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Complications

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What can go wrong?

With any form of surgery there may be complications. Serious complications are rare, but when they occur they may be devastating to the patient.

Prior to you agreeing to have spinal surgery your surgeon should discuss these potential risks  with you, and you should consider other non surgical procedures. Your surgeon should help you evaluate the benefits and risks relative to your specific situation.

Infection

Superficial wound infections may occur in unto 4 cases per 100. Because the infection is not deep, then often  the infection can be treated with a course of oral antibiotics.

If the infection is more extensive or deep, especially if there is instrumentation has been implanted during the surgery then further operations may be required to wash out the infected operation site and then intravenous antibiotics followed by  several weeks or months of oral antibiotics until the infection is eradicated.

The risk of infection is increased by certain medical conditions or medications or life style choices, which include, diabetes, obesity, an impaired immune system, oral steroids and smoking.

The type of surgery also affects the risk of infection, prolonged surgical procedures with significant loss of blood and posterior cervical surgery, because of the hair.

Bleeding

Significant blood loss is very rare after this operation, however very occasionally patients will bleed a lot and a collection of the blood, (a haematoma), will press on the nerves, the spinal cord or the caudal equina. If this occurs a further operation may be required to remove the collection of blood

Very occasionally one of the large blood vessels near the spine can be damaged resulting in sever blood loss.

Surgery should be planned to achieve the surgical goal with the simplest procedure possible, and the consideration of  blood collection during surgery (cell salvage) , which is given  back the patient.

Prior to surgery consideration should be given to stopping blood thinning medication, provision of blood collection or medication to help prevent bleeding.

Dural Tear or Cerebrospinal Fluid Leak

This occurs when the covering or sac (dura) surrounding the nerves or the spinal cord being torn. This can occur when the disc or bone is adherent to the dura, which is more likely in revision surgery.

If the leak is noted during the operation that he may be able to be closed by stitching closed the leak, or applying a variety of sealants.

Patients may experience a headache following the operation, which improves with bed rest for a few days, as the dural sac repairs and seals the headache improves and then the patient is able to mobilise.

A small minority of patients may have a persistent CSF leak, occasionally associated with CSF leaking from the wound and even rarer associated infection, which can cause meningitis. If the leak is persistent further surgery to close the leak may be required, this is required  in less than 1% of surgical cases.

Nerve Damage

The risk of damage to the nerves is rare, estimated at less than n 1%,  but if it occurs the there may be numbness, weakness or increased sensitivity in the area which the nerve supplies. The risk of nerve damage is increased in more complex operations or when surgery has already been performed in the same area and so there may be scarring.

Spinal Cord Paralysis or Cauda Equina Damage.

Paralysis is always a potential risk of spine surgery, yet in the vast majority of operative cases this risk is extremely low, estimated at less than 1 in 10,000 cases. The risk of paralysis is increased by certain factors which include, complex prolonged spinal surgery, correction of spinal deformity, previous spinal surgery in the the same area of the spine and pre-existing damage to the the spinal cord. Some areas of the thoracic spine have a greater risk if spinal cord damage occurring due to the poor poor blood supply to this area.

The Cauda Equina is below the spinal cord in the lumbar region of the the spine, anatomy, if this area is damage it may result in damage to the nerves to the legs but also the nerves which control, bladder, bowel and sexual function. Thos is a rare condition following surgery.

The risk of damage to the nerves or spinal cord is extremely rare with this operation degree however a patient needs to be discuss with the operating surgeon the risks on an individual basis.

Misplacement of Spinal Implants

Although every effort is made to place instrumentation in the correct position within the spine, this can be extremely challenging to even an experienced spinal surgeon, especially if the anatomy and surgical cases is complex.

The resultant misplacement may cause damage to the nerves or other structures and further surgery may be required if this occurs.

Failure to Obtain Fusion of the Bones

Some of the surgical procedures aim to fuse areas of the spine together, implants or instrumentation may need to be implanted into the body to help achieve this but ultimately the bones will need to fuse together.

There is absolutely no doubt that smoking reduces the success rate of fusion. Smoking interferes with the development of new blood vessels which are essential for developing new bone.

If the bone does no fuse there may be long term postoperative pain, or further surgery may be required

Further Surgery

Under certain circumstances further surgery may be required if a complication occurs. Fortunately this is rare occurrence , but causes include a persistent CSF leak, deep wound infection, misplacement of spinal instrumentation, failure of the spinal instrumentation and failure to achieve a spinal fusion.

