SPINAL SURGERY

in Hull and East Yorkshire

GEORGE SPINK FRCS (Neurosurg.) BSc Hons

 

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LUMBAR MICRODISCECTOMY

Patients with a slipped disc in the back do not usually require surgery. The majority (80%) will resolve within 8 weeks of onset of symptoms. The indications for surgery include:

-      radicular leg pain persisting for more than 8 weeks without improvement or resolution and with evidence on a scan of a disc compressing the appropriate nerve

-      severe unremitting pain of any duration that is uncontrollable with opiate analgesia

-      a progressive neurological deficit (evolving foot drop or sensory loss)

-      cauda equina dysfunction (indication for an emergency operation)

The operation is carried out as microsurgery through a small 4cm incision using an operating microscope. It involves a general anaesthetic and takes approximately 45 minutes. Some patients can be treated as day cases but most patients go home the day after surgery. The wound is closed using a cosmetically sensitive technique with dissolving stitches so there are no clips to be removed.


The risks of the operation include:

            Wound infection (2%)

            Spinal fluid leak (1%)

            Blood clot at operation site requiring re-operation (1%)

Nerve root injury resulting in worsening leg pain, numbness, weakness or paralysis (1%)

Cauda equina injury resulting in leg weakness, incontinence or impotence  (1 in 2000)

No improvement in symptoms (10%)

            Risk of spinal instability requiring further surgery (1%)

            General anaesthetic risks, including a small risk to life

 

Following surgery the patient may notice some back pain and stiffness but this should settle with simple anti-inflammatory medication, such as Neurofen. Some patients will develop tingling in the legs after surgery. This is due to swelling in the nerve following manipulation at surgery. It is temporary and will settle down after a few days.

Patients do not usually need to wear a back brace or support. A specialist physiotherapist will advice each patient on a postoperative exercise regime, to encourage back movements, rather than restrict them.