Information for Patients Undergoing Surgery
The procedure by which the surgical team informs the patient and their caregivers about the advantages and dangers of a proposed operation is known as informed consent. The purpose of this document is to help with that process. It includes information that the British Association of Spine Surgeons’ spine surgeons feel is a reliable source of knowledge so that you, the patient, can weigh the benefits and drawbacks of this procedure. At the conclusion of this page are two resources that will help you recover from your surgery.
Introduction
There are dangers involved with every procedure, and there is no certainty.
Your surgeon will go over the possible advantages and disadvantages of the procedure specifically for you. To supplement that information, here is a generic information source.
Patients who experience leg nerve discomfort typically undergo this kind of surgery. The sciatica. In people in their 30s and 40s, sciatica is common. It is typically caused by a disc prolapse or protrusion in this group of patients.
The elderly patient may have stenosis, or a narrowing of the bony spinal canal, as a result of degenerative processes. The ailment known as “spinal stenosis” usually results in discomfort and numbness in the legs when walking and standing.
The word for leg discomfort or nerve symptoms that only occur when walking is spinal claudication.
Generally speaking, a “discectomy” procedure involves removing the portion of the disc causing the leg pain. You might be better off leaving well alone if the discomfort is getting better or isn’t substantially harming your quality of life. Removing bone or soft tissue that is compressing the spinal canal’s contents is known as a “decompression.” It might be necessary for certain people to have both of the treatments.
A common symptom is back discomfort, which may be accompanied by less severe symptoms that extend down the legs. Surgical intervention is not always necessary to address the debilitating symptoms of back pain, since there are often safer and more effective non-surgical options available. Some people experience both back and leg discomfort at the same time.
The purpose of this document is to inform you about common procedures for spinal stenosis and sciatica. Any surgery carries some general hazards, but there are also some particular concerns associated with spinal surgery that you should be aware of.
Some Important Considerations
Leg pain is better treated with spinal surgery for sciatica and spinal stenosis than back pain. The back and leg pain might both become better.
Following surgery, numbness or weakening symptoms can very likely last.
Seventy-five percent of individuals with sciatica who see a general practitioner for the first time get well in 28 days. It’s possible that the sciatica pain will go away without requiring surgery. In the early stages, pills or injections might be used to relieve pain, however the condition usually improves on its own.
Although surgery seems to speed up recovery, there are risks involved.
Disc prolapses of some kinds are more prone than others to repeat. The recurrence rate following disc prolapse surgery is 7% to 15% after ten years. Whether you undergo an operation or not, this remains the same.
When a patient’s severe or troublesome symptoms have persisted for more than 6-8 weeks without improving to their satisfaction, surgery may be the best course of action. In terms of healing and results, recent research indicates that waiting about four months from the commencement may be the ideal time for surgery.
For patients who are fit and well, surgery carries a lower risk and is safer. It seems logical for patients to assume responsibility for lowering risks whenever feasible. Simple actions like quitting smoking, losing weight, and increasing cardiovascular fitness all have a positive impact.
Patients who are older may be more susceptible to certain risks, like heart disease. You need to let your surgical team know about the increased risk of bleeding when taking blood-thinning tablets such asprin, warfarin, or clopidogrel.
In general, diabetic patients are at a little higher risk of infection, and their nerves may not heal as quickly as those of normal people.
There are risk factors that may be unique to you.
Specific Usual Benefits
In 70–75 percent of cases, leg discomfort significantly improves.
20–25% may be better, but they still experience chronic leg pain.
5 percent might not profit at all.
Maybe 1% hurts more than that.
Lumbar Disc Surgery - What Do We Know?
Numerous research have been published in academic journals. There are situations when doctors can obtain a summary of the advantages of various treatments by integrating them into a systematic review. This was carried out by an impartial panel of spine experts called the Cochrane review, which examined 39 trials.
