regularly, as well as your wound and your limb power and movement. An intravenous infusion (drip) will be in your hand/arm until you are awake enough to eat and drink again, and you will have an oxygen mask over your nose and mouth until you are fully awake from your anaesthetic. Your pain will be controlled with injections initially, unless you prefer tablets, and then following this you will be able to have tablets. You will be encouraged to move around the bed as much as possible and if you feel well enough you will be able to get out of bed. Your oxygen mask will usually be removed following a few hours back on the ward, and you can get up to go to the toilet with assistance after surgery. The day after surgery The day following surgery your drip will be removed and your dressing will be checked but these are not normally removed for the first seven days. You will be encouraged to get out of bed and move around, the physiotherapist will see you to explain correct posture and the exercises that you will need to do and will check you are up and walking with the correct posture. You will also be reviewed by the medical staff. For routine spinal operations it is quite normal practice to go home the day after your operation. Going Home Medication will be organised for you to take home if you do not already have any, a district nurse will be arranged to check your wound and remove your stitches in approximately one week. Please make sure that if you are not going home to your usual address and are going to stay with someone else you let the staff know in advance. The nursing staff will inform you of the date the district nurse will need to remove your stitches and perform a wound check. It is advisable to arrange own transport home before your admission. If you are travelling home by car sit in the front passenger seat and recline the seat back to make you more comfortable whilst travelling. You will have absorbable sutures (stiches) and the dressing will remain in place seven to ten days post operatively. You will then attend your family doctor (GP) or district nurse to have the sutures trimmed. You will be sent an outpatient appointment to return for a check-up in approximately two months. Discharge Information Pain relief and medication The nursing staff will advise you about painkillers before you leave the hospital. Please tell the nurses what painkilling tablets you have at home. It is not unusual for you to get increased back pain for a few days to a few weeks after surgery. Occasionally there may be a flare up of leg pain in the first few days and there may be a few twinges and pains in your leg for a few weeks following your operation.
Try and avoid driving for long distances (more than 30 minutes) for the first two weeks. Usually you may return to work two weeks following surgery. After six weeks you can return to swimming and air travel and after ten to twelve weeks you can return to all sports and back care for long term which will be explained to you during your admission. Getting back to normal Remember that you have just had an operation. It is normal to feel more tired than usual for a few days afterwards. Research has shown that patients who return to a normal routine as quickly as possible make the best recovery. You should start walking immediately You should progressively return to your normal daily routine as quickly as possible. Returning to work You can return to work as soon as you feel you can cope even if your back is still uncomfortable. Heavy lifting should only be performed in the correct way and should be avoided for the first three months. The information contained within is a guide to help you understand what microdiscectomy is and what to expect. It may be that in order to address individual needs your experience is slightly different from that described. If you have any queries you can contact us.
Further Information The Spinal Team The consultants are: Mr Marcus DeMatas Mr Sathya Thambiraj Mr Prokopis Annis Mr Radu Popa Mr George Ampat Spinal Specialist Nurse Mark McGowan Tel: 0151 706 2000 Bleep 4099 Textphone Number: 18001 0151 706 2000 Bleep 4099 Spinal secretaries Jackie Landry Collette Rowan Julie Melia Barbara Mills Tel: 0151 706 3651 Textphone Number: 18001 0151 706 3651 Author: Trauma and Orthopaedic Directorate Review Date: September 2018
All Trust approved information is available on request in alternative formats, including other languages, easy read, large print, audio, Braille, moon and electronically.