Lumbar Spine Surgery

The spine is made up of 33 vertebrae. The lower part of the spine, comprising of 5 vertebrae, is called as lumbar spine. These vertebrae are slightly larger in size than the rest of the vertebrae and play an important role in bearing weight of the body. Apart from these 5 vertebrae, the intervertebral discs, muscles, tendons, ligaments and nerves are also important for healthy functioning of the lumbar spine. Stress, injury or damage to any of these structures may result in back pain.

Some of the spinal conditions that can cause low back pain and other associated symptoms include disc herniation, lumbar spinal stenosis, degenerative disc disease and adult degenerative spondylolisthesis. The low back pain and related symptoms usually resolve with non-surgical treatments. However, a lower back surgery may be considered, in case any of the following observations are made:

• Non-surgical treatment is ineffective in relieving pain and other associated symptoms.
• Severe pain
• Spinal instability
• Neurologic dysfunction along with pain, numbness and weakness in the arms and/or legs
• Loss of bladder or bowel function: This is a medical emergency

Surgery

There are different types of surgeries that can be performed for the management of lumbar spinal conditions. The goal of lumbar spinal surgery is to relieve nerve compression and stabilize the spine. The common lumbar spinal surgeries include: discectomy, laminectomy, foraminotomy, laminoplasty, laminotomy, intradiscal electrothermoplasty (IDET) and spinal fusion.

Spinal fusion is a surgical procedure employed to join the damaged vertebrae into one solid bone, preventing movement between them and relieving pain. In this procedure, a bone graft is inserted between the two damaged vertebrae that later heals and fuses the two vertebrae together. Spinal instrumentation that employs screws, rods and interbody devices to fuse the vertebrae is also used to stabilize the spine. Based on the approach for the surgery and the positioning of the incision, spinal fusion surgeries can be categorized into different types: anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), axial lumbar interbody fusion (AxiaLIF) and direct lateral lumbar interbody fusion (DLIF).

The type of surgery depends on various factors such as the general health of the patient and the spinal conditions responsible for the symptoms.

Moreover, the recommended surgery can either be performed through the traditional open approach or a minimally invasive approach. Minimally invasive surgery is a newer approach that results in smaller surgical scars, less blood loss, less preoperative pain, quicker recovery, shorter hospital stay and quicker return to normal activities. But minimally invasive approach can be done only in selected few patients.

Before the surgery

Before the surgery, the patient’s medical history and various diagnostic tests, such as X-rays or other imaging tests, are used to ascertain the underlying spinal conditions causing pain and other symptoms. The current health status of the patient is also evaluated through blood tests and other specialized tests, for diseases such as diabetes and heart disease. A surgeon always aims at providing the best possible surgical option to each individual patient. Based on the medical condition of the patient and the location of the diseased disc, the surgeon will decide on the type of fusion surgery as well as the approach for the surgery. The surgeon also explains the surgery and its benefits along with the possible risks to the patient.

A general health clearance is obtained from, the general practitioner, for the surgery.

Risk and Complications

The risks and complications of the surgery may include infection, bleeding, nerve injury, or spinal cord injury. Complications due to general anesthesia may also occur.

After the surgery

After the surgery the vital signs of the patient are closely monitored and special care is taken, by the nurses and medical staff, to manage the post-operative pain. Some discomfort around the incision and occasional muscle spasms in the back can occur and resolve in a few weeks after the surgery.

Post-operative Care

• The incision should be kept clean and dry till it heals completely. Care should be taken to cover it properly while bathing. Swimming and hot tubs should be completely avoided.
• Medications should be taken regularly, as prescribed.
• A back brace should be worn, as advised by the surgeon.
• Physical therapy should be taken, as advised.
• Lifting anything heavier than a shoe should be avoided.
• A healthy lifestyle should be followed to promote healing which includes healthy nutritious food, ample rest and abstinence from smoking. Walking is also encouraged.
• Driving should be avoided. However, a ride in the car, for small distances, is allowed.

Contact the surgeon at the earliest on observation of any of the following symptoms:

• Fever ≥ 101°F
• Increase in redness, swelling or pain at the incision site
• Significant change in the volume, color or smell of the incision drainage fluid
• Loss of bladder or bowel function: This is a medical emergency and the surgeon should be contacted immediately
• Numbness in the genital area

Contact your surgeon for any unanswered queries on lower spine (lumbar) surgery.