Patients who have severe back and leg pains due to arthritis of the spine may be offered back operation. Spine operations are more commonly used to treat lower back pain resulting from a damaged or degenerate intervertebral disc (the shock absorber between the bones), or spondylolisthesis (slip of one bone on the other). The goal here is to stabilise the spine so that pain (and sometimes deformity) is reduced. Operations are also used to treat lower leg pain resulting from pressure on a nerve or nerves in the back. The goal then is to free the nerves from pressure and so stop pain, numbness and weakness in the legs.
Surgery is usually recommended when all reasonable conservative measures (pain medications, nerve injections, physical therapies, braces etc.) have failed. It is often the last resort unless there are special circumstances like severe nerve injury that makes it the number one priority. Operations on the spine can be performed from the back or the front. We more commonly do it from the back. Operations from the front entails going through the abdomen and may be required in some special circumstances. More often than not, it is combined with a second operation from the back as well.
The goals:
Reduction of back pain
Stabilisation of an unstable spine
Reduction in amount of drugs used for pain
Prevention of deterioration in your condition
Improved lower back and leg function
Improved work, walking and recreational capacity
Improved quality of life
There are risks in back surgery as with any operation. The chance of a minor complication is around 4 or 5%, and the risk of a major complication is 2 or 3%. Generally, surgery is fairly safe and major complications are uncommon. Over 90% of patients should come through their surgery without complications. Our review in 2012 demonstrated good outcome in the majority of patients.
The specific risks:
Failure to benefit or to prevent deterioration
Worsening of pain
Infection
Bleeding and a need for Blood transfusion
Nerve damage (weakness, numbness, pain) occurs in less than 1%
Cerebrospinal fluid (brain fluid) leak: this risk is much higher in revision (re-operation) surgery
Surgery at incorrect level (this is rare, as X-rays are used during surgery to confirm the level)
Major neurological problems are very rare, but include paralysis, damage to a nerve, problems passing urine or stool and loss of erection.
Chronic pain (may require further surgery)
Before Surgery:
Please bring all your regular medications with you to hospital.
Consult with your surgeon if you are taking blood-thinning medications.
You may continue to take your routine medications (for example, heart and blood pressure medications), on the morning of surgery with a sip of water (unless otherwise directed).
You may not eat anything after midnight, the night before surgery and must cease drinking clear fluids (water, apple juice, black tea) 2 hours prior to your admission time (unless otherwise instructed.)
Please shower on the morning of admission. Do not use powder, apply perfume, makeup or nail polish and wear cotton underwear if possible.
Please be sure to take the following to the hospital for the operation; MRI/Xray/C.T Scans and all previous medical reports and results. Before your surgery it is imperative that you stop smoking, and you should not smoke for at least 12 months after. Smoking impairs the healing process and leads to worse outcomes following spinal surgery.
So if you need a back operation:
The operations are being performed safely in Nigeria, everyday, and many patients are benefiting from the procedures. Be clear in your mind that you have exhausted all other reasonable treatments such as weight loss, regular exercise, medication and even meditation. Be prayerful and trust in your surgeon for a successful outcome. Have no fear and trust in God to heal you.