Back surgery (spinal surgery)

Different surgical procedures to remove or repair worn or damaged bones (vertebrae) or discs in your spine. Back surgery may also be used to relieve pain due to pressure on nerves (sciatica).

The type of surgery recommended depends on the cause of your back pain.

Causes of back pain

A common cause of back pain and sciatica is a slipped disc (herniated disc) – where a spinal disc presses down on a nerve.

Back pain can also be caused by spinal stenosis, the narrowing of the spaces in your spine which puts pressure on a nerve, or cauda equina syndrome – a rare and severe form of spinal stenosis. Back surgery may be used after a spinal injury, a fracture due to osteoarthritis or to repair a displaced bone in your back, called spondylolisthesis.

Cancer can also cause back pain requiring surgery. This is called metastatic spinal cord compression, where a cancer from one part of the body has spread into the spine and the mass of cells presses on the spinal nerves.

Back surgery can relieve back pain and aims to let you move more freely without pain. Surgery can also help you become more active, improve your mood, reduce your need for pain medication, and may get you back to work if you’ve had to take time off. But for many people, it may not be necessary. Your doctor will usually recommend it only after you’ve had back pain for some time and have tried other treatments that haven’t worked for you.

These treatments include:

• Gentle exercise
• Painkillers
• Physiotherapy
• Psychological therapy
• Spinal injection therapy

Your doctor will assess your symptoms and will probably recommend an X-ray, a CT scan or an MRI scan. Our fast diagnostic service means you won’t have to wait long to find out if back surgery is right for you. At this appointment, your consultant will discuss which back pain treatment would be best for you and your lifestyle, so it’s a good time to talk about what you want.

Back surgery

There are many different types of back surgery and your consultant will recommend the one that will be best for you, depending on your condition. In some cases, more than one type of surgery will be performed in the same operation.

The most frequently used operations include:

Spinal (or lumbar) decompression surgery

Lumbar decompression surgery is used to treat spinal stenosis, cauda equina syndrome, slipped disc, metastatic spinal cord compression or a spinal tumour and spinal injury. The main types are discectomy, laminectomy and spinal fusion.

Discectomy

A discectomy means the surgical removal of a whole or part of a spinal disc.

A disc is a fluid-filled cushion of tissue that sits between each vertebra and acts as a shock absorber. If it's damaged, fluid can leak out and put pressure on your spinal cord and surrounding nerves – this is a slipped disc and is a common reason for having a discectomy.

During the procedure, your surgeon will make a small incision over the affected area of your spine and remove any parts of the damaged disc that is putting pressure on your nerves. Most of the disc will be intact and it will still be functional.

There are two types of discectomy:

• Open discectomy – your surgeon accesses the damaged disc through an incision in your back or neck
• Microdiscectomy – a minimally invasive technique where your surgeon inserts a microscopic camera to see the damaged disc and can perform the procedure using a much smaller incision in your back

Laminectomy

Your surgeon removes the back part of one or more of your vertebrae, called the lamina, to relieve pressure on the spinal cord. This pressure is often a result of bony overgrowths in the spinal canal which narrows the space in your spinal cord. It commonly occurs as you age.

Your doctor may recommend laminectomy if you have spinal stenosis, where the spinal canal is narrowed through wear and tear, or if previous treatments such as medication and physiotherapy have failed and your symptoms are worsening. Laminectomy is also recommended if you find standing or walking difficult, or if you're experiencing a loss of control of your bladder or bowel.

Spinal fusion

Your surgeon takes a piece of bone from elsewhere in your body (usually your hip) to insert between two vertebrae to strengthen them and prevent painful movement. You may have it after a break or fracture, to help fix scoliosis, or if one of your vertebrae is displaced and is causing pain (spondylolisthesis).

Vertebroplasty or kyphoplasty

Both are similar types of procedures where bone cement is injected into the spine to repair the damage, often due to osteoporosis. In kyphoplasty, a small balloon is inserted into the affected area and expanded to make space for the cement.

Foraminotomy

A procedure to relieve pressure and pain caused by vertebrae compressing on a nerve where it exits the spinal cord. The surgeon will make an incision in your back and remove part of your vertebrae to open up space where the nerve exits the spinal cord.

Interlaminar implant

In this procedure, a device is inserted between two vertebrae to ease pressure on your spinal nerves.

Disc replacement

This is where a damaged disc is replaced with an artificial one. The damaged disc can be partially or fully removed. The new disc is designed to act in the same way as a healthy disc, facilitating pain-free movement between your vertebrae.

Your consultant will discuss your options and recommend a treatment tailored to your diagnosis.

Advances in surgery

To find out more about recent advances and how back surgery is performed at your local Spire hospital, use the hospital search tool above.

