Lumbar dynamic stabilisation
In the natural course of spine degeneration, the disc and facet joints go through several stages of instability. The early stages are failure of the disc and paraspinal muscles, followed by osteoarthritis of the facet joints, subsidence of the vertebrae, and eventually stenosis.
In the early phase where there is increased motion and instability, a dynamic stabilisation is beneficial. The overall aim is to control excessive motion, to restore alignment, and to distract the abnormal disc segment.
The classic symptoms of spine degeneration are back pain, recurrent ‘giving way’ or locking of the back, and back muscle spasm. Leg pain, sensory disturbance and leg weakness may also be present if there is additional ‘pinching’ of the nerve from a disc prolapse.
When is lumbar dynamic stabilisation recommended?
- when there is a lumbar disc tear or prolapse, causing the above symptoms
- if you've had extensive physiotherapy, but are still in pain
- if you have made the necessary work and life style adjustments, eg: avoiding heavy lifting
- if you've had lumbar injections, but have not responded to them
- if you've had symptoms for at least six months
- following a consultation with a spine surgeon, where you were fully assessed with x-rays and an MRI scan
How is the surgery done?
- under general anaesthesia and with an antibiotic
- screws are inserted into the pedicle of the spine and bridged with a tough cord - a discectomy may be carried out if the disc had prolapsed
- the lumbar dynamic stabilisation procedure can take 2 hours depending upon the number of spine segments that require decompression
- a drain may be inserted into the back, and is removed after 24 hours
- you will be encouraged to mobilize after 24 hours or when you are feeling better
- you will be required to wear leg stockings to prevent leg clots (deep vein thrombosis)
- you will be given appropriate advice and information from the physiotherapist about exercises
What is the expected outcome of lumbar dynamic stabilisation?
- in most patients the likelihood of good/excellent relief of back pain is approximately 80%, but this may vary depending on duration of symptoms
- often, there is some degree of back pain following surgery. If you had significant back pain prior to surgery it's unlikely to be made better by the surgery as this is not an operation for back pain
- occasionally, you may experience a resurgence in pain, which is often temporary following initial surgery and reflects nerve root irritation and the fact that you have increased your activity level. This is treated in most cases with painkillers, although occasionally an epidural steroid is given to control pain
After surgery, what is the recovery like?
- patients who have a lumbar decompression are typically in hospital for 3-7 nights.
- you can drive after 3 –6 weeks and should be able to return to light work after 6 weeks
- you will encouraged to walk ½ to 1 miles a day
- do not be surprised if you still need regular pain killers for several weeks after surgery
- expect up to one year for recovery as ‘nerve recovery’ can be quite slow particularly bearing in mind that they had been compressed for such a long time
- it's important to remember that the back is not normal after decompressive surgery and that care needs to be taken in the future. Bending, lifting and twisting need to be avoided as these activities ultimately may have caused the problem in the first place, particularly for the first 3 months
- good back care is the rule for life!
- no surgeon can guarantee risk-free surgery or a 100% good outcome.
What are the potential risks and side effects?
Generally, the majority patients are happy with the outcome of a lumbar dynamic stabilisation, with at least 80% expected good result. Specific risks of surgery, in the order of 1-5%, include:
- infection (less than 1% risk)
- deep vein thrombosis (less than 1% risk)
- disc recurrence (approximately 5% risk)
- neural injury/dural tear (1-5% risk) – usually transient bruising of nerve which settles; it's very rare for permanent weakness to occur
- cauda equina syndrome (less than 1% risk) – this can be due to development of a clot, and causes weakness and bladder symptoms that will require return to theatre for removal of the clot
- increased back pain – this tends to be transient following surgery, and settles down
- burning pain - this often reflects damage to the nerve at the microscopic level from the chronic severe compression
Lumbar decompression is a good operation for leg and buttock pain, weakness, numbness, pins and needles but NOT back pain. In general, if symptoms still persist in a way that interferes with a patient’s quality of life and does not respond to simpler treatment, then surgery is a definite treatment option.
Return to treatments and operations.