The spinal column is held in alignment or balance by ligaments, cartilage and muscles that surround and protect the spinal cord membranes and the nerves that branch out to your legs, arms and all parts of your body.
Displacement (herniation) of the disk can lead to low back pain as well as pain and numbness in the legs (sciatic pain) and weakness of the muscles in one or both legs.
When the vertebrae are aligned, a canal is formed by the vertebral arch (lamina) that contains the spinal cord. Nerves pass through opening (foramina) of the adjoining vertebrae and into your arms and legs.
The muscles and ligaments attached to the vertebrae need to be kept in good condition to enable the spine to withstand the stresses of daily activity. A well-balanced, flexible spine is less likely to develop low back pain and is less likely to require medical treatment.
As a result of wear and tear on the spine, ligaments and disks, the disk may begin to protrude or collapse and put pressure on the never root leading to a leg or foot, causing pain in those areas (sciatica).
The problem can be aggravated by associated conditions, such as narrowing (stenosis) of the canal or shifting of the vertebra (spondylolisthesis), one upon the other.
You also may have low back pain from improper lifting of an object, a fall or sudden twisting. Most back pain from these causes is due to overuse of muscles and disappears in a few weeks.
Is Low Back Surgery for You?
If you have persistent back pain or pain in your thigh, buttock or leg: numbness or tingling in your leg; and/or weakness in your leg, and it doesn't respond to conservative, no operative treatment, your family doctor can refer you to an orthopaedic surgeon for an evaluation.
You and you orthopaedic surgeon will determine whether you would benefit from low back surgery which relieves pressure on the nerves in the spinal cord and/or stabilizes the spine.
The Orthopaedic Evaluation
The orthopaedic evaluation consists of four components;
- A medical history, in which your orthopaedic surgeon gathers information about your general health and asks about your symptoms.
- A physical examination to assess the stability, strength, alignment and motion of your back, as well as neurological evaluation.
- Diagnostic tests such as X-rays, which may be obtained to evaluate the bones and structure of your spine. An MRI (Magnetic Resonance Imaging) may be arranged to provide more detailed information about the spine. MRIs are not X-rays and use no radiation to create images. A myelogram also may be requested. A myelogram uses X-ray imaging and an injected dye to define bony and soft tissue structures affecting the nerve root. )
- Other imaging studies such as a CAT scan also may be ordered which provides details about the bones and soft tissues not seen on regular X-rays.
Discussion by you and your orthopaedic surgeon of the findings of the physical and diagnostic examination and the treatment for you condition. Initially, medication and physical therapy may be prescribed to reduce inflammation at the site of the pain and to strengthen the muscles supporting eh spinal column. If you are overweight, a weight reduction program may be suggested. In addition, you will be encouraged to begin a regular aerobic exercise program once your problem has been corrected.
Preparing for Surgery
You may be asked to stop taking certain medicine or to stop smoking. Depending on your age and general medical fitness, you may be asked to undergo a general medical checkup.
Some medicines may affect the results of your surgery. They may cause bleeding or may interfere with the effects of your anesthesia. These medications include aspirin and no steroidal anti-inflammatory drugs. Your doctor may ask you to stop taking the medication before your surgery.
Donating blood usually is not necessary for most low back surgery that does not include fusing vertebrae together. However, there is always a chance that some blood loss will occur during surgery. Your doctor will discuss the advantages and disadvantages of donating your own blood compared with using someone else's blood.
You will be able to walk after surgery, but you may need to arrange for some help with washing, dressing and activities, such as cleaning, laundry and shopping, for a few days after your surgery. Your orthopedic surgeon will probably recommend that you don't drive a car for a period of time after surgery.
Patients usually are admitted to the hospital on the day of surgery.
After admission, you will be taken to the preoperative preparation area where you will be interviewed by a doctor from the anesthesia department, who will review your medical history and physical examination reports. You and your doctor will discuss the type of anesthesia to be used. The most common types of anesthesia used for low back surgery are general (you are asleep for the entire operation or spinal (you may be awake but have no feeling from your waist down). The surgical procedure usually takes one to three hours, depending on you problem. Your orthopaedic surgeon will remove a portion of bone and ligament overlying the nerve roots and will remove displaced disk material to relieve pressure on the nerve roots. Fusion is sometimes done at the same time, if instability (spondylolisthesis) is present.
When your surgery is completed, you will be moved to the recovery room, where you will be observed and monitored by a nurse until you awake from your anesthesia. You will have an intravenous (IV) line inserted into a vein in your arm. You also may have a catheter inserted into your bladder to make urination easier.
When you are fully awake and alert, you will be taken to your hospital room. Your IV and catheter will be removed soon after.
Your Hospital Stay You will feel some pain at the site of your surgery.
Your doctor will prescribe api9n medicines to help reduce this discomfort. You ill be encouraged to breathe deeply and to cough frequently to avoid fluid build-up in your lungs. You may be given a small machine called an incentive spirometer to help you.
You will be encouraged to begin walking on the same evening after your surgery or the next day to help speed your recovery.
A physical therapist may instruct you on how to walk up and down stairs without assistance, how to sit properly and how to maintain good spinal balance. You also should exercise your legs in bed to help prevent blood clots. A follow-up program of physical therapy may be prescribed, depending on the situation.
Possible Complications after surgery
The incidence of complications after low back surgery is low. Major complications that can occur include, but are not limited to, infection, heart attack, stroke, blood clots and recurrent disk herniations. Although rare, new nerve damage can occur as a result of this surgery. These complications may result in pain and prolonged recovery time.
Woulnd Care Your wound may be closed with stitches (sutures) or stapes, which will be removed approximately two weeks after surgery. If the wound is clean and dry, no bandage is needed. If drainage continues after you are home, the would should be covered with a bandage and a call made to your surgeon.
Diet Some loss of appetite is common. Eating well-balanced meals and drinking plenty of fluids is important. Your doctor may recommend iron supplement pills or vitamins before and after your surgery.
Activity Loss of energy is frequently experienced after major surgery, but this improves over time. An exercise program designed to gradually increase your strength and stamina may be prescribed. Initially, your doctor will recommend that you should only participate in walking. Later, he will encourage you to swim or use an exercise bile or treadmill to improve your general physical condition.
Avoiding problems after surgery
It is important that you carefully follow any instructions from your doctor relating to warning signs of blood clots and infection. These complications are most likely to occur during the first few weeks after surgery.
Warning signs of possible blood clots include the following:
- Swelling in the calf, ankle, or foot
- Tenderness or redness, which ay extend above or below the knee
- Pain in the calf
- Occasionally, a blood clot will travel through the blood stream and may settle in your lungs. If this happens, you may experience a sudden chest pain and shortness of breath or cough. If you experience any of these symptoms, you should notify your doctor immediately.
- Infection following spine surgery occurs very rarely. Warning signs of infection include:
- Redness tenderness and swelling around the wound edges
- Drainage from the would
- Pain or tenderness
- Shaking chills
- Elevated temperature usually above 100 degrees if taken with an oral thermometer
If any of these symptoms develop you should contact your doctor.
After you have recovered from your low back surgery, you may continue to have some achy pain in your lower back; this may be persitent. You can reduce the pain by staying in good physical condition. If you are overweightk you should enroll ina program to help you lose weight and keep it off.
Your doctor will evaluate you after your surgery to make sure that your recovery in progressing as expected.
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