Indications for surgery:
Significant radicular pain, consistent with the affected nerve root, following failed conservative management
Neurological deficit –Weakness, numbness, loss of reflex
Bladder/ Bowel dysfunction – may require emergency treatment
Evidence for surgery:
Several, well designed, randomized controlled trials have shown that patients improve faster with surgery than with best medical management. Surgery is also offered to patients who have failed prolonged medical management.
Benefits of surgery:
Typically rapid relief of leg pain and possible improvement in neurological dysfunction. Emergency treatment is indicated to give best chance of improvement in caudaequina syndrome.
Risks of surgery include:
Serious risks – death, neurological worsening – Serious weakness, numbness, bladder and bowel dysfunction – all rare risks <1%
More common risks – The quoted risks across several series looking at this operation and its outcome. I will discuss your individual risks at the time of consent.
disc recurrence approx 5-10% in literature
incidental durotomy and CSF leak 2-5% in literature
significant ongoing pain approx 10-20% patients in literature
worsened pain approx 5% in literature
spinal instability requiring future spinal stabilisation approx 2-5%
infection approx 1-5% patients in literature
medical or anaesthetic complications
After this operation if you are mobilising well and in minimal pain you may elect to go home on the day of surgery. Otherwise if you remain an inpatient you will mobilise on the same day as the surgery and would typically return home the following day, though some patients may require more time before discharge.You will be assessed by our physiotherapy team to determine if you are safe to return to your home environment. Occasionally some patients may benefit from a short period of rehabilitation.
Pain is typically well controlled with Paracetamol and NSAIDS.
Mobility restrictions are designed to limit discomfort and reduce risks of disc recurrence. I would advise sitting for a maximum of 30 minutes at a time and then walking around. Patients should avoid lifting anything heavier than a full kettle of water. Bending should be at the knees only. Exercise should be walking on the flat, building distances up over the six week post-operative period.
Driving should be avoided for the first 2 weeks post op and then should be commenced only if there is no foot weakness and good range of movement without discomfort to allow the driver to easily be in full control in an emergency situation. If this is not the case the patient is legally bound to avoid driving.
Return to work is variable between different types of jobs. A minimum of 2 weeks off is necessary and usually I would recommend returning to work in a graduated fashion starting after your 6 week post operative consultation.