Lumbar disk surgery for a ruptured or herniated disk is the most commonly performed surgical procedure for buttock pain radiating into a leg.
A great effective result from back disk surgery is as much dependent on proper patient selection as the actual performance of the surgery.
A common cause of pain in the back and leg is a ruptured or herniated disk. With sudden stress such as with lifting a heavy object or by gradually wearing out, the annulus of the disk may tear and allow the soft nucleus to squeeze out through the annulus like toothpaste.
The nucleus may then press on a nerve root. Though the injury is in your back, your brain interprets the pain as if it was in your foot or leg. The history your doctor takes and the examination that your doctor gives you allows your doctor to determine which muscles and reflexes are effected, as well as which part of your leg may be have decreased feeling. This information allows your doctor to diagnose which nerve root is being pinched by the ruptured disk.
Unless the back and leg pain from a ruptured disk is excruciating or there is significant weakness, a trial of non-surgical therapy is indicated.
- Medication for the relief of pain and muscle spasm
- Bed rest in a comfortable position such as with two pillows under the head and two under the knees
- Physical therapy that may include deep heat and message, ultrasound and traction
- Stretching exercises: A program to strengthen abdominal muscles and lumbar extensor muscles.
You may have to undergo certain tests to decide whether you need surgery, and to determine the exact location of the ruptured disk.
Some of these tests are:
- A x-ray of the lumbar spine. The x-ray may show narrowing of the disk space, bony overgrowth of bone or evidence of instability of the spine
- An electromyogram or EMG which measures nerve function. This is accomplished by placing small needles in the muscles and recording the result on a special machine
- A CT scan or MRI. These scans produce detailed computer generated images of your ruptured disk and surrounding bone and other tissues These tests may also rule out other causes of pain and weakness in your leg
- A myelogram followed by a CT scan. A myelogram is an invasive test. Though invasive, a myelogram is probably the most accurate test. An iodine containing dye which shows-up on x-rays is injected into the fluid surrounding the lumbar nerve roots.
You may wish to undergo surgery for removal of a ruptured disk if you have :
- significant weakness
- have not improved on medication and physical therapy
- the various tests confirm the presence of a ruptured disk that shows nerve root compression.
The surgery is designed to remove the ruptured portion of the disk away from the injured nerve root. This usually results in relief of the leg pain and may allow the muscles that are weak to regain their strength.
A small incision is made in the skin over the area of the ruptured disk. The muscle is moved away from the lamina of the vertebrae above and below the level of the ruptured disk. Using an air drill or special bone instruments a little bit of the lamina is removed to gain access to the disk.
The main part of the surgery is then carried out using an operating microscope. Using special instruments, some of the ligament under the bone is removed and the nerve root carefully moved. The ruptured disk is then found and removed from in front of the nerve root. The disk space may then be entered and additional loose disk material removed. The hole made in the disc closes over time. Hemaseal is placed about the covering (dura) of the nerve root to reduce the amount of post-operative scarring. It helps stop any microbleeding and should seal any small unseen leaks in the dura.
Bleeding is controlled, the wound is sutured together and a sterile dressing applied.
No surgery is absolutely safe and free of complications. Some of the possible complications ruptured disk surgery are:
- Untoward effects of anesthesia
- Bleeding or losing blood with the possible need for blood transfusions
- Nerve root injury that could result in paralysis, loss of feeling, or loss of bowel and bladder control
- Tear in the covering of the nerves, the dura sack, with leaking of fluid
- Injury to blood vessels
- The possibility of unforeseen complications
Furthermore, a ruptured disk may recur in five to ten percent of cases. And necessitate the need for an additional surgery.
After surgery you will usually be given instructions for taking care of yourself until you are seen back in the office. In particular you should contact your doctor if there is any
- redness or discharge from the wound
- trouble with urination
Most patients are discharged from the hospital on the first day of surgery. Elderly patients may require additional hospital stay.
You will have a waterproof cover over your dressing so you can shower but no soaking in a bath. Do not remove the dressing. If the plastic covering comes off, use saran wrap to cover the wound while showering and then use a blow drier to dry the wound if it gets wet.
Wear your corset for the first week for comfort and to remind you not to bend or twist. No lifting more than ten pounds which is about a gallon of milk. No driving a car if your are in pain or taking pain medication.
Physical therapy will be started about two weeks after the surgery to strengthen the lumbar extensor muscles and the abdominal muscles.
Do not expect that removal of the ruptured disk will guarantee that you will never have a back problem in the future. No back that has suffered a ruptured disk is normal. After surgery it is important that you learn to live with your back. Strengthen the muscles and do an exercise program daily. You must learn to move and bend correctly