Spinal Surgery

Spinal surgery is an operation on the bones, discs, nerves, or supporting structures of the backbone (spine) to relieve pain, restore movement, or correct a structural problem. The spine runs from the base of the skull down to the tailbone and protects the spinal cord — the main cable of nerves that carries signals between the brain and the rest of the body.

Depending on the problem, a neurosurgeon (a specialist in the brain and nervous system) may remove a damaged disc, fuse two or more vertebrae (spinal bones) together, widen a narrowed spinal canal (the tunnel through which the spinal cord passes), or stabilise the spine with rods and screws. The exact technique is chosen to take pressure off the nerves or spinal cord and to give the spine the stability it needs.

Spinal surgery is considered when a specific structural problem in the spine is causing significant symptoms — such as pain, weakness, or numbness — and non-surgical treatments like physiotherapy, pain medicines, or injections have not provided enough relief over a reasonable period. The decision is made case by case by the treating neurosurgeon.

• Herniated disc (a disc that has slipped or ruptured and is pressing on a nearby nerve)
• Spinal stenosis (narrowing of the spinal canal that compresses the spinal cord or nerve roots)
• Degenerative disc disease (wear-and-tear breakdown of spinal discs causing chronic pain or instability)
• Spondylolisthesis (a condition where one vertebra slips forward over the one below it)
• Spinal fractures caused by injury, osteoporosis (thinning of the bones), or tumour
• Spinal tumours — either primary (starting in the spine) or secondary (spread from elsewhere in the body)
• Spinal infection (such as an abscess pressing on the spinal cord)
• Scoliosis (abnormal sideways curvature of the spine) causing severe deformity or pain
• Cauda equina syndrome (sudden compression of the nerve bundle at the base of the spine — a surgical emergency)

Surgery is usually not recommended in certain situations. These include cases where symptoms are mild and manageable without an operation, where there is no clear structural cause that surgery can fix, or where the patient's overall health makes the risks of a major operation too high. Your doctor will weigh these factors carefully.

• Back pain with no identifiable structural cause on imaging
• Patients with serious heart, lung, or kidney conditions that raise surgical risk significantly
• Active, uncontrolled infection elsewhere in the body
• Blood-clotting disorders that cannot be corrected before the operation
• Patients who have not yet tried appropriate non-surgical treatments

Like all major surgery, spinal surgery carries recognised risks; the likelihood and severity vary with the type of operation, the level of the spine involved, the patient's age, and general health. Your surgeon will discuss the risks that apply most to your specific situation.

• Pain at the incision (cut) site that persists beyond the expected healing period
• Infection — at the skin surface, deeper in the wound, or in the spinal disc or bones (discitis or osteomyelitis)
• Bleeding during or after the operation, sometimes requiring a blood transfusion
• Nerve damage — causing new or worsened numbness, weakness, or pain in the arms, legs, or trunk
• Dural tear — an accidental small hole in the dura mater (the protective membrane surrounding the spinal cord), which may cause a cerebrospinal fluid (CSF) leak
• Blood clots in the leg veins (deep vein thrombosis) or lungs (pulmonary embolism — a clot that travels to the lungs)
• Failed back surgery syndrome — ongoing pain after surgery that does not fully resolve
• Hardware complications — screws, rods, or cages shifting, breaking, or causing irritation
• Adjacent segment disease — increased stress on the discs or joints next to a fused area, which may cause problems over time
• Anaesthesia (the medicine used to put you to sleep) complications, including reactions or breathing difficulties
• Incomplete fusion (in spinal fusion procedures) — the vertebrae do not fully join together
• Very rarely: paralysis or loss of bladder/bowel control, most often associated with severe pre-existing damage

Preparation for spinal surgery usually begins several weeks before the operation date. Your surgical team will give you a personalised checklist, but the steps below cover what is typically expected. Following these instructions carefully helps reduce the risk of complications.

Lifestyle adjustments before surgery: Smoking narrows blood vessels and slows healing, so surgeons usually ask patients to stop smoking for several weeks before and after the operation. Alcohol can interfere with anaesthesia and blood clotting, so it is commonly advised to stop drinking in the days leading up to surgery. If you are significantly overweight, your team may recommend weight reduction before a planned procedure. Your doctor will advise whether to pause or continue blood thinners (medicines that prevent clots), anti-inflammatory medicines (medicines that reduce swelling), and any other regular medications. Never stop prescribed medicines without guidance from your medical team.

