Lumbar Discectomy FAQ’s
Do pinched nerves go away on their own?
The pinched nerves are usually caused due to inflammation of the nerve roots near the spinal cord where they exit. The inflammation, once improved, causes relief in the pinched nerve. This improvement in inflammation can be caused rest, anti-inflammatory medication, steroid medications or cortisone shot. Occasionally the cause of inflammation may be persistent compression over the nerve, which may not get better with all form of conservative management.
How can you prevent getting back pain after a discectomy?
A discectomy is usually for patients who have undergone a disc disease, and therefore, modifying the factors that may lead to disc disease or deterioration of the disc, can lead to decreased back pain in the future after surgery. These factors include control of weight, control of chronic diseases like Diabetes, quitting smoking, practicing good posture, involvement in exercise program, especially for the back and core muscles.
How soon after the surgery can I start physical therapy?
Patients are not required to start their physical therapy till two weeks after the surgery. After two weeks of surgery, physician reexamination will help in deciding if the patient requires physical therapy or not. Many of the patients do not require physical therapy after the surgery.
Does smoking cause spine problems?
Smoking has proven to cause spine problems, including neck and lower back. At the same time, smoking is detrimental for patients who require spine surgery, especially fusion surgeries. It has been shown that smoking delays spine fusion, as well as lead to higher incidence of nonunion and possible need for revision surgeries.
What if, during my surgery, you encounter a different issue other than expected?
Usually, before the surgery, we discuss with the patient regarding all the possible spine issues that we may expect and how to manage them. If there is an unexpected issue, which has not been discussed earlier, we would go ahead and discuss it with the patient’s relative and treat it accordingly from there. If there is something which can wait, and is not detrimental to the patient, and relatives are not able to make decision on it, we may leave it for a later date to be discussed with the patient after the surgery.
How long is it possible to stay for back surgery?
Most of the patients with back surgery can be discharged within one to four days after the surgery depending on the type of surgery and the type of recovery that they have. Patients who undergo complex spine surgeries may need longer period of hospitalization and recovery.
Which pain medications will I be sent home with? What are the possible side-effects of these prescriptions?
Most of the patients with cervical spine surgery, will be sent with some narcotic pain medication to take care of their pain. These medications do have their multiple side-effects, which may be constipation, nausea, vomiting, impaired judgement, drowsiness, headache. Though patients who are treated with narcotic pain medication for acute pain, mostly do not lead to addiction, but these medications do have addiction potential.
Will you know before the surgery if I need a brace afterwards? If so, will I be fitted for one before the surgery?
Most of the patients with spine surgery do not need a brace. If we expect that the patient will need a brace, we will get the patient pre-fitted with a brace so that it is available immediately after the surgery. Occasionally the need for brace may be decided at the time of surgery. In such cases a brace is arranged in immediate post-operative period.
Will I need any other medical equipment like a walker when I go home? Should I get an adjusted bed or sleep downstairs?
Patient may need other medical equipment like walker or a stick. If that is required, patients are provided with such equipment in the hospital before their discharge and are trained how to use them by the physical therapist and occupational therapist. If the patient needs to use stairs, patients are trained by the physical therapist before they are let go home. If the patient needs an adjustable bed, they are informed about that. That can be done prior to the surgery. It is desirable for patients to stay downstairs for a few weeks if possible.
Who can I call if I have questions after the surgery?
In case patient has routine questions regarding after the surgery or regarding the surgery, they can call the physician’s office and talk to the nurse or secretary or the physician. If they’re not available on the phone, they can leave a voice mail and they will be answered later. In case the patient has a medical emergency, then they should not call the physician office but rather call 911 or get to the hospital ER as soon as possible.
How often will I see you after my surgery?
Patients are usually followed at two weeks, six weeks, three months, six months, and a year after surgery.
What symptoms would warrant a call to your office after the surgery?
If the patient develops problems like chest pain, breathing problems, sudden neurological deterioration, or any other emergency they should call 911, or go to the emergency room directly. Patients who develop worsening pain at the surgery site, discharge from the wound, fever; they should call in the office.
How long should I wait to bathe after the surgery?
Patients are usually asked to avoid bathing, until the incision heals, which may take two to three weeks. Patient can take shower after 72 hours of surgery with an impervious dressing in place. The dressing can be changes if the wound is visibly soaked. Patients are asked not to rub the area of surgery for about two to three weeks. They can gently dab it dry with a towel.
