2. Surgical Complications

Surgical complications can occur during the procedure (intraoperative) or after it (postoperative). These are detailed below.

Intraoperative Complications

• Dural Tear and Spinal Fluid Leak (1% risk): The dura is a protective layer surrounding the spinal cord and nerves. A tear in this layer may occur during surgery. Small tears are often covered with a muscle patch and heal naturally, while larger tears (>5 mm) may require sutures or sealants like fibrin glue or Duragen patches. If unnoticed, a tear can lead to spinal fluid leakage, causing headaches or increasing the risk of spinal meningitis.
• Nerve or Spinal Cord Injury (1 in 5,000 risk): Surgery near the spine poses a small risk of damaging the spinal cord or nerves due to instruments, swelling, or scar tissue formation. Such damage may result in paralysis, pain, numbness, weakness, or, if pelvic nerves are affected, sexual dysfunction.
• Excessive Bleeding: Abnormal bleeding during surgery is uncommon but possible.
• Injury to Nearby Structures: Damage to adjacent tissues or organs is rare but can occur.

Postoperative Complications

• Wound Infection (1-2% risk): Any surgical procedure carries a risk of infection. Superficial infections affecting the skin may be treated with antibiotics or stitch removal. Deeper infections involving the vertebrae or spinal cord are more serious and may require additional surgeries to drain the infection or remove implants like screws or plates.
• Persistent Symptoms: After surgery, you may temporarily experience numbness, weakness, or burning sensations similar to preoperative symptoms. These usually resolve as the nerves heal, but recovery times vary.
• Blood Clots (Deep Vein Thrombosis – DVT): Blood clots in the legs are a potential risk after surgery, which can be serious if they travel to the lungs.
• Disc Re-Herniation (2-5% risk): In some cases, the disc may herniate again due to a weakened annulus (the disc’s outer layer). This is most common within the first 2-3 months but can occur later if proper posture and exercise guidelines are not followed. Treatment may involve repeat discectomy or fusion of the affected disc.
• Implant and Fusion Issues:
  • Cage or Bone Graft Migration: In procedures involving a fusion cage or bone graft to replace a disc, the implant may shift before it fully integrates with the bone. If it moves significantly, it may fail to stabilize the spine or could damage nearby structures, requiring a second surgery.
  • Nonunion (Failed Fusion): In some cases, the bones fail to fuse properly, leading to a condition called nonunion. This can cause pain and instability, potentially stressing or breaking metal implants. Additional surgery may be needed to add bone graft, replace hardware, or use an electrical stimulator to promote fusion.
  • Hardware Issues: Metal screws, rods, or plates used to stabilize the spine may loosen or fracture before the fusion fully heals. This may necessitate surgery to remove or replace the hardware.

3. Medical Complications

Beyond surgical and anesthesia risks, spine surgery can lead to general medical complications, such as:

• Heart attack
• Stroke
• Pneumonia
• Urinary tract infections

These risks are influenced by the patient’s overall health and medical history.

Key Points to Understand

• Risks Vary by Individual: Your specific risks depend on factors like your health, the complexity of the surgery, and your body’s response to treatment.
• Most Complications Are Manageable: Many complications, such as small dural tears or superficial infections, can be effectively treated with minimal long-term impact.
• Rare but Serious Risks Exist: While severe outcomes like paralysis or death are extremely uncommon, they are possible and should be discussed with your surgeon.
• Postoperative Care Matters: Following your surgeon’s guidelines on posture, activity, and rehabilitation can reduce risks like disc re-herniation or implant issues.

For a personalized assessment of risks and benefits, consult your spine surgeon. They can provide detailed information tailored to your condition and procedure.