Preparing for back surgery

It’s important for you to be as fit as possible before your surgery as it will help you with your recovery and reduce your risk of any complications. Once you've agreed with your consultant that you'll be having back surgery, you should eat a healthy and balanced diet, exercise regularly and stop smoking.

You'll be asked to sign a consent form once you’ve decided to proceed with the surgery. You may also be asked to attend a pre-operative appointment to check that you’re fit for surgery. Here, you may undergo some blood tests and have an X-ray or MRI scan of your spine. During this assessment, you can also ask any questions or discuss your concerns about your surgery.

Your consultant will also advise if you should wear compression stockings and/or have an anti-clotting injection to prevent blood clots from forming after the procedure. You'll also be given instructions to follow on the day of your procedure, which may include washing with antibacterial soap and what to wear and bring with you.

You’ll have to stop eating for the six hours before your back surgery, but you'll be able to drink clear fluids until two hours before. You’ll also need to arrange a family member or friend to come and pick you up, travelling home on public transport is not advised.

Who will be involved?

Your back surgery will be performed by an orthopaedic or neurological surgeon, but you’ll also be seen by an:

• Anaesthetist – to administer anaesthetic during the operation
• Physiotherapist – to take you through some exercises you can perform at home

How long does back surgery take?

Your operation will take at least an hour but may take much longer if you need a more complex procedure.

Anaesthetic

You’ll have a general anaesthetic, so you’ll be asleep and unable to feel anything during your operation.

Pain after back surgery

As with most operations, you’re likely to feel some discomfort afterwards, which may last days or weeks. You’ll be given painkillers and we can help you manage any pain as you recover. The good news is the severe back pain you felt before your back surgery should go away or improve, so you should be your active self again in a few months.

Your hospital stay

The average hospital stay is one to four days.

How quickly you recover from your surgery depends on how fit you were before, and on the type of operation you have. Following your surgery, you can expect to be in hospital recovering for one to four days.

You may be able to drive again as soon as two weeks after your surgery, but you’ll need to check with your insurance policy first.

You’ll be able to return to desk-based work around four to six weeks after your surgery, but if your job involves a lot of driving or heavy lifting, you may need to allow three months for recovery. You can also expect to return to your usual activities after two or three months.

Physiotherapy and ongoing treatment

Our expert aftercare team will encourage you to walk around the day after surgery, and our physiotherapist will take you through a series of exercises to do at home. It’s important to carry on with these exercises to speed up your recovery, strengthen your muscles, reduce the risk of scarring around your nerves and avoid getting blood clots in your legs.

If you have stitches, they'll be removed after around 10 days. This may be done at the hospital you had your surgery at, or one of our nurses will visit you at home.

Your lifestyle after treatment

Most people who have back surgery find that their symptoms improve, so they’re free from pain again and can move about easily.

Your dressing will need to be kept dry until your wound has been reviewed by a doctor, which may be up to seven days after the procedure. Once reviewed, you can wash as normal without the dressing.

You may find in the days following your surgery that staying in any position for too long causes discomfort. Changing positions regularly can help relieve this pain. Your back may also become stiff and painful overnight, so start your physiotherapy exercises before getting up.

Keeping to a routine, building up to activities gradually and having others help you and to socialise with will all help with your physical and emotional recovery too.

Your doctor will discuss how to enjoy your usual activities safely and may advise against some activities, like heavy lifting or awkward twisting, until you’re fully recovered.

Most people have back surgery without complications, but all surgery carries some risks, which your consultant will talk through with you before you go ahead. These can include:

• Bleeding or damage to blood vessels around your wound
• Blood clot in your legs – known as deep vein thrombosis (DVT), this can also spread to an artery in the lung and cause a pulmonary embolism
• Developing a reaction to bone cement or it leaking (for vertebroplasty or kyphoplasty)
• Damage to spinal nerves or cord – during the procedure your nerves could be stretched, bruised or damaged, this may lead to muscle weakness or bladder and bowel dysfunction
• Dural tear – a tear in the sac of tissue that surrounds your spinal cord and nerves, this may also result in a leak of the cerebrospinal fluid
• Infection – this can occur around the incision marks on your back, though commonly treated with antibiotics
• Facial sores – lying face down during your surgery can result in red sores on the forehead and chin, or a puffed face
• No improvement in back pain or developing back pain symptoms again within a few years of surgery
• Paralysis (this is exceptionally rare)

You should call a doctor right away if you experience any of the following symptoms after your back surgery:

• Severe pain unlike your normal symptoms
• Redness, swelling or oozing around the incision site
• Fever (temperature higher than 38.5°C)
• A sudden feeling of weakness or numbness which is not going away
• Loss of bladder or bowel control
• Severe headache which is not improved with painkillers

At Spire hospitals, your safety is our top priority. We have high standards of quality control, equipment and cleanliness and a rigorous system of review and training for our medical teams.