Back surgery

About back surgery

Your GP may refer you for back surgery if you have severe back pain that hasn't improved after other treatments (such as physiotherapy or referral to a pain clinic), or to reduce nerve pain affecting your arms or legs. There are a number of different types of back surgery. The type you have will depend on your condition.

  • Discectomy may be used if you have a bulging disc, a bone spur (a benign bony growth on a bone), or a herniated or slipped disc.
  • Spinal disc replacement is only suitable for a small number of people with a slipped or worn disc.
  • Laminectomy may be used if you have spinal stenosis (a condition in which the spaces in your spine narrow).
  • Foraminotomy is usually used if you have a bulging disc, a bone spur or a thickened vertebral disc.
  • Vertebroplasty is only suitable for some types of compression fracture to your back bone, caused by conditions such as osteoporosis or as the result of trauma.
  • Spinal fusion is carried out mostly for people with conditions such as spondylolisthesis (when one of your back bones slips forward and out of position) or severe degenerative disc disease (when the discs in your spinal cord gradually become worn down).

What are the alternatives?

If your GP or surgeon suggests back surgery, this is as a last resort. However, for most conditions causing back pain, your doctor is likely to suggest some alternative treatments to try to reduce or relieve your back pain before referring you for back surgery. You may have manual therapy, which involves manipulating and massaging your back, acupuncture, anti-inflammatory medicines or epidural injections.

Preparing for back surgery

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice. At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during back surgery?

Your surgeon may use open or keyhole surgery. Open surgery involves making a single, large cut on your back. Keyhole surgery involves making several small cuts on your back and your surgeon will use special instruments to do the operation.

Exactly how your surgery is carried out will depend on the type you are having.

  • Discectomy. Your surgeon will remove one or more of your discs through a small cut in your back. He or she may also remove part of the bony coverings of your spine (lamina), with a section of ligament.
  • Spinal disc replacement. This procedure aims to restore disc height and movement between your vertebrae. Your surgeon will remove the affected discs and replace them with artificial ones.
  • Laminectomy. Your surgeon will remove the bony coverings of your spine and shave back any thickened ligaments, joints and bone spurs (overgrowths of bone). This will widen your spinal canal and relieve pressure that has built up around your spinal nerves.
  • Foraminotomy. Your surgeon will carry out a keyhole procedure to widen your foramina (the bony holes through which spinal nerves branch off from your spinal cord) and reduce pressure on your spinal nerves.
  • Vertebroplasty. Your surgeon will make a small cut on your back and using X-rays as guidance, will slowly inject a cement-like mixture into your vertebrae to stabilise your spine.
  • Spinal fusion. Your surgeon will join two or more of your vertebrae together using a bone graft and a special metal scaffolding made of screws, rods or plates.

If you need more information about the procedure you’re having, speak to your surgeon.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you have open surgery, you may need a catheter to drain urine from your bladder into a bag. You may also have fine tubes running from the wound. These drain fluid into another bag and are usually removed after a day or two.

With most back surgeries, you will need to spend at least one night in hospital. You will need to spend some time resting in bed, but may be able to get up and walk around the day after your surgery. You may also be given a corset or brace to wear that will support your back, but this will depend on the type of operation you have had. A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) may suggest some exercises to help with your mobility and recovery.

Your surgeon may close your wound with stitches or staples, which may need to be removed approximately two weeks after surgery. If you have dissolvable stitches, the length of time they will take to disappear depends on what type you have.

Your nurse will give you advice about caring for your back, hygiene and bathing before you go home.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from back surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your physiotherapist may recommend starting an exercise programme between four and six weeks after your back surgery. The exercises are designed to help you recover and reduce any back pain you may have. Please see our frequently asked questions for more information.

Depending on what type of surgery you have had, your surgeon may advise you not to lift heavy objects, bend, sit still for long periods or stretch for the first four weeks after surgery. You may also be unable to drive a vehicle. If you have any concerns about what you can and can’t do, speak to your surgeon.

You can usually return to work after about eight weeks, but this depends on the type of surgery you have had and what your job involves.

What are the risks?

As with every procedure, there are some risks associated with back surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure, for example, feeling sick as a result of the general anaesthetic. You will feel some pain and stiffness in your back and possibly in your legs.

Complications

This is when problems occur during or after your operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT).

Complications may require further treatment such as returning to theatre to stop bleeding.

A general complication of back surgery can include spinal cord or nerve damage. This can lead to numbness, pain, paralysis and loss of muscle, bladder or bowel control, and erectile dysfunction if you’re a man, but this is very rare.

You may have complications specific to the type of operation you have. For example, after surgery for a slipped, herniated or bulging disc, around three to 12 in 100 people will have another slipped disc and need further treatment. Or, if you have an implant fitted, the screws or implants in your back may come loose and you will need further surgery.

If you experience any unexpected problems after your surgery, such as ongoing pain, or arm or leg weakness, contact your GP or surgeon.

What exercises can I do to strengthen my back after my back surgery?

Answer

There are many different exercises you can do to help strengthen your back after you've had a back operation.

Explanation

The type of exercises recommended by your physiotherapist will depend on the type of back surgery you have. Don't do any exercises until you have spoken to your physiotherapist. He or she may suggest that it will be helpful to do some spinal mobility and flexibility exercises. This can include gentle core stability exercises to help improve the mobility of your back and strengthen your muscles and ligaments, such as the following.

  • Pelvic tilt. This is where you lie on your back and tilt your pelvis into a neutral position.
  • Knee roll. This is where you lie on your back with your knees together and roll them from side to side.
  • Bridging. This is where you lie on your back with your feet flat on the floor and gently raise your back.
  • Tummy tightening. This is where you pull in your stomach muscles.

If any particular exercise makes your pain worse, stop and seek advice from your surgeon or physiotherapist.

Is there anything I can do to help my recovery after back surgery?

Answer

Yes, there are lots of different things you can do to help your back recover after surgery.

Explanation

Your surgeon or physiotherapist may suggest some exercises or general things you can do around your home to help you recover after back surgery. These may include the following.

  • Eat a well-balanced diet with sufficient levels of calcium and phosphorus to help your bones heal and grow.
  • Try to maintain a healthy weight or lose excess weight – this will reduce the pressure on the muscles in your lower back.
  • Sit on chairs that support your lower back. If you need to sit for long periods of time, make sure you switch sitting positions every now and again, and stretch to relieve any tension. You can also place a pillow or rolled-up towel behind the small of your back to maintain your posture.
  • If you smoke, try to stop because smoking reduces blood flow to your lower back and can cause your discs to degenerate.

Will I be able to play sports after my back surgery?

Answer

Yes, but this really depends on when you feel ready. It's also important to seek the advice of your surgeon.

Explanation

About six weeks after back surgery, you may be able to start activities which cause the least strain and pressure on your spine, such as swimming.

Walking, swimming and gentle back stretches may all be beneficial for people with chronic back problems. Ask your physiotherapist or surgeon for advice about when to start exercising and what activities you can do.