I'm Ioannis Fouyas. I'm a consultant neurosurgeon.
I work in the Aberdeen Royal Infirmary
and I perform spinal and intracranial procedures.
I would advise patients
who have significant pain affecting their lifestyle
to have a spinal operation
if the pain is affecting substantially their wellbeing
and they want the most effective treatment,
which inevitably has a small risk of making them worse.
Sometimes in the lumbar spine
you can have either a disc bulge or wear and tear
pushing the nerves that come out of the spine and supply the legs,
and this pressure on the nerves causes severe pain.
Our main aim of surgery is to relieve the pressure from the nerve,
so we always operate from the back,
with the patient lying flat with the tummy down.
What we do is we strip off the muscles between the bones.
And what we have is an area here which hasn't got any bone at all.
It just has a ligament.
And what we do is we remove that area,
so we remove the ligament and sometimes a bit of the bone,
depending on how much space we have and how much space we want to create.
The next thing we find is the nerve.
If the problem is caused by a disc bulge, we trim the disc bulge.
If the problem is caused by a swollen joint,
we remove the part of the joint which is pushing the nerve.
The principle of surgery is the same,
to create a window between two adjacent bones
which will enable us to find the nerve which is pushed
and remove what is pushing it,
either the disc from the front or the wear and tear from the back.
And that's why, after the operation,
the leg pain gets better quite soon,
because the pressure gets better quite soon.
And that's why sometimes you have stiffness and discomfort in the back,
because of all the stripping of the muscle around the bones.
This operation is thankfully not very risky,
but the main concern that we have is infection.
Thankfully it doesn't happen very frequently.
The possibility of infection in that area
is probably in the region of one per cent,
and equally reassuringly we do have quite good antibiotics to clear it.
One of the natural worries of every patient
who has an operation on the spine
is getting paralysed, going into a wheelchair,
which thankfully is exceptionally uncommon.
Another risk is to create what we call leakage of cerebral spinal fluid.
Another worry that patients have
is how likely it is for the problem
for which they were operated on to come back.
And that is uncommon, nevertheless, but it can happen.
Generally speaking, when I discuss the expectations,
risks and long-term problems with spinal decompression in general,
I tell my patients that there is between 70 and 90 per cent chance
of having a very satisfactory outcome.
I do find that people who have come to that understanding
and have accepted the fact that they need to have something done
because their problem is causing a major effect
in the way they enjoy life or they can't enjoy life,
it's this sort of patient that ought to have the operation.