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What You Need to Know About Lumbar Herniated Disc Surgery

June 29, 2017
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Burt L is a Madison, Wisconsin resident AND fellow Backer who is set for back surgery next month due to bulging discs in his L4 & L5 vertebrae.

I am 52 years old and suffering [from bulging discs]. I am scheduled to have surgery in one month. I haven't been able to knock this thing down on my own. After a strict regimen of physical therapy (simple floor exercises for strengthening core), drugs for pain management, sitting on a big blow up ball at my desk job (sitting is painful and sends me overboard with the pain and numbness), hanging upside down on an inversion board for brief periods of time twice a day, and finally lots and lots of laying on my back [to] rest, but nothing is helping. My question is what was surgery like before, during and after? - Burt L.

Maybe you've tried all other methods of treatment and nothing worked like Burt. You meet with your doctor and he says you need surgery. Do not begin to stress out. We are here to remove your anxiety and give you the dish on what to expect pre, during and post-operation. 

First things first. What type of back surgery are you preparing for? Well, that's a great question, people.

There are three basic types of back surgery

  1. Discectomy: A portion of a damaged disc is removed to relieve pressure on a nerve.
  2. Laminectomy: A surgeon removes parts of the bone, bone spurs, or ligaments in your back. This relieves pressure on spinal nerves and can ease pain or weakness. It can make your spine less stable. If that happens, you’ll probably need a spinal fusion. Doctors sometimes do the two procedures together.
  3. Spinal Fusion: The doctor will join spinal bones, called vertebrae, together. This limits the motion between them and how far your nerves can stretch.

Before Surgery

Even before you go under, there may be complications from your herniated disc. The most serious complication is the development of the cauda equina syndrome (CES) — a serious neurologic condition in which damage to the cauda equina causes loss of function of the lumbar plexus (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord. CES is a lower motor neuron lesion.

This results when a very large fragment of disc material is ruptured into the spinal canal in the area where the nerves that control the bowels and bladder travel before they leave the spine. Pressure on these nerves can cause permanent damage to them. If this occurs, you may lose the ability to control your bowels and bladder. This is a serious problem. Fortunately, CES is also very rare. Nevertheless, if your doctor suspects that this may be occurring, he or she would most likely recommend surgery immediately in order to try to remove the pressure from the nerves.

A week prior to surgery, it's advised that you stop smoking, chewing tobacco, and drinking alcohol. These activities can cause bleeding problems. Additionally, you should talk to your doctor about stopping all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (Coumadin, Plavix, etc.) a week before surgery as well.

The Mayo Clinic lists seven things you need to do in order to prepare for surgery:

  • Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
  • Remove makeup, hair pins, contacts, body piercings, nail polish, etc.
  • Leave all valuables and jewelry at home (including wedding bands).
  • Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
  • Bring a list of allergies to medication or foods.

Arrive at the hospital two hours before (surgery center one hour before) your scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks. An intravenous (IV) line will then be placed in your arm.

During Surgery

Every surgery has risks. Luckily the success rate of this type of procedure is usually 90 percent or higher. Possible complications include dural tears, nerve root damage, bladder incontinence or bleeding. There is sometimes a risk of another complication due to the anesthesia used during any type of surgery as well as this procedure.

But like we said already (and we can say it a million more times until you believe it), most of the time, the operation is safe, effective, and rarely results in recurrent herniated discs symptoms. If complications do occur, these are among the most common:

Nerve Injury
Removing a herniated disc requires working around the nerves of the spine. During the operation, these nerves may be injured. If this occurs, you may have permanent damage to the nerve involved. This may cause permanent numbness, weakness or pain in the area where the nerve travels in the leg.

Dural Tear
A watertight sack of tissue called the dura mater covers the spinal cord and the spinal nerves. A tear in this covering can occur during surgery. It is not uncommon to have a dural tear during any type of spine surgery. If this is noticed at the time of surgery, it is simply repaired and usually heals uneventfully. If it is not recognized, the tear may not heal. It may continue to leak spinal fluid. This can cause problems later. A spinal headache can result from the spinal fluid leak. A leak can also increase the risk of infection of the spinal fluid - called spinal meningitis. If the dural leak does not seal itself off fairly quickly on its own, you may need a second operation to repair the tear in the dura.