Gibson A. Waddell G. Cochrane Database Syst Rev. 2007 Jan 24;(1)
The authors’ conclusions are as follows: although any beneficial or negative effects on the lifetime natural history of the underlying disc disease are still unknown, surgical discectomy for carefully chosen patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management. Results from microdiscectomy and open discectomy are essentially similar. Other minimally invasive procedures (apart from chemonucleolysis with chymopapain, which is no longer generally accessible) have conflicting data.
The Most Recent Evidence
In patients with sciatica due to lumbar disc herniation, extended conservative treatment versus early surgery: cost-utility in conjunction with a randomized controlled trial
Van den Hout, Wilbert B. et al. BMJ, June 14, 2008, vol. 336, p. 1351–1354
283 people were enrolled in the trial across nine hospitals in the Netherlands. Of those who had symptoms for 6 to 12 weeks, 141 had early surgery. For six months, 142 patients received conservative therapy. Eventually, 62 (44%) of these required surgery.
Compared to conservative care, early surgery relieved sciatica more quickly, but after a year, the results were identical and remained unchanged.
According to the economic research, the cost of healthcare increased as a result of early surgery (1819 Euros). From a social standpoint, productivity savings resulted in a minor effect (-12 euros, range -4029 to 4006 euros). The price per QALY was forty thousand euros. The economic analysis comes to the general conclusion that early surgery is probably cost-effective.
The outcome measures in the clinical findings paper are the VAS scores and the Roland Morris scores. There is not much of a difference between the two groups at 26 weeks. At admission, the leg’s VAS was 6.5; at follow-up, it was just 1. The patient benefits in the near term from a quicker recovery from leg pain following surgery. Of all surgery patients, 1.6% experienced complications.
During the two-year follow-up period, 6% of surgically treated patients in both therapy groups experienced recurrence sciatica, necessitating further surgical intervention. Twenty percent of patients had unsatisfactory results from both long-term conservative therapy and early surgery. The early surgery did not lessen this.
“Since the treatment effects of early surgery disappear after six months, well-informed patients, rather than physicians, should decide whether and when to have surgery,” the study’s conclusion states.
Lumbar Spine Decompression - What Do We Know?
About 65-70% of patients report reduced pain after lumbar decompression surgery, and patients’ walking distance is frequently increased by a factor of four. The procedures are for problems with quality of life. That is to say, the patient and the surgeon should discuss whether or not to have surgery if the patient finds the symptoms tolerable. Many spinal conditions either get better or stay the same.
Is lumbar spinal stenosis treated surgically or nonoperatively? a controlled, randomised experiment. Spine of Malmivaara A January 2007; 32(1): 1–8 a 94-patient trial. Whatever their initial course of treatment, patients all improved over the 2-year follow-up, but those who underwent decompressive surgery reported more improvement in terms of total impairment, back pain, and leg pain. Over time, the initial surgical treatment’s relative advantage decreased, but two years later, the surgical outcomes were still good.
The Operation
Usually performed under general anesthesia, the procedure calls for a brief hospital stay—often just one night. An early return to regular activities is encouraged by most surgeons because it speeds up recovery.
Both a “minidiscectomy” and a “microdiscectomy,” which require the use of a microscope, are frequent treatments, and the outcomes of both procedures are fairly similar. The major purpose of these procedures is to release pressure on nerves, usually by eliminating a disc prolapse. The process of removing bone that can be pressing on a nerve and producing symptoms is called a decompression. An “undercutting facetectomy” occurs when a bone from one of the spine’s tiny joints, also known as facets, is removed. It is not uncommon for a combination of “discectomy” and “decompression” to be necessary, especially as people age.
Your surgeon will go over the procedure’s principles and specifics with you. The particular operation is frequently customized for each person.
Risks of Surgical Treatment
Demise
It is difficult to estimate the risk of death, but it is likely less than one per 700 surgeries for sciatica. It would result from unforeseen circumstances such pulmonary emboli, or blood clots that travel from the legs to the lungs, or catastrophic blood loss from large blood arteries. Patient characteristics like smoking, high blood pressure, heart disease, and particular age-related risks will all affect the risk. Because the patients undergoing decompression surgery for stenosis are typically older and less fit, the risk of death from this procedure may be higher than that of disc surgery—possibly one in 350.
