Why do people have back surgery?
This is a major form of surgery and it is used to predominately treat back problems associated with the spinal column. These may have been caused by considerable wear and tear between joints, a disease such as arthritis or as the result of injury. Common injuries include falls, poor lifting, car accidents or sports injuries. The pain caused by these factors is likely to impact on the leg as well as on the back. Back surgery is normally used to treat severe fractures of the spine or dislocations.

In cases where the spine has started to degenerate a person may suffer pain caused by changes in a spinal disc. Discs can lose water and start to harden. The result is that the disc no longer functions as a shock absorber ‘cushion’ and causes discomfort during back movements. A disc may poke out (a slipped disc) or even collapse which will put enormous pressure on surrounding nerves causing great pain.

However in some cases back surgery is not always necessary. Many minor back problems can be resolved by lifestyle changes, medication physiotherapy or regular massage. In some cases back injuries may have been caused by tendon strain or pulled muscles. However, if pain continues for an unacceptable period of time it may be time to consider what surgical options are available.

What happens during consultation?
The level of your back problem will be extensively discussed with your surgeon. As mentioned back surgery is a complex operation and all avenues will be explored before taking a final decision. There may be health risks associated with some surgery such as obesity or previous injuries. The benefits must outweigh the potential risks before a surgeon agrees to an operation.

Getting the most out of your consultancy
Often in cases where clients are unhappy with the results of surgery it is because they did not discuss their expectations thoroughly or were afraid to talk about the outcome or risks.

You have to make an informed decision before signing the consent form so ask plenty of questions. You want to feel relaxed and confident and completely understand what will happen during surgery.

You may want to know:

• About the surgeon’s qualifications.
• How many operations of your procedure are carried out each year.
• How you prepare for the surgery.
• What realistic results can be expected and when.
• How long the results will last.
• About the side-effects and possible complications.
• How long it will take to recover.
• About the extent of scarring and how it will change in time.
• What happens if anything goes wrong.

Preparation for surgery

• Avoid alcohol, aspirin, garlic and food oils a least a week before surgery as they can cause excessive bleeding.
• Do not eat or drink anything six hours before your general anaesthetic.
• The surgeon and anaesthetist need to know your medical history.
• You will be advised of any health checks or X-rays required before your procedure.
• Prior to surgery you will be met by your surgeon who will assess you and discuss your queries.

Spinal surgery
Most forms of back surgery are designed to ease nerve compression caused by injury or degeneration. The following procedures are some of the most common operations carried out to alleviate back problems.

A laminectomy involves the removal of one or more vertebrae to gain access to the damaged area. The aim is to create more space to release the section of the damaged nerve in the spine.

During a discectomy part of the damaged disc is removed to free a trapped nerve. The space left by the removed section fills with scar tissue over several weeks. Techniques include an open discetomy where the surgeon opens the spine and back muscles to gain access to the disc and a miscodiscectomy where the disc can be treated through a small incision in the back.

Spinal fusion is an operation designed to bond two or more vertebrae together to improve spinal alignment and stability. This is particularly common when the spine has become unstable as the result of slipping vertebrae.

Again there are a variety of techniques. Plates or pins may be inserted into the spine to strength the column; bone grafts may be taken from other areas in the body to form a bonding strong spinal bridge or the disc may be removed and a device known as a cage inserted in its place. The cage fuses together different parts of the vertebrae.

Road to recovery

• Your first day is likely to be spent in a recovery room bed being cared for by nursing staff. Your surgeon will visit you and advise you when you can leave.
• Enjoy plenty of rest and avoid any energetic activities.
• If you have had a drainage tube inserted it will be removed within two days. Bandages are normally taken off after one to five days.
• You will be advised on ways to move around without disturbing the repaired vertebrae.
• Avoid alcohol, aspirin, garlic, food oils and smoking. All of these can interfere with the body’s healing processes.
• Any discomfort, bruising or swelling should be treated with prescribed medication.
• Your surgeon will tell you when you can return to normal activities.
• Scars may initially appear noticeable. In time they will take on a more normal skin colour but will not disappear completely.
• You must contact your doctor if you suffer from an abnormally high temperature, severe pain that is not treated with medication or if you experience severe bleeding.

All surgery carries an element of risk
Most people believe that the benefits of back surgery outweigh the risk. However before you sign the surgery consent form you should be aware of any possible complications and side effects.

With spinal surgery there is an extremely rare chance of nerve damage that may impact on other parts of the body. In a small percentage of cases a disc problem may recur.

Physical complications associated with any type of surgery include problems healing, the danger of infection and the potential formation of clots that may be life-threatening. Excessive bleeding or bleeding under the skin, known as a haematoma, may require a return visit to the surgery. Some patients may also have an allergic reaction to anaesthesia. In a minority of cases there may be a problem with fluid loss or an excessive build up of fluid that needs to be drained.

Complications are rare and depend on individual circumstances such as a person’s health and the extent of the procedure. Your surgeon will be able to explain how the risks apply in your case.