How long will I be out of work?
Patients with low demand work and desk job, can be back to work as soon as three to six weeks after the surgery depending on patient pain control as well as recovery. Patients who are in heavy lifting or control of heavy machinery or handyman job, may take three to four months, or even more to get back to work depending on their recovery from the surgery.
How soon after the surgery can I start physical therapy?
Patients after back surgery are usually started on physical therapy, if they need, depending on physician’s advice, at two to four weeks after the surgery. Many of the patients do not need physical therapy. A decision to go into physical therapy will depend on the surgery as well their recovery.
What if I get an infection?
If the patient has a superficial infection, few days of antibiotics will help heal these infections. Occasionally patient may develop deep infection. In these patients may need IV antibiotics for a longer period. If despite all efforts or in patients with rapid deterioration due to infection, surgery may be needed to help clean off the infection.
How common is surgery?
Most of the patients do not need surgery and can be treated with conservative means. When the patients do not respond to conservative measures, or if they have worsening neurological deficit, or worse pain, they may need surgery.
Will I have irreversible damage if I delay surgery?
Patients who develop neurological deficit in the form of weakness or involvement of bowel or bladder may have irreversible damage if the surgery is delayed enough.
When do I need fusion?
When patient has back pain or has a surgery in which enough bone is removed to destabilize the spine, in these cases patient may need a fusion surgery to stabilize the spine, as well as to alleviate the symptoms.
What are my risks of low back surgery?
General surgical risks of low back surgeries include bleeding, infection, persistence of pain, reversible/irreversible nerve damage leading to tingling, numbness, or weakness down the legs or involvement of bowel or bladder, failure of resolution of symptoms, failure of fusion, failure of implants. Most of the patients can undergo a safe surgery due to the development of vision magnification as well as refined surgical techniques. There are anesthesia risks also associated with this surgery.
When will I be back to my normal activities?
Though these things depend on the type of surgery patient has undergone, patient can usually be progressively back to their normal activities, starting from three to five days from surgery. Patients are encouraged to take care of their activities of daily living, as well as light household activities. Patients can get back to driving once they are free from pain medication and are able to sit for a duration of period for driving, which may take upto 2-3 weeks or more.
What type of surgery is recommended?
The type of surgery depends on the presenting complaint, examination findings, as well as imaging findings in the form of x-ray and MRI. Some patients may need to undergo just discectomy, or laminectomy, while others may need a fusion surgery on their back to relieve their symptoms. To know more about the type of surgery, the patient needs to discuss this with their spine surgeons.
How long will the surgery take?
Spine surgeries like discectomy and laminectomy usually last about one to one and a half hours. Spine fusion surgeries, may take longer periods, up to two and a half to four hours or more. It depends on type of surgery, and as well as the level of spine to be operated upon.
Why does a spinal disc cause pain?
There are multiple reasons for a disc to cause pain if it is injured. The pain may be just because of injury to the disc itself or rupture of the ligaments through which it passes into the spinal canal. It may also cause pain because of pressure on the nerve roots that are pushed by the disc in the vicinity.
What is a difference between a herniated disc and a bulging disc?
Bulging disc is when the disc pushes the ligament pushing into it into the spinal canal while herniated disc is when the disc itself gets out of the ligament and comes to lie into the spinal canal. Bulging disc may be normal and may not cause pain. Herniated disc also does not cause pain in all patients but they may cause compression on the nerve roots and cause radiating pain going down the legs or, in severe cases, may cause weakness associated with tingling, numbness, involvement of bowel or bladder.
Are bulging discs normal in an adult?
Bulging discs, especially in the lower spine, may be normal findings in an adult. They rarely cause problem by causing pressure on the nerve roots.
How did I herniate my disc?
Herniation of disc may be caused by multiple factors. If the disc is diseased due to age, other chronic diseases, smoking, etc., then they are more prone to injury. Any sudden movement or lifting or moving, heavy weights, can cause enough pressure in the disc to cause rupture and herniate.
What are the symptoms of a herniated disc?
Herniated disc can present either present with back pain or radiculopathy in the form of pain going down either lower extremity or either leg. It may or may not be associated with tingling or numbness. In severe cases, there may be weakness of specific group of muscles in the leg or involvement of bowel or bladder.
Are all bulging discs and all herniated discs painful?
