Comprehensive study addresses complications of spine surgery

Sep 23 2011
As spine surgery becomes more common, researchers reviewing hospital data say that more doctors and patients need to be aware of potential complications in the first 30 days after procedures to treat spinal stenosis, disc herniations and other conditions.

Back pain is the number two neurological condition affecting Americans, second only to headaches. Eighty percent of people will have back pain at some point in their lives. Pain can be caused by injury or disease in any of the structures of the spinal column, including the vertebrae, the facet joints or the intervertebral discs that cushion the space between the bones. Conservative therapies for the first line of treatment are best, and may include over-the-counter analgesics. Alternative treatments for back pain include acupuncture, hypnosis, chiropractic care and massage therapy.

However, there are some situations in which spine surgery is unavoidable. Common procedures include a discectomy, which removes part or all of a disc that has ruptured or moved out of place, or a laminectomy, which excises bits of bone. These operations are remedies for conditions in which structures of the spine put pressure on the surrounding nerves. Both surgeries may be followed by spinal fusion, which connects consecutive vertebrae in order to stabilize movement.

Spine surgery has become more routine thanks to advances in technique and diagnostics, according to the American Academy of Orthopaedic Surgeons (AAOS). However, little is known about why certain complications, such as blood clots or infections, can occur after surgery.

Researchers reviewed three years of spine surgery data from the National Surgical Quality Improvement Program, including more than 3,400 patients. Procedures were performed for the treatment of spinal stenosis, disc herniations, degenerative disc disease and other conditions. The average age of patients was 55.5 years. Three quarters were white, and 54 percent were men.

Within the first 30 days after surgery, the most serious complications included blood clots in the leg, infection and unplanned needs for further surgery. Patients were at risk for fatal complications if they were older or had a history of surgical wound problems, the researchers said. Other risk factors for post-surgery complications include a history of heart problems, neurological problems, wound infections, sepsis or use of corticosteroids.

Despite the study's findings, the authors said it should not deter patients from having required surgery.

"Many studies exist that illustrate the safety and efficacy of spine surgery, and the intent of this work was not to be alarmist," said author Andrew Schoenfeld, M.D. "Our goal was to identify medical conditions and other factors that could be addressed prior to surgery in order to further enhance the safety of spine surgery and help achieve the best results for patients."

In order to help minimize the risks for post-surgery complications, the AAOS recommends that candidates discuss any previous history of infections with their physicians. Patients should also make sure they are in prime shape by having a physical check-up or quitting smoking, if applicable. If possible, they may also want to consider postponing surgery to undergo a weight control program, the AAOS said.