What is lumbar surgery?
Lumbar surgery includes a variety of orthopedic procedures involving the portion of spine that makes up the lower back. Common types of lumbar spine surgery include:
Lumbar decompression back surgery, which includes several procedures to relieve pressure on the spinal cord or spinal nerves
Lumbar disc replacement, which removes a spinal disc and replaces it with an artificial disc
Lumbar fusion, which joins two vertebrae in the lower back. Spinal fusion permanently stops movement between the two vertebral bones.
Lumbar laminectomy, which removes the entire lamina in a vertebra in the lower back. The lamina is a bony area that makes up the back part of each vertebra. It is a form of lumbar decompression surgery.
Lumbar laminoplasty, which opens the lamina instead of removing it
Lumbar spinal stenosis surgery, which includes several procedures to treat lumbar spinal stenosis. Spinal stenosis is a narrowing of the spinal column that puts pressure on the spinal cord and nerves.
Why is lumbar surgery performed?
Doctors may recommend lumbar surgery to treat persistent pain and physical problems with the spinal canal, spinal discs, or vertebrae. Pain from lumbar spine conditions can affect the lower back, hips, or legs. The goals of surgery are to improve mobility, stabilize the spine, and enhance your quality of life.
Common conditions that may respond to lumbar surgery include:
Degenerated, herniated, bulging or ruptured spinal discs
Scoliosis, which is an abnormal curvature of the spine
Tumors in the back or spine
Vertebral fractures, such as compression fracture
Your doctor may only suggest lumbar surgery if other treatments with less risk of complications fail to help you. These other treatments can include medications, spinal injections, physical therapy, and spinal manipulation, such as chiropractic care.
Who performs lumbar surgery?
Orthopedic surgeons commonly perform lumbar surgery. Orthopedic surgeons specialize in treating diseases, disorders and conditions of the muscles, bones and joints. Other types of doctors may also perform these surgeries, including interventional radiologists, neuroradiologists, and neurosurgeons who specialize in the spine.
How is lumbar surgery performed?
Lumbar surgery takes place in a hospital or surgery center. The specific details of the procedure will vary depending on the type of surgery you need. Most low back surgeries are major procedures. Your surgeon will use either a traditional open surgery technique or a minimally invasive one. In general, minimally invasive approaches result in less pain, fewer complications, and a faster recovery time. Talk with your surgeon about the pros and cons of both techniques.
The type of anesthesia you need will depend on the specific surgery. Many lumbar surgeries require general anesthesia, which lets you sleep the entire time. Some outpatient procedures may use regional anesthesia along with sedation to keep you relaxed during the procedure.
What to expect the day of your lumbar surgery
In general, this is what happens the day of your lumbar surgery:
You will change into a hospital gown and talk with a preoperative nurse. You may have a brief medical exam.
You will get a sedative to help you relax before the team takes you to the operating room (OR).
Your team will start anesthesia in the OR. With general anesthesia, you won’t remember anything else until you wake up in the recovery room. Operating time varies by the type of surgery. Times range from about an hour for simple procedures to 5 to 7 hours or longer for complex spinal fusions involving multiple vertebrae.
What are the risks and potential complications of lumbar surgery?
All surgeries involve risk and the possibility of developing complications. Some of these risks and complications can be serious and may develop during the surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Potential lumbar surgery complications
In most cases, outcomes are successful, but potential lumbar surgery risks and complications include:
Nerve, muscle, or blood vessel damage
Ongoing pain or disability
Healing problems, which is more common in people who smoke
Problems with an artificial disc or spinal bone graft
Pseudoarthrosis after lumbar fusion. This condition occurs when there is not enough bone formation to support the graft fusing the vertebrae. If it occurs, more surgery may be necessary to correct it.
Spinal headache, which is due to leaking cerebrospinal fluid
Worsening or recurrent symptoms
Reducing your risk of complications
You can reduce your risk of certain complications by:
Understanding and following your doctor’s activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery. This includes instructions for medications you currently take and any your doctor prescribes.
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Telling all members of your care team if you have allergies
How do I prepare for lumbar surgery?
The steps you take to get ready for surgery can improve your comfort and outcome. You can prepare for lumbar surgery by:
Arranging a ride home. You will also need someone to stay with you for the first 24 hours.
Getting preoperative testing if your doctor orders it. This will vary depending on the procedure and your medical history.
Losing excess weight before surgery
Making sure all your healthcare providers have your complete medical history. This includes chronic conditions, allergies and medications. When listing medications, include prescriptions, over-the-counter drugs, herbal treatments, and vitamin supplements.
Not eating or drinking before surgery as directed
Stopping smoking as soon as possible to help the healing process
Taking or stopping medications as directed
Questions to ask your doctor
Making a list of questions can help you remember everything you want to ask when you see the doctor. Here are some sample questions:
Why do I need the lumbar surgery you are recommending? Are there any other options we can try first?
How many of these procedures have you performed? Do you have outcomes to share?
How long with the surgery take? When can I go home?
What restrictions will I have after surgery? What kind of assistance will I need at home?
When can I return to work and other activities?
When will I start physical therapy? How many treatments are typically necessary for recovery? Do you and the therapist communicate about my progress?
How will you manage my pain?
What changes, if any, to my medication plan do I need to make?
When should I follow up with you?
How should I contact you after hours if I have a problem?
What can I expect after lumbar surgery?
You can make planning and preparing for a successful recovery easier by knowing what to expect.
Lumbar surgery recovery time
A hospital stay after lumbar surgery is common. The length of your stay will depend on the surgery. However, some lumbar surgeries are outpatient procedures and you will go home the same day. For both inpatient and outpatient surgeries, your team will give you detailed instructions before you leave. This will include information about medication, activity level, and follow-up appointments.
Lumbar surgery recovery may involve wearing a back brace or cast to stabilize your spine while it heals. This will limit your activities. However, your doctor will likely encourage you to walk frequently. Your doctor will also likely refer you to physical therapy to complete a rehabilitation program. You will learn how to move, reposition yourself, turn over in bed, and walk in ways that protect your spine. You will also learn what you need to avoid, such as twisting your spine or hyperextending it during recovery. Full recovery from lumbar surgery can take several weeks to months.
Will I feel pain?
Pain and discomfort are realities after lumbar surgery, and managing them is important for healing and a smooth recovery. Controlling pain allows you to walk and participate in rehabilitation activities that are necessary for your recovery. Tell your doctor if your pain worsens or changes in any way. It could be a sign of a complication.
When should I call my doctor?
If you have questions between appointments, contact your doctor’s office during regular business hours. However, you should call your doctor right away or seek immediate medical care if you have:
Breathing problems or shortness of breath
Confusion or changes in level of alertness
Chest pain, pressure or tightness
Drainage of pus, redness or swelling around your incision
Fever. It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
Inability to urinate or move your bowels
Leg pain, redness or swelling, which could mean you have a blood clot
How might lumbar surgery affect my everyday life?
Talk with your doctor about realistic expectations after lumbar surgery and ask what you can expect. For many people, surgery results in symptom relief very soon during recovery. Sometimes, symptoms improve, but do not totally resolve after surgery. It is possible that some level of pain or disability will remain. You can help improve your long-term outcome by maintaining a healthy weight, practicing good posture, using proper body mechanics, and exercising to keep your back strong and healthy.