Not all bulging discs or herniated discs are painful. But bulging discs in most cases are not painful and are asymptomatic. Herniated disc have a higher chance of causing symptoms in the form of pain going down either lower extremity or either leg. It may or may not be associated with tingling or numbness. In severe cases, there may be weakness of specific group of muscles in the leg or involvement of bowel or bladder.
What is degenerative disc disease?
Degeneration means gradual damage of the tissue. Degenerative disc disease represents aging of the disc, either appropriate to the normal age of the patient, or maybe accelerated due to injury or chronic disease, or other factors like smoking, obesity.
What is lumbar instability?
Lumbar instability means that the spine is not stable and there is excessive abnormal movement between two vertebrae. This is usually diagnosed by imaging in the form of X-rays, CT scan, or MRI of the patients. Instability may lead to compression of nerve roots causing radiculopathy with or without back pain.
What is Spinal Stenosis?
Spinal Stenosis means narrowing of the spinal canal. It is can be at the cervical or thoracic or lumbar level. Most common spinal stenosis is at lumbar level and it, when narrowed, can compress nerves, causing pain going down the legs, with or without tingling, numbness, weakness, or involvement of bowel or bladder.
What is Sciatica?
Sciatica is another name for lumbar radiculopathy, in which patient has pain going down their legs. The pattern of pain depends on the nerve root involved, but the most common is pain going down the outer side of the thigh and leg into the foot.
What is lumbar disc disease? how is this problem diagnosed?
The diagnosis of Lumbar disc disease is made by history and examination of the patient. The confirmation of diagnosis is done by imaging in the form of X-rays and MRI. Occasionally the patient is having contraindication to MRI, patient may need to undergo a CT scan. When a CT scan is done, occasionally the patient may need to get injected with a dye before the CT scan and this is called CT myelography. Occasionally patient may need a CT scan along with MRI also.
When should I consider surgery for the back pain?
Most of the patients get treated with conservative means. In case the patient is not getting relief despite continuous conservative measures, or if there is worsening of pain associated with or without weakness or involvement of bowel or bladder, the patient may need surgical intervention in the form of surgery.
Am I a candidate for minimal-invasive spine surgery?
Some patients are good candidates for minimally-invasive spine surgery and they can get better with that. History, physical examination, as well as special investigations like X-ray and MRI, are needed in order to discuss regarding options of minimal invasive spine surgery. Some patients are not good candidates for minimal invasive spine surgery and doing such a surgery in such patients may lead to non-resolved solution of the symptoms or worsening.
Are there any warning symptoms?
Warning symptoms of lumbar disc disease include worsening pain, tingling and numbness, development of weakness, or worsening of weakness, involvement of bowel or bladder in the form of incontinence of urine or stools, presence of fever, unintentional weight loss. In such conditions patients should immediately seek medical attention.
Do you need any tests?
General blood workup is needed in most patients before the surgery. This will include blood counts as well as metabolic profile. Special tests may be needed in some patients if the physician has suspicion of some other disease. Most of the patients will have to undergo X-ray and MRI, or a CT scan before the surgery to confirm their diagnosis.
What are the possible surgical complications from a low back surgery?
Common complications of a low back spine surgery are bleeding, infection, leak of cerebral spinal fluid temporary or permanent neurological deficits, blindness, worsening of pain, failure of fusion, failure of implants. There may be risks due to the anesthesia also.
How long does it take to perform on discectomy?
A discectomy of the lumbar spine is usually performed in 45 minutes to 1 hour. This period does not involve the re-surgical setup as well as postsurgical recovery from anesthesia.
What is microdiscectomy?
Microdiscectomy involves removal of the disk from the lower back so as to remove the compression on the nerve root through a small incision and with the use of microscope. This is a minimal invasive procedure and can be performed on outpatient basis or a hospital setting and leads to rapid improvement in symptoms in most of the cases.
What is the difference between a laminectomy and discectomy?
The disc is present in the front of the spinal cord or nerve roots and the lamina are present behind the spinal cord of the nerve roots. Discectomy involves surgery usually from the front, though it can also be performed from the back especially in the lower back and involves removal of the disc to remove the pressure from the front of the neural elements. Laminectomy on the other hand is performed from the back and involves removal of pressure from the neural elements from the back. Sometimes especially in the lower back area, both the surgeries can be combined and usually performed from the back.
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