Anterior Cervical Spine Surgery, Complications.

Laryngeal Nerve Palsy (Hoarseness)

The surgical approach to the cervical spine from the front is less painful than approaching  the neck from behind but does have its drawbacks – there is a small risk of hoarseness, due to damage to the laryngeal nerve. In the vast majority of patients this is due to stretching of the nerve and gets better without treatment. Rarely this is permanent, and requires treatment from an Ear, Nose and Throat surgeon.

Difficulty Breathing or Swallowing (Dysphagia)

Immediately following anterior cervical surgery there may be swelling or a haematoma may collect.

Temporary difficulty swallowing, because the voice box (larynx) and throat (oesophagus) need to be pushed to one side, is very common following anterior cervical surgery. This usually resolves within a few days to weeks and is rarely persistent.

Horner’s Syndrome

Temporary difficulty sw

General Complications of Surgery

Patients undergoing spinal surgery are at risk of medial complications. The risk depends upon an individual patients health and past medical history. The relative risks should be discussed with the operating surgeon prior to deciding to proceed with surgery.

Potential serious complications include, but are not exclusive to the following:

Deep Vein Thrombosis and Pulmonary Embolus

This is when a blood clot, deep vein thrombosis (DVT) forms in the deep veins of a limb, usually the legs. It can block the flow of blood within these veins, or a blood clot may break off and travel to the lungs causing a pulmonary embolus.

When  pulmonary emboli  form in the lungs they may  cause severe shortness of breath or on very rare occasions death.

Increased risks for DVT and PE include prolonged bed rest, extensive surgery, obesity, cancer, previous DVT, paralysed leg/s and heart failure.

To prevent DVT and PE the patient will have elastic stockings put on prior to surgery. While in surgery, the patient has leg pumps fitted around the calves to improve the circulation, which is continued after the operation until the patient is mobile.

The patient is encouraged to mobilise out of bed as soon as possible following the operation, usually the day after surgery. Before this, the patient can wiggle their  toes and move the legs around in bed as soon as wakening from the anaesthetic.

Blood thinning injections may be used in patients who are at high risk of a DVT or PE, this is generally avoided prior to the surgery to prevent excess bleeding.

Myocardial Infarction (MI)

MI or heart attack occurs when there insufficient blood supply to the heart. This is more likely to occur if a patient has had previous heart problems.

Stroke or (CVA)

Stoke  Cerebral Vascular Accident (CVA) is when there is inadequate blood supply to the brain, or a bleed into the brain, which leads to an area of the brain becoming damaged. This is more likely to occcur if a patient has already had a  stroke or a Transient Ischaemic Accident, (TIA)

Death

Death due to elective spinal surgery is extremely rare, patients who are too unwell will not be offered surgery and alternative treatments will be used. The most common reasons for death  are myocardial infarct (heart attack) due to the stress of the surgery, a rare reaction to a drug (anaphylaxis), pulmonary embolus or severe bleeding.

Reducing the Risks of Spinal Surgery

Avoid Surgery

Consider non surgical treatments prior to electing to undergo spine surgery, many surgery procedures may be avoided, by optimising pain relief medication, physiotherapy and spinal injections.

Keep Surgery as Simple as Possible

When surgery cannot be avoided then there may be some different types of surgery that can undertaken. Generally simpler, smaller surgical procedures, if appropriate are less likely to have complications.

Optimise Health Preoperatively

If you are having non emergency spinal surgery, then optimising your health preoperatively may help t reduce your risk of having a complication.

Good diabetic control, loosing some weight so the you are not obese, and optimising your blood pressure control are all measures that may reduce your risk of having a complication.

If you smoke, you ideally need to stop before your operation and remain non a non smoker post operatively. Some procedures ma not be advised if you continue to smoke.

Preoperative Assessment

All patients having surgery will require a preoperative assessment, which is undertaken by the a specialist pre assessment nurse.

During  the patients medical conditions are reviewed, and appropriate investigations requested.

Patients medications are reviewed and a clear plan should be made as to which medications need to be stopped prior to surgery, especially with respect to any blood thinning medication.

If a patient has significant medical problems then they may need to be seen by a anaesthetist prior to the day of surgery, to see if they are suitable to have the surgery and also to optimise their medical conditions.