Immobility
There is little chance of paralysis, which results in loss of feeling, control over the bowels and bladder, and loss of function of the legs. Less than one in every 300 surgeries, most likely. It might happen if there is bleeding into the spinal canal following surgery (called an extradural spinal hemorrhage). In patients on blood thinners (warfarin) or experiencing an unintentional durotomy (spinal fluid leak), the risk of paralysis is increased. We would do everything in our power to turn things around if something unfavorable of this like happened. Damage to the blood supply of the nerves or spinal cord can occasionally result in paralysis, which is irreversible.
Sickness
Superficial wound infections can happen in 2% to 4% of spine surgeries, thus they are relatively uncommon. Individuals with diabetes, those taking steroids, or those with decreased immune systems are more likely to become infected.
Though less frequent, deep spinal infections are far more dangerous. Less than 1% of cases result in a deep spinal infection. Antibiotics are frequently used to lower the risk of infection, and ultra clean air flow theaters are frequently used for the procedure. In the event of a severe infection, a protracted and intensive course of antibiotics may be necessary in addition to multiple surgeries to wash out the spine.
Unexpected durotomy
This is the location of an opening in the dura, the spinal canal’s lining. The hole will allow the spinal fluid inside the spinal canal to flow out. If the surgeon plans to do it on purpose as part of the procedure, then it may happen. It could happen if the bone or disc is extremely adhered to the spinal canal’s lining. In 3% of people undergoing initial sciatica surgery, this happens. It occurs in 8% of instances during decompression surgery, making it more common.
Due to scarring, it is significantly more likely following a prior spinal fusion. The risk of problems is higher for revision or repeat operations than for first-time ones.
Stitches or a patch may occasionally be used to close the break in the dura, the spinal lining. Sometimes letting things heal on its own is safer. In order to redirect the fluid, the surgeon may occasionally implant a drain. Usually, the fluid leak stops in a few days and has no lasting effects. Even with measures, spinal fluid can occasionally seep through the wound. Meningitis and infection are possible outcomes of this, and more surgery may be needed to address the issue.
spinal nerve injury
The illness process may have already harmed the spinal nerve that is generating the pain. Technically effective surgery may not be able to heal the nerve due to scarring caused by the disc prolapse. To try to get rid of the disc that is under the nerve, the nerve might be stretched. In addition, direct surgical trauma or pressure effects required to regulate bleeding can harm the nerve.
Blood vessel damage
Significant bleeding may ensue from this, which could be fatal. It has been documented that injury can happen to the aorta, the major blood vessel at the front of the spine. Amputation may also occur from injury to the major blood arteries in the legs. These kinds of incidents are uncommon, happening fewer than once every 10,000 procedures. Vital organ damage: The liver, kidneys, and colon are in front of the discs and could be harmed. This would also be extremely rare but potentially fatal.
The incorrect procedure
Numerous discs and vertebrae make up the spine. To ensure he is operating at the proper location in the spine, the surgeon frequently takes x-rays during the procedure. To ensure that the patient is receiving the proper care, numerous safety checks are conducted. The right level will occasionally be approached when the x-rays reveal that the incorrect disc space has been opened. Such intraoperative monitoring is crucial to prevent surgery at the incorrect level or site.
What You Need To Know
You will have multiple opportunities to speak with the medical staff caring for you about the procedure. It is imperative that clarifications are provided in language that you can comprehend.
After The Operation
Here are some useful tips from the Royal College of Surgeons on recovering quickly following a discectomy.
Early resumption of activities has been found to yield better outcomes. You should be able to resume your most routine activities in a few weeks. Don’t stop going; pace your actions.
Before you become rigid, move about. Increase your output a little every few days. You won’t injure your back, but it will ache.