Back surgery

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who are having back surgery, or who would like information about it.

Back surgery is usually done to relieve back pain caused by wear and tear, or for severe arm or leg pain caused by a build-up of pressure in the spine.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About back surgery

Your doctor may refer you for back surgery if you have severe back pain that hasn't improved after other treatments (such as physiotherapy), or to reduce nerve pain affecting your arms or legs. There are a number of different types of back surgery. The type you have will depend on your condition.

• Discectomy may be used if you have a slipped disc.
• Spinal disc replacement is only suitable for a small number of people with a slipped or worn disc.
• Laminectomy may be used if you have a condition known as spinal stenosis (a condition in which the spaces in your spine narrow).
• Foraminotomy is usually used if you have a bulging disc, a bone spur or a thickened vertebral disc.
• Vertebroplasty is only suitable for some types of fracture to your back bone.
• Spinal fusion is carried out most commonly for people with conditions such as spondylolisthesis (when one of your back bones slips forward and out of position) or degenerative disc disease (when the discs in your spinal cord gradually become worn down).

What are the alternatives?

If your surgeon suggests back surgery, this is as a last resort. However, for most conditions causing back pain, your doctor is likely to suggest some alternative treatments to try and reduce or relieve your back pain before referring you for back surgery. You may have manual therapy, which involves manipulating and massaging your back, acupuncture, anti-inflammatory medicines or epidural injections. See Related topics for more information.

Preparing for back surgery

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during back surgery

Your surgeon may use open or keyhole surgery. Open surgery involves making a single, large cut on your back. Keyhole surgery involves making several small cuts on your back and special instruments to do the operation.

Exactly how your surgery is carried out will depend on the type you are having.

• Discectomy - your surgeon will remove one or more of your discs through a small cut in your back. Part of the bony coverings of your spine (lamina) may also be removed, with a section of ligament.
• Spinal disc replacement - this procedure aims to restore disc height and movement between your vertebrae. Your surgeon will remove the affected discs and replace them with artificial ones.
• Laminectomy - your surgeon will remove the lamina and shave back any thickened ligaments, joints and bone spurs (overgrowths of bone). This will widen your spinal canal and relieve pressure that has built up around your spinal nerves.
• Foraminotomy - your surgeon will carry out a keyhole procedure to widen your foramina (the bony holes through which spinal nerves branch off from your spinal cord) and reduce pressure on your spinal nerves.
• Vertebroplasty - your surgeon will make a small cut on your back and using X-rays as guidance will slowly inject a cement-like mixture into your vertebrae to stabilise your spine.
• Spinal fusion - your surgeon will join two or more of your vertebrae together using a bone graft and a special metal scaffolding made of screws, rods or plates.

If you need more information about the procedure you are having, speak to your surgeon.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you have open surgery, you may need a catheter to drain urine from your bladder into a bag. You may also have fine tubes running from the wound. These drain fluid into another bag and are usually removed after a day or two.

You will need to spend some time resting in bed, but may be able to get up and walk around the day after your surgery. You may also be given a corset to wear that will support your back, but this will depend on the type of operation you have. A physiotherapist may suggest some exercises to help with your mobility and recovery.

Your nurse will give you advice about caring for your back, hygiene and bathing before you go home.

Recovering from back surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information that comes with the medicine and ask your pharmacist for advice.

Your physiotherapist may recommend starting an exercise programme between four and six weeks after your back surgery. The exercises are designed to help you recover and reduce any back pain you may have.

You can usually return to work after about eight weeks, but this depends on the type of surgery you have and what your job involves.

What are the risks?

Back surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic. You will feel some pain in your back and possibly in your legs. Up to two in three people have stiffness or back pain after surgery.

Complications

This is when problems occur during or after your operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT). Complications may require further treatment such as returning to theatre to stop bleeding or antibiotics to deal with an infection.

A general complication of back surgery can include spinal cord or nerve damage. This can lead to numbness, impotence, pain, paralysis and loss of muscle, bladder or bowel control, but is very rare.

You may have complications specific to the type of operation you have. For example, after surgery for a slipped disc about one in 10 people will have another slipped disc and need further treatment. Or, if you have an implant fitted, the screws or implants in your back may come loose and you will need further surgery.

If you experience any unexpected problems after your surgery, such as ongoing pain or arm or leg weakness, contact your doctor. The exact risks are specific to you and differ for every person. Ask your surgeon to explain the type of complications specific to your procedure and how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.