Spine Surgery Risks and Potential Complications

Surgery of any type has the potential for complications, and spine surgery is no different. If you have a scheduled spine surgery, one of your first questions is likely about the risks of your procedure. While your surgeon will explain the possible risks of your specific back or neck treatment, this article describes potential general complications of spine surgery: anesthesia, bleeding, blood clots, dural tear, infection, lung problems, and persistent pain.
Mature male doctor looking at clipboard and looking confused while standing against grey backgroundYour surgeon will explain your risk for a complication depending on many factors, including your overall health and previous surgical experience.In your pre-surgery meetings with your medical team, it’s important you accurately answer questions related to your medical history, allergies, medication regimen, and lifestyle choices, as these can help your doctor understand your potential surgery risks. Many factors can affect your risk for a surgical complication, such as:

  • Overall health
  • Age
  • Previous surgical experience
  • Coexisting medical conditions (such as diabetes)
  • Smoking status

Fortunately, the likelihood that any of the general surgery complications listed below will occur during or after your surgery are rare.

If you want to learn about more specific spine surgery risks, read Nerve, Fusion, and Implant Complications of Spine Surgery.

Anesthesia Risks
Most spine surgeries are performed under general anesthesia. You will be given medication through an intravenous (IV) line to put you to sleep, so you won’t feel pain during the procedure.

Risks from anesthesia are rare but serious. These risks include heart attack, stroke, brain damage, and death. These complications may be caused by drug reactions or problems stemming from other medical conditions.

How you can help minimize your anesthesia risks: Tell your surgeon and anesthesiologist if you or a family member has had an adverse reaction to anesthesia, and if you use tobacco and/or alcohol.

Bleeding
The techniques your spine surgeon uses from incision to closure of the surgical wound are meticulously performed to minimize and reduce blood loss. However, harm to major blood vessels can happen, which can cause bleeding.

Some ways your surgeon minimizes bleeding complications include:

  • Prior to surgery, your medical team may take a sample of your blood, so they know your blood type in case you need additional blood during surgery. Most often, this is a donor blood transfusion. Some patients may donate their own blood in advance of their surgery date to avoid donor blood products.
  • Intraoperative blood salvage, sometimes called auto-transfusion, recovers your own blood during surgery by suctioning it from the surgical site. Specialized equipment, sometimes called a cell-saver device collects the blood, filters and washes it before it is returned to your body through a separate IV.

Blood Clots
Patients undergoing surgical procedures, especially surgery involving the pelvis or the lower extremities, are at risk of developing blood clots inside the veins in their legs (a condition known as deep venous thrombosis or DVT).

After surgery, the body’s clotting mechanism is very active because it is trying to stop the bleeding caused by the surgery. Injury to the blood vessels around the surgical site can also cause clotting.

Clots can form in the large veins in the calf, and they may continue to grow and extend up into the veins in the thigh. In some cases, they can reach the veins of the pelvis. If part of the clot breaks free, it can travel through the veins to the lung(s) and cut off blood supply to the part of the lung that is blocked. This blood clot in the lung is called a pulmonary embolism, and it is potentially life-threatening.

Blood clots can occur during the first few weeks after surgery. Warning signs of a possible clod clot include:

  • Swelling in the calf, ankle, and/or foot
  • Tenderness and/or redness, which may extend above or below the knee
  • Pain in the calf

Warning signs of a pulmonary embolism include:

  • Sudden chest pain
  • Shortness of breath
  • Cough

While hospitalized, medical staff will carefully monitor you for DVT and symptoms of pulmonary embolism (among other potential complications). However, even if hospitalized, alert the nurse immediately if you experience these symptoms.

  • If you’ve been discharged home and experience symptoms, call 911 immediately.

How you can minimize your risk of DVT:

  • Your doctor will recommend you move (eg, sit up, walk) as soon as possible after surgery so your blood circulates.
  • If you need to stay in bed, you can pump your feet up and down (as if pushing on the gas pedal) to get blood moving back to your heart.
  • You may also be given special stockings to wear called pulsatile stockings, which wrap around each calf and thigh. A pump inflates the stockings every few minutes, squeezing the veins in the legs and pushing blood back to the heart. Another type of stocking, called TED hose, squeezes the veins of the legs shut. This reduces the amount of blood that pools in the veins of the leg, reducing the risk of blood clots.

Your doctor may also prescribe you medication to reduce the risk of blood clots. These blood-thinning drugs include aspirin, heparin, enoxaparin, or warfarin.

Dural Tear
A dural tear occurs when the thin, protective covering over the spinal cord and spinal nerves is torn during the procedure. Sometimes, your surgeon can detect the dural tear during surgery and repair it immediately. Most dural tears heal without incident. However, if it doesn’t heal, spinal fluid can leak out through the tear and cause a spinal headache.

The main takeaway about dural tears after spine surgery: If you experience headache after your surgery, tell your surgeon. You may need a second surgery to repair a dural tear.

Infection
The risk of infection following spinal surgery is small in most patients. You will receive IV antibiotics immediately before surgery to reduce your risk of infection.

If an infection does develop, it may be superficial (in the skin incision only), or it can spread deeper to the areas around the spinal cord and vertebrae.

Common symptoms and signs of an infection include:

  • A red, hot, and swollen wound
  • Increased pain
  • Fever, sometimes accompanied by chills
  • Clear liquid or yellow pus oozing from the incision
  • A foul-smelling odor at the wound site

The main takeaway about infection after spine surgery: If you experience any of these symptoms, contact your doctor immediately or go to the emergency room. A superficial wound infection can usually be treated with antibiotics, but deeper wound infections may require additional surgery to drain the infection and oral or IV antibiotic therapy. In some cases, your surgeon may need to remove any bone graft and/or spinal instrumentation or devices implanted during spine surgery.

Lung Problems
Your lungs can be affected by anesthesia, lack of activity, and pain medication following spine surgery, so you will need to exercise your lungs after surgery. Healthy lung function is an essential part of post-operative healing, as your lungs send oxygen to areas of your body that need it to heal. If your lungs are not working properly after surgery, it can lead to pneumonia (a lung infection).

How you can minimize your risk of lung complications: Your doctor will ask you to take frequent deep breaths and cough often. Getting out of bed, even to sit upright in a chair, helps your lungs function better. You may be given a device called a spirometer, which measures how hard you are breathing and helps improve your deep breathing. You may also work with a respiratory therapist, who can teach you how to maintain healthy lung health.

Persistent Pain
After spine surgery, your recovery journey begins. Spine surgery recovery can be a long, challenging, and painful process. It may be many weeks or months before you notice a decrease in your pain or other symptoms. And, in some cases, spine surgery does not completely reduce or resolve your pain—it may actually increase your pain.

  • The main takeaway about pain after spine surgery: The best way to keep post-operative pain at bay is to follow your surgeon’s recovery instructions, but some pain after surgery is normal even if you do everything right after your procedure. However, you should talk to your surgeon if you have persistent, worsening pain after your surgery.

Spine Surgery Complications Are Rare, But Be Informed
While the general spine surgery risks described in this article are rare, it’s important you understand any potential complications that could occur during or after your treatment.

Before you undergo your procedure, ask your spine surgeon questions about the risks associated with your specific back or neck surgery, including ways you can help prevent potential complications. Knowing the risks allows you to weigh them against the potential benefits—and that ultimately leads to a fully informed decision about whether the procedure is best for you.

Updated on: 05/02/18
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