How Safe Is Cervical Spine Surgery?

Complications during routine neck surgery are rare, and a study shows the most serious—death—is virtually nonexistent.

Written by Kelly Rehan, Jeffrey C. Wang, MD, Zorica Buser, PhD

Every surgical procedure carries a risk of complications. But even if the risk is low, serious complications can occur. Spine researchers seeking to better understand death rates of patients undergoing cervical spine surgery found that death is a very rare, virtually nonexistent complication of neck surgery.

“In our multi-center retrospective study, there was no case of intraoperative death after cervical fusion,” said Zorica Buser, PhD, and Jeffrey Wang, MD, 2 of the co-authors of the study, which was published in Global Spine Journal. “In general, this is a very rare event. An elective cervical spine fusion can be a safe procedure as long as the patient’s spinal pathology and other conditions are carefully evaluated.”
Neck Surgery Common in the United States
Neck problems are one of the top 5 surgically treated conditions in the United States.

The study authors noted that the neck’s anatomical design makes it susceptible to excess stress and pressure, which leads to spinal conditions like herniated discs and spinal stenosis.

While as much as 80% of neck problems can be managed with non-surgical therapies, such as medication, surgery may be necessary to decompress nerves and/or stabilize the spine.

A Closer Look at the Study
The purpose of this study was to identify how often death occurred during (intraoperatively) cervical spine surgery, along with any associated risk factors.

To learn how often death occurs during neck surgery, the researchers reviewed medical records of 258 patients who had elective spine surgery at 1 of 21 surgical centers. The average patient age was 54, and the surgeries were performed between 2005 and 2011. Most of the surgeries were done using the anterior (front of body) approach, followed by posterior (back of body) and circumferential (360°).

The researchers found no cases of death during the procedures—a 0% mortality rate. Additionally, the overall complication rate was low among the patient sample.

Elective Versus Emergent: A Factor in Spine Surgery Safety?
The researchers noted that one of the key factors that may increase death risk during surgery is whether the procedure is an emergency or elective (routine). The researchers referenced a previous study that found 19 people who had emergent cervical surgery died during surgery, versus 1 who died during an elective procedure.

Emergent cervical spine surgery may occur after a trauma or if the patient has a spinal tumor.

Low Risk, But Complications Exist
The success rate of cervical spine surgery is very high, but complications have been reported.

“The take away is that most of the complications were very rare, some were almost nonexistent,” Buser and Wang said. “Dural tear and C5 palsy were the most common, but again, they had a very low frequency.”

While dural tear (a tear in the protective covering of the spinal cord) is the most common neck surgery complication, its total incidence is only 0.77%. C5 palsy (a temporary paralysis in one or both arms) is the second most common complication, with a total incidence of only 0.42%.

While complications are generally quite rare, you may be at a higher risk for certain complications based on the type of neck surgery you undergo.

For example, neck surgery complications frequently involve the esophagus. Patients undergoing an anterior cervical discectomy and fusion (ACDF) are at a higher risk of dysphagia (difficulty swallowing), nerve injury in the larynx (voice box), and pharynx wall swelling.

While those esophageal complications may not be a cause for concern on their own, they can lead to aspiration pneumonia, which can be fatal.

Though cervical surgery’s complications are extremely rare, the authors wrote that people who have cervical myelopathy have higher death rates associated with surgery compared to people who don’t have myelopathy. Cervical myelopathy is a condition in which spinal cord in the neck region is compressed.

“Myelopathy can contribute to various post-operative complications, which can interfere with the vital functions of the body,” Buser and Wang said. “In a very severe case, this could lead to death. That means that myelopathy would have an indirect role in intraoperative death.”

Now What? How You Can Use This Study’s Findings
While this study reinforces the safety of routine cervical spinal fusion, you can do your part to improve your surgery’s success by discussing your risks and benefits with your surgeon before undergoing your procedure.

“Each patient is unique, and careful pre-operative planning is a key for the successful surgery,” Buser and Wang said. “It is important to evaluate spine pathology [cause of disease or disorder] and any other comorbidities, such as smoking, diabetes, and mental disorders. Patients should discuss their conditions with their surgeon, and how they might impact both the fusion success and a chance of post-operative complications.”

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Anterior Cervical Discectomy and Fusion (ACDF) at an Outpatient Spine Center