Pre-operative (before surgery) tests and assessments usually include:

• Blood tests — to check for anaemia (low red blood cell count), clotting ability, kidney and liver function, and infection markers
• Imaging of the spine — MRI (magnetic resonance imaging), CT scan, or X-ray to map exactly where the problem is
• Neurological assessment — testing muscle strength, reflexes, and sensation to record your baseline before surgery
• Heart and lung checks — ECG (electrocardiogram, a tracing of the heart's electrical activity) and sometimes a chest X-ray, especially for older patients or those with existing health conditions
• Anaesthesia review — a meeting with the anaesthetist (the doctor who manages your sleep and pain during surgery) to discuss your medical history and plan your anaesthesia safely

Fasting: In most hospitals, patients are asked to stop eating solid food for a set number of hours before the operation and to stop drinking even clear fluids a shorter time before. Your team will give you the exact fasting instructions for your specific case.

What happens on the day of surgery — a typical sequence of steps:

• 1. You are admitted to the hospital and change into a surgical gown.
• 2. A nurse records your vital signs (blood pressure, heart rate, temperature) and confirms your identity and the planned procedure.
• 3. An intravenous (IV) line — a thin tube inserted into a vein, usually in the arm — is placed to give fluids and medicines.
• 4. You are taken to the operating theatre and positioned carefully on the operating table — usually lying face down for back surgery or on your back for neck surgery.
• 5. The anaesthetist gives general anaesthesia (medicine that puts you into a deep sleep) so you feel nothing during the operation.
• 6. The surgical site is cleaned with antiseptic and covered with sterile drapes.
• 7. The surgeon makes an incision (cut) over the affected part of the spine. In minimally invasive (keyhole) approaches, this cut is much smaller than in traditional open surgery.
• 8. The surgeon carries out the planned procedure — which may include removing disc material, trimming bone, inserting implants, or fusing vertebrae. Neurophysiological monitoring (continuous checking of nerve signals during surgery) is often used to help protect the nerves.
• 9. The wound is closed with stitches or staples, and a dressing is applied.
• 10. You are moved to the recovery room, where you wake up under close observation.

Recovery from spinal surgery varies widely depending on the type of operation, the level of the spine involved, and the patient's overall health. Minor minimally invasive procedures may allow discharge within one to a few days, while complex fusion or deformity correction may require a longer hospital stay and a more gradual return to normal activities. Your team will guide each stage of your recovery.

• Immediate monitoring: After waking in the recovery room, you will be moved to a ward or, if needed, an ICU (intensive care unit) for close observation of your vital signs, nerve function, and wound.
• Pain management: Pain in the days after surgery is normal and expected. The team will use medicines — including pain relievers and, where appropriate, nerve-pain medicines — to keep you as comfortable as possible. Pain typically lessens as healing progresses.
• Mobilisation: In many cases, the physiotherapist (a movement and rehabilitation specialist) will help you sit up and take a few steps as early as the day after surgery. Early gentle movement helps prevent blood clots and speeds recovery, but the pace is always guided by your surgeon.
• Wound care: The dressing over your wound is usually changed by nursing staff on a regular schedule. You will be taught how to keep the wound clean and dry at home, and told what signs of infection — such as redness, swelling, warmth, or discharge — to watch for.
• Brace or collar: Depending on the procedure, you may need to wear a back brace or neck collar (cervical collar) for a period of weeks to protect the healing spine. Your surgeon will specify how long and when it can be removed.
• Activity restrictions: Heavy lifting, bending, and twisting are usually restricted for several weeks to months. Driving is typically not permitted until cleared by your surgeon. Return to desk work, light activity, and eventually heavier tasks is usually a step-by-step process.
• Physiotherapy and rehabilitation: A structured physiotherapy programme is commonly recommended to rebuild strength, improve posture, and teach safe movement habits. This often continues for several months after discharge.
• Follow-up appointments: Wound checks, neurological assessments, and repeat imaging (X-ray or MRI) are typically scheduled at set intervals — often at a few weeks, three months, and six months after surgery — to confirm that healing and fusion (if performed) are progressing as expected.
• Smoking and alcohol: Continued smoking significantly slows bone fusion and wound healing. Doctors generally advise patients to remain smoke-free throughout the entire recovery period.
• Warning signs to report urgently: Sudden worsening of pain, new numbness or weakness in the arms or legs, loss of bladder or bowel control, fever, or signs of wound infection should be reported to your medical team without delay.