In people with a disc prolapse causing leg pain (radiculopathy), lumbar microdiscectomy will be successful in over 90% of people. The majority of people will also see an improvement in back pain, though apart from a few exceptions, it is not a recommended procedure for back pain alone as in a small number of people, back pain can be made worse following a microdiscectomy.
When we talk about leg pain we really mean any pain experienced from the mid thigh, below the knee and often into the foot. Back pain includes that felt over the lower back area, buttock, groin and upper thigh. Microdiscectomy can also help symptoms of pins and needles and muscle weakness but may not resolve areas of numbness. Wear and tear in the lumbar spine often goes hand in hand with wear and tear in other areas such as the hips and knees. Part of your consultation will be in determining the exact cause of your pain so that you receive the correct treatment quickly and do not undergo unnecessary investigations or procedures.
Overall, microdiscectomy is a very safe and effective operation but as with all operations there are risks. The risk of a superficial infection or a spinal fluid leak is in the region of 1-2%, both of which can be treated straightforwardly. The risk of serious complications such as nerve root damage or a serious infection in our hands is less than 1%. In the worst-case scenario, nerve root damage can result in difficulties with continence or weakness in the ankles and feet. While these risks are extremely rare, we feel that this emphasizes the fact that surgery is a last resort for people with spinal problems.
Many people with a disc prolapse will improve without surgery and we will advise you about your chances of this during your consultation. Unfortunately, a person who suffers a lumbar disc prolapse carries a 5-10% chance of a further disc prolapse in the future, whether they have surgery or whether the disc prolapse heals on its own. We will advise you about how to reduce the chance of this happening and provide you with a “back to health” program to follow during your recovery.
A small number of people (2%) can develop persistent leg pain despite adequate surgery. Post-operative MRI scans often demonstrate fibrosis / scarring in these people and surgery will not improve this situation. Typically, this pain can be helped with specialist input from pain doctors. At CNS, we have strong links with chronic pain colleagues in the unlikely event that this should arise.
Most people are admitted on the day of surgery will be home within 24 hours, often on the day of surgery. The operation usually takes less than an hour. The surgery is not particularly painful but you will be given effective pain killers during and shortly after surgery so that we can have you walking within a couple of hours of surgery and in the majority of cases, home the same day.
The recuperation period varies between people but on average is 2-4 weeks. During this time we encourage people to walk as much as possible but to only sit for limited periods (20-30 minutes). You will be advised to refrain from driving for at least 1-2 weeks, longer if you are still in pain. We do not routinely recommend any formal physiotherapy at this early stage but we will provide you with a graduated program of exercise to suit you level of activity and interest. At the 4-6 week stage you should be thinking about taking some more vigorous exercise, building up to 2-3, 20-30 minute sessions per week. Any aerobic exercise (swimming, cycling, walking) is suitable but we recommend that you avoid contact sports, rowing machines and lifting weights. Physiotherapy can help if you are having difficulties at this stage.
It is important to remember that wear and tear conditions such as disc prolapse actually affect the whole spine. Surgery deals with a particular part of the problem but it does not reverse the whole wear and tear condition. It is important that people follow our advise on looking after the spine to reduce the likelihood of back pain in the future. We will advise you about some important factors including posture, weight control and lifting techniques.