07-04-2021

Recovery time after surgery for an L4-L5 herniated disc

One of the most frequent questions that patients ask themselves before undergoing surgery for an L4-L5 herniated disc, is how long it will take before they can return to their daily activities. Instituto Clavel answers this question here.

The L4-L5 vertebrae are the lowest in the lumbar area of the spine. They act as a support for the upper torso and enable movement in different directions, along with the rest of the structures that make up the spine. Precisely because of their location, and the weight load they bear, they are prone to developing structural injuries such as disc herniation (this is also the case of the L5-S1 segment). 

When the disc in this segment herniates, the patient can suffer pain in the buttocks, legs, or feet. There can be additional symptoms, like muscle weakness when flexing and extending the ankle (which can worsen balance), and also numbness or tingling around the ankle and the affected foot. Symptoms may vary depending on the exact location of the hernia. 

Surgery for L4-L5 disc herniation  

When dealing with a case like this, there are various treatment options, including physical therapy, medication, and pain therapies such as infiltrations, as well as surgery. 

At Instituto Clavel, we employ the most accurate radiological tests, including magnetic resonance imaging and computed tomography to complete the diagnosis. In addition, we perform a study of the posture and sagittal balance of the patient's spine, using the EOSedge scanner

In some cases, when there is a notable structural alteration of the spine, we will recommend surgery as the definitive procedure for pain relief. In other cases, with less significant structural alterations, we start with milder, conservative treatments, using selective medication and guided physiotherapy. 

When surgery is required, at Instituto Clavel, we are committed to minimally invasive surgery, so the kinds of surgery we use for this pathology are usually one of the following: 

  • Lumbar microdiscectomy: the affected material of the herniated intervertebral disc is removed and, if necessary, partial emptying of the disc is carried out to prevent relapse. 
  • Arthroplasty, or disc replacement surgery (ADR): The damaged disc is removed and replaced by a disc prosthesis that imitates the characteristics of a healthy natural disc. We perform this operation using the anterior approach through the patient’s abdomen to avoid damaging nerve tissue. 
  • Arthrodesis or lumbar disc fusion: at Instituto Clavel we have multiple means and approaches for carrying out spinal fusion surgery. The most common is the posterior transforaminal or TLIF approach. However, some patients may benefit from a lateral XLIF approach to access the disc, which avoids manipulation of the nerves and muscles. 

How long will it take me to recover from the surgery for a L4-L5 disc hernia? 

The answer to this question will depend on the initial state of the patient and the technique used in each case. The number of days of hospital stay also varies. Patients who have a lumbar microdiscectomy need to stay in the hospital for 24 to 48 hours after the operation, while those who undergo an anterior approach (ALIF) or a lateral approach (XLIF), may need 3 or 4 days in the hospital before returning home. 

In general, when the surgery has been a microdiscectomy or a disc arthroplasty (ADR), the patient usually returns to work after 3 or 4 weeks, if their job is does not require physical exertion, for example an office job. For work that involves carrying heavy loads, or other significant physical exertion, this time may be longer: in the case of ADR, up to 6 weeks, and in the case of microdiscectomy, up to 3 months.  

For patients who undergo lateral approach lumbar fusion, it is estimated that recovery and return to activities will take place gradually over a period of 3 to 6 months after the operation

However, when we refer to this recovery period, we do not mean absolute rest or that the patient must stay in bed. At Instituto Clavel we recommend mobilization as an essential part of post-surgical recovery. This mobilization process will be progressive, and is always adapted to the capabilities of the patient, with a gradual increase of activity during the first weeks following surgery. 

Furthermore, at Instituto Clavel, we lay out a comprehensive approach to recovery for each case and we have a personalized rehabilitation service at FisioSpine. At our personalized physiotherapy unit, we provide treatment for recovery after surgery that is selective and adapted to each pathology, to help the patient get back their autonomy and return to the daily activities of life. 

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