A posterior lumbar
discectomy is performed to decompress a nerve root, and attempt
to relieve lower extremity pain. During the operation,
the patient is put to sleep by the anesthesiologist, and is
then gently turned to the prone (face and abdomen down) position,
using cushions and gel rolls to protect and cushion the body.
The lower back is cleaned in a sterile manner, and the surgeon
then makes a vertical (up and down). The surgeon will
dissect down to the spinous process (bone protruding back
from the spine) and then push the muscle away from the lamina
( the roof of the spinal canal). Often, an x ray
will be taken at this point to confirm that the appropriate
level is being operated upon. Next, the surgeon will
remove a portion of the lamina in order to allow access to
the spinal canal and nerve roots. This is often done
under magnification, usually using the microscope. The
surgeon will identify the nerves, and gently move them aside,
while attempting to find the disk or bone spur pushing into
the nerve root. After doing so, the offending fragment
will be removed, and often the surgeon will enter into the
disc space from where the herniated disc originated, and attempt
to remove as much of remaining material as possible.
After doing so, he/she will close. The muscle falls
back into place once the retractor is removed, and the deep
fascia (firm fibrous tissue of the low back) is sewn closed,
as is the subcutaneous tissue (tissue deep beneath the skin)
and skin. The would is dressed with a sterile dressing,
and the patient is returned to the recovery room.
lumbar discectomy is a frequently performed procedure.
Even though the risks of complications are relatively low,
there are risks. These can be broken down into two categories,
1) those related to the operative site, and 2) those related
to the risks of anesthesia.
related to the operative site:
Exposure: The patient is placed in a prone position
(on their abdomen). In this position,
there can be pressure sores, pressure injuries to nerves,
and injury to the eyes as a result of pressure to them.
During surgical dissection, injury to muscle surrounding
the spine can occur.
Root injuries: If there is any injury to the spinal
cord (in the upper lumbar area) or nerve roots, the
consequences may involve loss of sensation, increased burning
sensation, paralysis, weakness, loss of bowel, bladder,
sexual function. There may be a spinal fluid leak,
which could occur after a tear of the covering of the spinal
cord or nerve roots. If this did occur, it may
be necessary to have the patient flat in bed for several
days after the surgery. Even if everything goes as
well as hoped, there is a risk of recurrence of a disc fragment
in the future, requiring additional surgery in the lumbar
spine. There is a small chance of causing instability
with the discectomy.
Risks: These include such general difficulties,
such as bleeding, infection, stroke, paralysis, coma and
death. Incisions on the low back generally heal well,
but if could be tender, or may heal in an unpleasant
manner. There is also the possibility that the surgery
may not relieve the symptoms for which the procedure was
performed. The problem for which the surgery was performed
may recur, requiring additional surgery in the future.
In addition, although every attempt is made to protect all
areas of the body from pressure on nerves, skin and bones,
injuries to these areas can occur, particularly with prolonged
Anesthesia: Blood clots in the legs, heart attacks,
reaction to the anesthetic, reaction to blood transfusion,
if it given.
be no bending, twisting, or heavy lifting for several weeks
after surgery. Physical therapy may or may not be
implicated. Your doctor will gradually ease your work
restrictions, depending on your progress.
keep the wound dry and clean. Notify your surgeon
of any drainage or temperatures greater than 101 Fahrenheit.
The goal of
this surgery was to relieve the pressure on the nerves in
your back and reduce your leg pain. We expect you
to do normal activities better because of the surgery.
Some continuuing back and leg pain is not unusual during
the first few days and weeks following surgery. Hurt
does not necessarily mean harm. You may experience
numbness in the foot or leg, but this does not impair function.
The following is a list of suggestions that should help
speed your recovery and give you every possible chance for
the best results from your surgery.
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been set up.
- Take it
easy until seen by the physician. This does not
mean bed rest, but athletic activities during this period
are definitely not recommended. Please give your
incision a chance to heal. Avoid bending.
- Lift nothing
heavier than a half gallon of milk until seen by your
- Avoid sitting
for periods of time longer than 45 minutes. It is
OK to sit in a lounge chair which is laid back, for as
long as you wish.
- No jogging
- After you
get home, you may begin walking up to one mile per day.
- You may
walk up or down steps as often as you like. Please
take them smoothly and slowly.
- No driving
until OK with your physician. Do not ride further
than 50 miles at a time. This applies during
the first month after surgery.
- You may
shower after you go home unless otherwise instructed.
Cover the incision with plastic wrap before the shower
and remove it afterward. Change dressing immediately.
Tub baths are not advisable. You may shower without
covering the incision one week after the staples are out.
Follow instructions concerning care of tapestrips, stitches
or staples. Your surgeon or his nurse clinician
will explain the techniques used in the closure of your
- Sexual activities
- If you notice
swelling, redness or opening of the incision, or if there
is any clear fluid draining from it, please contact your
surgeon immediately! If you develop a fever, stiff
neck or chills, contact the office immediately.
Take your temperature at 4:00 PM daily until the clips
are removed. Call in greater than 101 degrees Fahrenheit.
- If you have
any questions, call our office, and for after hours emergencies,
call the medical society.
- Take your
medications prescribed on discharge, as directed.
- It takes
6 - 18 months for a nerve to heal. During that time
you may experience numbness, tingling, fleeting pain,
or creepy/crawly sensations.
- For three
months after a herniated disc repair, you are at increased
risk for a recurrence.