For further information on disectomy complications, read Part 1.
Paralysis means inability to move, or weakness. Without a doubt this is the scariest part of any spine operation when you’re thinking about surgery. However, there are a few things to think about. First, the injury to the nerve by the disc itself can cause weakness. Sometimes the weakness is not noticed until in the doctor’s office. Sometimes however, a weakness can be profound and you will see people not being able to lift up their leg or their foot and dragging themselves around with a limp.
Neurosurgeons such as those at ProMed SPINE know that the nerves are very sensitive and unforgiving. Once weakness sets in you have 24 hours to try to remove the pressure from the nerve with the hope that it recovers fully. If it goes past 24 hours, the chances of a full recovery become lower.
As for the risk of weakness from surgery, it is pretty low. If your surgeon is very careful, experienced, and used to the way nerves should be handled, the risk of nerve damage and weakness is extremely low. There are occasions where temporary weakness may occur since the nerve has been unusually and severely injured by a very large disc herniation. While every case is different, please make sure that you discussed this with your surgeon before the operation. Neurosurgeons who are very used to handling the brain and spine nerve tissues can give you a more realistic idea by looking at the MRI and by examining you thoroughly in their office. And by the way, don’t be shy about reviewing the MRI with your surgeon. Once you see the MRI, understand what it looks like, see the nerve, see the disc, and how the disc is affecting the nerve, you yourself will understand so much more about any information you may come by.
In summary, the risk of weakness after such small microscopic surgery is very low in the hands of experienced neurosurgeons who are used to handling nerves. This operation is more about the nerves than the disc.
Here is a myth: if you have one spine surgery, you will have another in the next two years. This is simply not true. Every surgery has risks but it also has benefits. You should be offered surgery only when the benefits of surgery outweigh the risks.
When done correctly, a microscopic discectomy can result in immediate resolution of the symptoms with minimal damage or disruption to a normal body and spine. It prevents prolonged nerve damage and subsequent consequences. The disruption to the normal spine through a dime sized incision is so small as to be inconsequential to the future of your spine.
Many people live for years after such a small surgery and never worry about another. They simply are able to live their lives the way that they want to. The surgery is designed to return the quality of life that you have lost. While it involves small amount of risk inherent to any operation, the benefit is that you get your life back. While life goes on at different stages in our lives, we may have different injuries unrelated to the surgery. In other words, people may require spine surgery regardless of the fact that they had in spine surgery before or not. But also keep in mind that the fact that you have a disc herniation simply means that you injured your disc. This disc can further be injured and get worse over time with or without surgery. That means that even if you don’t have the surgery, and deal with all the pain and the consequences of nerve damage, at some point this disc or adjacent ones may suffer an injury that requires surgery. The factors that affect these possibilities are many and include things like your genetic makeup, your activity level, your weight, and many others.
In summary, it is not true that if you have one spine surgery, you will need another one soon.
As you may know, the process of healing involves scarring. The nerves are no different. They have to scar to heal. However, there are ways to make sure that they don’t scar too much and they continue to function well. Generally speaking, scar formation after spine surgery should not really affect the function of the nerves or the spinal cord under normal circumstances.
In addition, there are many things that neurosurgeons can do to prevent excessive scar formation. Nerves take special handling, and surgeons should be equipped with a variety of materials and techniques to minimize scar formation. Please do remember to ask your surgeon about it and if you are told that “scars just happen and we can not do anything about it”, get a second opinion.
NEVER GET BETTER
When people suffer from excruciating pain, numbness, weakness, or bowel or bladder incontinence because of their spine, they wonder if surgery can help them. There are all sorts of stories out there where people have had surgery (in some cases multiple surgeries) and never got better. Even worse, they have a big scar to show for it with new spine problems.
However, there are thousands of patients who undergo spine surgery every week. Do you really think that they all don’t get better? The ones who don’t get better are the ones who are on the internet. The ones that get better – a significant majority – go on with their lives and forget about the surgery. They even forget the name of their surgeon or what procedure they had, because the pain is gone. They simply go back to their own lives and get busy living.
There are however, those cases where the patient never gets better. Here are some of the reason this might happen:
The surgery was done for the wrong reason
Rarely, the surgery goes wrong
In most cases, if the surgeon thoroughly examines you from a medical standpoint, listens to ALL of your complaints, asks you plenty of in-depth questions about your condition and pain, and correlates all of that information with your MRI or CT images, you are on to a good start. All of these have to match with each other to allow an experienced surgeon with extensive knowledge of the nerves and good judgement to decide if what appears on the MRI is really the source of your pain.
I have seen far too many people who have had multiple back operations for their leg pain that did not help at all. It turns out, some people may have similar leg pain from their hip, knee, tumor in the nerve itself, pelvic tumor, diabetes, or even their arteries and veins in their legs. If your surgeon does not take his/her time and listen to you, examine you in detail and review the images of the MRI or CT scan all at the same time, please get a second opinion before surgery!
Some patients (or even doctors) hear of a disc herniation in the spine and leg pain in the same sentence and conclude that if you operate on the spine, the leg pain gets better. This is simply not the case. There are plenty of people who have leg pain without a disc herniation as well as plenty who have disc herniation without leg pain. So if you get an operation or injection for the wrong reason, clearly, you are not going to get better. You would be one of those people who are complaining about their persistent pain after spine surgery. Make sure that:
Your surgeon has all the information. This includes a detailed history of your complaints.
Your surgeon performs a thorough examination after listening to you
Your surgeon pays attention to your MRI images AFTER he/she listens to you and examines you. This is a must because in this manner, the surgeon has not made up their mind before even seeing you.
Your surgeon explains everything to you and how it all makes sense.
You feel comfortable with your surgeon and have a good line of communication both before You have someone with you who can also hear the doctor and ask additional questions.
Don’t be afraid to get a second opinion!
Infection is by far one of the most feared complications of any surgery, for patients and more so for the surgeons. This is especially true about spine surgery where the nerves are involved. However, this one is easy. It generally follows a consistent pattern with the surgeon and institution. The techniques that different surgeons use vary, of course. There are ways to virtually eliminate infection by taking a few extra steps and being hyper-vigilant about this during surgery. Please do not hesitate to ask your surgeon about the rate of infection of his surgeries!
The hospitals and surgery centers have protocols that are in place as minimum requirement by the governing boards/government. However, there are plenty of other things that can be done to eliminate and minimize infection. Ask your surgeon was he does specifically that is above and beyond what is required. Also, ask your surgeon how he may monitor you after surgery to make sure that no infection starts and goes unnoticed.
Generally speaking, however, infections after spine surgery are very uncommon. There are some people who are more prone to infection. They may be on some medications such as steroids and anti-inflammatory medications for UC, or arthritis. Some patients’ immune systems are suppressed on purpose with medication to control autoimmune disease. Some people may have certain blood deficiencies that make them more prone to infection or hinder their healing. In any case, this is a must-have conversation before surgery.
In summary, the risks associated with Microdiscectomy Outpatient Surgery are very minimal while the benefits for such an effective and fast operation are plenty.
So, by all means, get your quality of life back and start living. That is what is really on the line.