Spine Surgery Risk Factors and Potential Complications

No surgical procedure is completely free of risk for complication. If you’re facing the decision to undergo back or neck surgery, it’s important to talk with your spine surgeon to obtain a clear picture of your personal risk factors. Fortunately, for many patients, the risk for surgical complication is rare and often risk factors can be managed to avoid development of a surgery-related problem.
Modern operating room with monitorOften, the patient’s risk factors can be managed to avoid development of a surgery-related problem.It’s also important to understand that no surgeon has zero complications and all patients, whether they undergo a surgical procedure or not face risks every day. Driving to work is riskier than most people realize. Using the example of driving, I stratify surgical complications into two categories—(1) speed bumps and (2) stop signs.

  1. Speed bumps are more common, can be handled, and in the long run, do not affect a good outcome. From persistent nausea after anesthesia, to a blood clot in the wound that requires removal, to an infection typify common complications that are manageable.
  1. Stop signs are bad. These complications are less common and may have long-term consequences. Some include neurological deficit, stroke, extended hospital stay, and death.

The point is patients should worry about stop signs, not speed bumps. I encourage every surgeon to print or book mark this article and distribute it to their patients.

Medical and Lifestyle Factors May Increase Risk for Complication
While most patients who undergo spine surgery to treat neck and back disorders experience good outcomes, some may have greater risk to develop a complication during or after their surgical procedure.

In general, some factors that may affect development of a surgery-related complication include:

  • Anemia (low red blood cell count)
  • Cardiovascular disease (eg, chronic obstructive pulmonary disease, COPD)
  • Corticosteroid medication dependence (eg, lupus treatment)
  • Diabetes1
  • Heart problems
  • Kidney disease
  • Metabolic bone disease (eg, osteoporosis)
  • Obesity
  • Respiratory problem (eg, shortness of breath, asthma)
  • Smoking

Aside from the risk factors listed above, there are others that are revealed to your spine surgeon by your medical history and physical examination. Having a risk factor doesn’t necessarily mean you're not a candidate for spine surgery—rather, your surgeon makes his treatment recommendation based in part on your entire medical profile that includes risk factors for complication.

Potential Spine Surgery Complications
Complications may develop immediately before, during and up to the time of discharge and/or after spine surgery.

  • Anesthesia risks: Most spinal surgeries are performed under general anesthesia, which bears small risks of heart attack, stroke, brain damage, and death.
  • Bleeding: Some bleeding is normal and expected, therefore, surgeons routinely use different types surgical techniques, instruments and devices to help control and stop bleeding. Although a rare occurrence, a blood vessel may be damaged.
  • Blood clots: People having surgery in their lower body are at a higher risk of developing blood clots inside the veins in their legs, which is called deep venous thrombosis (DVT). If the clot moves to the lungs, it’s called a pulmonary embolism (a life-threatening complication).
  • Dural tear: A dural tear is also called intradvertant durotomy. This occurs when part of the protective layer covering the spinal cord is torn allowing cerebrospinal fluid to leak out. Often, a dural tear is found during the surgical procedure and promptly repaired. Dural tears are common, especially in revision cases, meaning a second spine surgery is performed to treat an unexpected outcome.
  • Fusion fails: Nonunion and pseudarthrosis are medical terms used when spinal fusion does not heal properly or completely.
  • Infection: Infections may develop in the skin around the incision and/or develop below the wound near the operative area, but the chance of this is rare. Sterile procedures and antibiotics administered before surgery significantly reduce the risk for infection.
  • Nerve, spinal cord damage: The advent of sophisticated surgical tools that enable pre-operative procedure planning, microscopes, and intraoperative imaging help reduce the risk for neural damage (eg, bruise, cut). Nerve or spinal cord damage can cause pain, paralysis, sexual dysfunction and other sensory and functional symptoms.
  • Lung problems: Lung function after surgery can be decreased by anesthesia, medication, and lack of physical activity. Medical staff teaches patients deep-breathing exercises to improve lung function and avoid development of conditions such as pneumonia.
  • Persistent pain: You will likely be in pain after spine surgery, but you should report debilitating pain and/or new symptoms to your surgeon. Persistent pain may also be considered a post-operative surgery complication.
  • Spinal implant problems: Spinal implants (or instrumentation) include interbody devices, plates, rods and screws that are implanted to help stabilize the spine. These devices can break or move, although rare. If this occurs, a second spine surgery may be necessary. Patients ask about rejection of implants. This usually refers to loss of fixation or not fusing. Allergies to device materials (eg, metal) are rare.
  • Transitional syndrome (adjacent segment disease): Adjacent segment disease is a potential complication of spinal fusion. Fusion may alter the biomechanics of the fused spinal segment (eg, L2-L3) changing the way forces and stresses are distributed. This can add stress to the bones (eg, vertebrae) above and below the fusion, potentially leading to development of micro-movement, a type of instability that can cause pain.

7 Essential Questions to Ask Your Spine Surgeon
The prospect of undergoing spine surgery can be one of the most daunting decisions a patient ever makes—but having a good relationship with your surgeon can help thwart stress and anxiety.

  1. What are the potential risks and complications associated with my procedure?
  2. Am at greater risk for developing a complication?
  3. What short- and long-term problems may I face if I don’t undergo this procedure?
  4. Is a minimally invasive surgical procedure an option for me?
  5. What changes should I make before surgery to help reduce my risk for potential complications (eg, weight loss, exercise, quit smoking)?
  6. After my spine surgery, what symptoms or red flags may indicate something is wrong?
  7. Can I see the consent form that I will sign the day of my procedure? (The consent form details an exhaustive list of risks that your surgeon may not have noted in your conversations. These risks are usually very rare, but they may prompt additional questions for your surgeon.)

Work with Your Spine Surgeon, Be Informed and Set Realistic Expectations
Can being fully informed eliminate the possibility of spine surgery complications? No. Sometimes, problems occur that are out of your control. But remember: Spine surgery complications are rare. Most people have good long-term outcomes after spine surgery. Educating yourself beforehand and building a strong relationship with your spine surgeon go a long way toward ensuring your own surgery success.

Updated on: 05/15/18
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Spinal Fusion Instrumentation Removal: Pros and Cons

If an issue with your spinal instrumentation develops, your doctor may recommend removing it or leaving it in place. Why would your doctor suggest one or the other?
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