Who needs this operation?

Most joints in the body have been affected by a variety of disease processes and have been treated by fusion in the early days of surgery and more recently by replacing the joint with an artificial one. Whilst the spinal discs are not joints in the technical sense, they do allow a degree of movement which when all discs are taken together confers a considerable degree of flexibility on the spine as a whole.

When a disc is damaged it may lead to pain or abnormal movement, both of which may need correction. Most people get through life with the discs they were born with; in some, however, the discs degenerate, through ageing processes, trauma or repeated stress to the extent that they become increasingly painful. This is typically a central back pain which may spread to the legs in a vague manner, or even into the abdomen.

Standard treatment for this type of pain includes rest during an acute exacerbation, with anti-inflammatory medication, followed by physiotherapy. Injections, such as epidurals may help. In most instances the pain will resolve adequately, but when it does not the patient may feel that the symptoms are bad enough to warrant surgery.

Pre operative advice

48 hours before surgery, take some gentle laxatives (colace, senna) to ensure you have your bowels opened on the day of surgery.

On the day of your surgery it is important to remain Nil By Mouth (NPO). Do not eat beyond midnight the night before you arrive but you may continue to drink water up to two hours before admission, where you will be advised further.

It is not necessary to bring your medications with you, as these are supplied from Pharmacy at Hospital (you can use your medications when you return home). However, if you take a number of medications, please bring a list of names and doses so they can be appropriately supplied by the pharmacy department.

How Is It Done?

The operation is performed under a general anaesthetic with the patient lying on their back. An incision is made in the left lower quadrant of the abdomen and the muscles are split to allow access. It is unusual for the muscle to be cut at this stage, so recovery of function can be expected.The spine is approached through the retro-peritoneal space, the peritoneum being the sac containing the bowel, and by moving the blood vessels carefully away towards the right side. The spine can now be seen and the damaged disc can be removed. The disc replacement is inserted after distraction of the disc space (spreading it to restore its normal height) and the wound is then closed. X-rays are used during the operation to make sure the artificial disc is in the right position.

Post operative Care

You will wake up in recovery, where you will spend a short time recovering from the anaesthetic.

You will then be transferred back to the ward. The contact numbers and visiting times are listed below.

You will remain to be Nil By Mouth until you begin having bowel sounds again. The bowels maybe slow to begin working again, and it is important not to eat or drink too quickly post operatively to avoid sickness and further complications. You will have maintenance fluids intravenously to keep you hydrated.

On day 1 post operatively, you will be seen by the physical therapy team on the ward. They will start teaching you how to safely get out of bed, and will help you to start walking again. You may feel light-headed or dizzy the first few times you get up — this is normal, and will wear off. The physiotherapist will also fit you with a brace to support your spine. You will have to wear this for 6 Weeks.

Your wounds will be managed by the nursing staff, they will be dressed as needed. They will also provide you with the appropriate information for discharge.

When you go home

Exercises commence gently on the first post-operative day. You will be taught flexion exercises as extension (of the spine) is to be avoided during the first six weeks after disc replacement. X-rays are taken at six weeks and again at three, six and twelve months after surgery.

Most people are fit to return to gentle activities including non-manual labour, within three to four weeks. Those employed in heavy manual labour should plan to be off work for a minimum of six weeks and may need to consider re-training in a less physically demanding job. This should be discussed with Dr Bhatti.

Flying is not a problem, but airports are. Avoid standing for more than 10 minutes and carrying luggage, especially off the carrousel. Try to avoid sitting for too long — get up and exercise when it is safe to do safe. Please also check with your airline before flying.

The Nursing staff on the ward will have given you some information on wound care prior to discharge. If you have any concerns regarding you wound, please do not hesitate to contact us. The stitches are dissolvable and will not need removing. In general, all dressings can be changed after 72 hours, with a new dressing applied every day thereafter if the incision is draining. However, if no drainage is present, the dressing may be discontinued. Moreover, you may shower and wet the incision after 72 hours, but bathing or soaking the incision is not recommended for 2 weeks.

Pain killers can be constipating so we encourage you to eat food that will help to keep your bowels working well. Drink plenty of water.

Brace with Chairback lumbar support

After your operation you will need to wear a brace to support your muscles and spine (Similar to wearing a cast on your arm after surgery). It should be worn when you are out of the house, walking, shopping, when you are sitting in the car, bus, train or tube. You don’t need to wear it in bed or when you are sitting at home.

You may need to wear this for several weeks. Xrays may be used to see when it is safe to start weaning off it. You will be fitted with the appropriate size by the PT on the ward, and then be taught how to put it on correctly.

Skin care

• The brace should be worn over the top of a vest, or light t-shirt to prevent skin abrasions.
• Don’t wear any greasy or oily lotions, or talcum powder, and fully dry the skin before applying the brace.
• The brace may leave some small red marks on the skin. These should disappear within 30 minutes of removing the brace. This is normal, the skin will gradually build up resistance to the brace. If it does not disappear after 30 minutes, contact the clinic as below.
• Clean your brace regularly with a damp cloth and soapy water. Wipe and dry thoroughly before re-applying.