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, 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 (spondylolisthesis).

Cancer can also cause back pain needing surgery. This is called metastatic spinal cord compression, where cancer from one part of your 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.

Non-surgical treatments

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.

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.

Types of back surgery

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 cut over the affected area of your spine and remove any parts of the damaged disc that are putting pressure on your nerves. Most of the disc will be intact and it will still be functional.

There are two types of discectomy:

• Microdiscectomy — a minimally invasive technique where your surgeon inserts a microscopic camera to see the damaged disc and can perform the procedure via a small cut in your back
• Open discectomy — your surgeon accesses the damaged disc through a cut in your back or neck

Laminectomy

Your surgeon makes a cut into your back over the affected vertebrae and pushes aside the muscles as needed. They then remove 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.

The size of the cut made into your back will depend on the condition causing your back pain and the size of your body. In some cases, smaller cuts can be made and the procedure's performed using a special surgical microscope. 

Your doctor may recommend laminectomy if you have spinal stenosis, where the spinal canal is narrowed through wear and tear, or if previous treatments for your back pain, 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

There are three different ways your surgeon can approach this procedure. They can access your spine by making a cut into the front of your body, your side or your back. They will take a piece of bone from elsewhere in your body (usually your hip) to insert between two vertebrae to strengthen them and prevent painful movement. Alternatively, they may use a bone graft, which can be made from demineralised bone matrices (DBMs), bone morphogenetic proteins (BMPs) and synthetic bones.

You may have this surgery 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 caused by 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. Your surgeon will make a cut 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, allowing 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 Healthcare 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 and 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 six hours before your back surgery, but you can drink clear fluids until two hours before. You’ll also need to arrange for 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. After your surgery, a physiotherapist will 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 won’t 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.

Back surgery recovery time

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

Spinal (or lumbar) decompression surgery 

It will usually take four to six weeks for you to return to your normal activities.

Discectomy recovery time 

It will usually take six to eight weeks to return to your normal activities.

Laminectomy recovery time 

It will usually take four to six weeks to return to your normal activities. If you have spinal fusion surgery alongside a laminectomy, your recovery may take longer. 

Spinal fusion recovery time

It usually takes four to six weeks to return to desk-based work and around three months to return to more physical activities. 

Vertebroplasty or kyphoplasty recovery time

You can usually return to your normal activities a day after your vertebroplasty or kyphoplasty. However, it is recommended that you avoid intense exercise and heavy lifting for several weeks. 

Driving after surgery

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.

Returning to work

You’ll be able to return to desk-based work around four to six weeks after your surgery. However, 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 to 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 that in the days after your surgery 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 to help you and to socialise with will all help with your physical and emotional recovery.

Your doctor will discuss how to enjoy your usual activities safely and may advise against some activities, such as 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. 

If you have a vertebroplasty or kyphoplasty, you may develop a reaction to the bone cement used or it may leak inside your body.

During your surgery, certain tissues may become damaged such as your: 

• Dura mater — the covering that sits over your spinal cord and nerves can be torn (dural tear), which may cause cerebrospinal fluid to leak into your body
• Spinal nerves or cord — your nerves could be stretched, bruised or damaged and this may lead to muscle weakness or bladder and bowel dysfunction

Other complications include: 

• Bleeding or damage to blood vessels around your wound
• Blood clot in your legs — this is called deep vein thrombosis (DVT), this can also spread to an artery in the lung and cause a pulmonary embolism 
• Facial sores — lying face down during your surgery can result in red sores on the forehead and chin or a puffed face
• Infection — this can occur around the site of surgery on your back; it is usually effectively treated with antibiotics
• 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:

• A sudden feeling of weakness or numbness which is not going away
• Fever 
• Loss of bladder or bowel control
• Redness, swelling or oozing around the site of surgery
• Severe headache that is not improved with painkillers
• Severe pain unlike your normal symptoms

At Spire Healthcare 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.