Overview

 

This is an extremely common condition, frequently referred to as a ’slipped disc’. The central portion of the lumbar disc (nucleus pulposis) bulges through the surrounding fibrous tissue (annulus fibrosis) and may cause irritation or compression of an adjacent nerve. This often occurs in the presence of an abnormal or degenerate disc, which has a small tear in the annulus fibrosis.

This may cause leg pain, with associated numbness, and weakness. Occasionally the disc may compress the sac of nerves at the end of the spine called the cauda equina (see cauda equina syndrome), which may damage the nerves controlling bladder, bowel and sexual function

Complications

Infection

Infection following this procedure is extremely rare, but if this occurs, the vast majority of infections will affect only the wound (a superficial infection), which requires some dressings, removal of a stitch and a short course of treatment with antibiotics. Deeper infections are much less common and very occasionally may require a further operation to wash out the infected operation site. Infection of an operated disc space or of bone may require initial intravenous antibiotics, and then several weeks or months of oral antibiotics until the infection is controlled.

Bleeding

Significant blood loss is very rare after this operation, however very occasionally patients will bleed a lot and a collection of the blood will press on the nerves. If this occurs a further operation will be required to remove the blood collection. Dural Tear or Cerebrospinal Fluid Leak (CSF Leak) This occurs when the sac (dura) surrounding the nerves and the brain is opened, allowing the fluid within the sac (Cerebrospinal Fluid CSF) to leak out of the sac. This is usually treated by placing a material over the tear, which assists the closure of the wound. The patient may experience a headache following the surgery, but the vast majority of patients will be treated with only a few days bed rest, while the headache resolves and the leak seals.

Nerve Damage and Paralysis

Paralysis is always a potential risk of spine surgery, yet although this risk exists in the vast majority of operative cases this risk is extremely low. Factors that may increase the risk of paralysis include more complex operations as well as the area of the spine that is operated on. In the presence of pre-existing nerve or spinal cord damage causing muscle weakness or where a nerve or the spinal cord is already squashed there is an increased risk of these structures being injured because of the manipulation needed to try to free the nerve or spinal cord. Nerve or spinal cord damage may also affect control of the bladder and bowel. The risk of damage to the nerves or spinal cord is extremely rare with this operation degree however a patient needs to be discuss with the operating surgeon the risks on an individual basis.

Laryngeal Nerve Palsy (Hoarseness)

The approach to the spine from the front is less painful than going from behind but does have its drawbacks – there is a small risk of hoarseness, due to damage to the laryngeal nerve. In the vast majority of patients this is due to stretching of the nerve and gets better without treatment. Rarely this is permanent, and requires treatment from an Ear, Nose and Throat surgeon. Difficulty Swallowing (Dysphagia)

Temporary difficulty swallowing, because the voice box (larynx) and throat (oesophagus) need to be pushed to one side, is very common following anterior cervical surgery. This usually resolves within a few days to weeks and is rarely persistent.

Smoking

There is absolutely no doubt that smoking reduces the success rate of fusion. Smoking interferes with the development of new blood vessels that are essential for developing new bone.

General Complications of Surgery

Patients undergoing spinal surgery are at risk of medial complications. The risk depends upon an individual patients heath and past medical history and the relative risks should be discussed with the operating surgeon prior to deciding to proceed with surgery.

Potential serious complications include:




This is when a blood clot forms within the legs blocking the veins deep within the leg. Occasionally this may lead to a pulmonary embolus. A blood clot forms in the lungs which may cause severe shortness of breath or on very rare occasions death. Increased risks for DVT and PE include prolonged bed rest, extensive surgery, obesity, cancer, previous DVT, paralysed leg/s and heart failure.

To prevent DVT and PE the patient will have elastic stockings put on prior to surgery. While in surgery, the patient has leg pumps fitted around the calves to improve the circulation. This is continued after the operation until the patient is mobile.

The patient is encouraged to mobilize out of bed as soon as possible following the operation, usually the day after surgery. Before this, the patient can wiggle the toes and move the legs around in bed as soon as wakening from the anaesthetic. Blood thinning injections may be used in patients who are at high risk of a DVT or PE, this is generally avoided prior to the surgery to prevent excess bleeding.


Myocardial Infarction (MI)

MI or heart attack occurs when there insufficient blood supply to the heart. This is more likely to occur if a patient has had previous heart problems.


CVA

CVA or Stoke is when there is inadequate blood supply to the brain, which leads to an area of the brain becoming damaged. This is more likely if a patient has had a previous problem.


Death

Death due to elective spinal surgery is extremely rare, however death can occur with any surgery and usually occurs after the operation. The most common reasons are myocardial infarct (heart attack) due to the stress of the surgery, a rare reaction to a drug (anaphylaxis) or pulmonary embolus.

Surgery

A general anaesthetic is required and once this is administered the patient is placed on their front. An X-ray machine is used to localize the area of the spine that needs to be operated on. This allows the surgery to be made through a smaller scar and reduces the risks of scar tissue forming around the nerve and causing post-operative pain.

The muscles around the spine are moved out of the way, and a small hole or foraminotomy is made in the soft tissues or bon to gain access to the prolapsed disc. The nerves are carefully reflected out of the way and the disc prolapse is removed, thus reliving the pressure on the nerve. The annulus is left in position.

Post operative care

On the evening of the surgery or the following day you will be able to mobilise with the help of the nursing staff. You will reviewed by your operating surgeon the day after surgery and the majority of patients will go home that day. You will be seen by a physiotherapist prior to discharge home and encouraged to mobilise as much as possible. Plans will be made for physiotherapy treatment within the outpatient department.

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