Bladder Incontinence
Bladder or urinary incontinence is the involuntary leakage of urine. Control over the urinary sphincter is either lost or weakened.

Remember above when we mentioned CES? According to the Spine Hospital at the Neurological Institute of New York, this syndrome results from squeezing of the cauda equina — the sac of nerves and nerve roots at the base and just below the spinal cord in the lumbosacral spinal canal. The nerves of the cauda equina provide motor and sensory function to the legs and the bladder. Compression of these nerves can interrupt their function, and the effects can be severe. Cauda equina syndrome can lead to bladder and bowel dysfunction (loss of bladder/bowel control) and even permanent paralysis in the muscles of one or both legs. Urinary incontinence occurs more often in women than in men.

Bleeding
If for some reason the surgeon nicks a nerve, there is a chance for bleeding to occur. Over-bleeding can be very serious. Your medical team will be prepared for this during surgery and will prevent excess blood loss. As with any surgery, there is the potential for major or even life-threatening blood loss.

Let's say the surgery was a success — with a 90 percent success rate, they usually are. You now may be thinking (or at least we hope you are), “What happens after surgery?”

After Surgery

For whatever the reason, some complications do not show up until after surgery; some show up fairly quickly and some may take months to become evident. Post surgery complications may include:

Infection
Any surgical operation has a small risk of infection, and operations on the spine are no different. Infection can occur in the skin incision, inside the disc or in the spinal canal around the nerves. If an infection occurs that involves a skin incision, you may only need an antibiotic.

Re-Herniation
If you have a micro-discectomy, there is always the chance (about 10-15 percent) that the same disc may herniate again. It is most likely to occur in the first six weeks after surgery, but it can occur anytime. You might need a second operation if this occurs.

Persistent Pain
Let's face it, sometimes these operations do not work. You may continue to experience pain for many reasons. Sometimes the nerves are actually damaged by the pressure from the disc herniation and may not recover completely. You may also develop scar tissue around the nerves weeks after the operation that causes pain similar to what you had before the operation. Your pain may also be from other problems in the back that have not been corrected by removing the herniated disc.

Degenerative Disc Disease
Any injury to a disc can lead to degeneration of the spinal segment that is involved. A disc that has been operated on — and a portion removed — has definitely been injured. The development of additional back problems in the area where a disc has been removed is not certain, but there is an increased chance. This situation may require a second operation if the pain from the degenerative process becomes severe. This usually takes several years to develop.

Now, You Recover

While recovery times may vary, here is what you'll want to be thinking about as you get back to living your life normally again.

Rehabilitation
After surgery, your doctor will probably suggest that you see a physical therapist before you start an exercise routine. Exercise is vital to recovery and to maintaining a healthy spine. Consider it part of long-term health management and risk reduction. Regular exercise is the most basic way to combat back problems. You need to make sure the exercises you choose are effective and safe for your particular case.

Exercise
Scientific studies have shown that people who exercise regularly have far fewer problems with their back. It helps strengthen the muscles in your back that correspond with your spine. It can reduce your risk of falls and injuries. It can strengthen your abdomen, arms, and legs, which reduces back strain. Stretching reduces the risk of muscle spasms. In addition, weight bearing exercises help prevent loss of bone mass caused by osteoporosis, reducing your risk of compression fractures. Aerobic exercise, the type that gets your heart pumping and pulse rate up, has been shown to be a good pain reliever as well. The natural chemicals in the body that combat pain — called endorphins — are released during exercise and actually reduce your pain. You don't have to run nine miles around the local track, you just have to remain as active as possible. 

Speak with your medical team to locate a physical therapist who can help you start a new healthy routine where you not only are helping yourself recover, you may even feel good during the process.

Have you had a lumbar herniated disc surgery? What was it like? Please feel free to share your experiences in discussions. Actually — we encourage it.

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