The Spine
The spinal column consists of a column of vertebrae (bones) that are separated by soft pads of tissue called discs. Discs serve as shock absorbers of the spine. Each of these bones has a canal that runs top to bottom. Together they form a tunnel referred to as the spinal canal.
Nerves run through this tunnel carrying signal between the brain and body. The lamina of each vertebra forms the back of the spinal canal. The foramen is a small opening where a nerve leaves the spinal canal.
What Causes Back Pain
Two common causes of back pain are disc injury and degenerative disc disease. As discs degenerate, they lose their water content and height, bringing vertebrae closer together. The nerve openings are consequently narrowed and the added pressure from the disk can pinch a nerve causing back or leg pain.
Often confused with each other, a bulging disc is normal, while a ruptured disc is not. A bulging disc is a normal process which happens as the discs carry body weight throughout the day. The weight of the body causes the discs to “bulge” out. This “bulge” disappears at night as the weight is removed. A ruptured disc is an injured or damaged disc that leaks out watery jelly (called nucleus pulposus) from the center of the disc. This leakage reduces the shock absorber effect and sometime the jelly presses against a nerve and causes pain, primarily leg pain.
Spine Surgery
The first, a laminectomy-discectomy, involves removing the lamina and disc from the affected vertebra. This is to create an opening to take the pressure off the nerve. This opening is protected by the thick back muscles.
The second spine surgery is a spinal fusion.
Read more about a spinal fusion including the BAK Cage fusion.
Read more about a 360 degree spinal fusion with cages and pedicle screws (TLIF)
Read more about the new artificial disc replacement (Charité)
Read more about the new prosthetic disc nucleus (PDN)
Preparing for Surgery
It may be necessary for an additional medical evaluation by your own family physician depending on any preexisting health conditions. If you are a smoker, it is advisable for you to stop two weeks prior to surgery. This will help your back to recover faster. Certain medications may also be stopped two weeks before surgery as advised by the surgeon. Patients in good health may be asked to donate one unit of their blood to be used following fusion surgery if necessary.
After midnight on the night prior to your surgery, you cannot eat or drink anything.
What to Expect After Surgery
A plastic drain will be seen through the surgical dressing to remove any blood that accumulates in the surgical area. The drain will probably be removed on the second day after surgery. The dressing will also be changed and a smaller one applied.
An IV may remain in your arm for two to three days to administer antibiotics or other medications you may need. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. You will begin regular fluid and food intake under the direction and advice of your surgeon. You may be given a “pain pump” or PCA-patient controlled anesthesia pump for the first 1 to 2 days after surgery (see Medication/Pain Control below).
After the acute pain has diminished, usually the day after surgery, a physical therapist will help you begin standing and walking again. They will also show you the proper way to get in and out of bed, sit and stand, and sleep position.
Most patients can return home one to four days following surgery.
Physical Therapy
Your back rehabilitation program will begin ten days after surgery and will be monitored by a physical therapist. Stretching and exercises will be demonstrated that need to be done each day.
Medication/Pain Control
It is normal for you to have some discomfort. You may be given a “pain pump” or PCA-patient controlled anesthesia pump for the first 1-2 days after surgery.
This device delivers pain medicine into your IV when you want it. You push a button and the medicine is delivered (usually morphine or Demerol). Your surgeon orders the pump set so that you only receive the appropriate amount of medicine needed. The pump is usually set to deliver medicine up to every 8 minutes. Or if you don’t want to bother with pushing the button, the pump can be set to deliver medicine automatically on a set schedule determined by your doctor. As soon as you are eating well, your doctor will switch from IV medicine to pain pills that you take by mouth. This is usually done on the first or second day after surgery. You will receive a prescription for pain medication before leaving the hospital.
Going Home
Prior to your discharge instructions for what to do at home will be given. Adhere to all precautions until your follow-up visit ten to fourteen days following surgery.
If you see any of the following, contact your surgeon immediately: drainage and/or foul odor coming from the incision, fever of 101 degrees or higher for two days, increased swelling, tenderness, redness, and/or pain, and/or increased pain, numbness, or weakness in your leg.
Resuming Activities
Returning to a sedentary or office job may be possible as soon as three to six weeks following surgery. A job requiring prolonged walking, standing, or lifting may need a full two to four months of recovery first.
Driving is usually possible in two weeks. Caution should be taken getting in and out of the car.
Special Instructions
Follow-up to remove staples will be scheduled for ten to fourteen days following surgery. Another follow-up to see progress will be scheduled four to six weeks following surgery. Other follow-ups which may continue for as long as a year after surgery, will be scheduled depending on progress.
Spine Fusion page
Spinal Stabilization page
Orthoseek
American Medical Association