Any surgery carries the risk of complications. Spinal surgery is uniquely complex as surgery is done near the spine and spinal cord. Complications may occur and while the chance of complications is usually small, you should understand the risks and discuss any of these complications risks with your surgeon. This list is not meant to be exhaustive or detail complications in full.
Ask your surgeon about any questions you have regarding your surgical procedure.
Most spinal operations require general anesthesia and a very small number of patients may have anesthesia related problems. Problems can arise from drug reactions, other medical conditions you may have, or problems with the anesthesia. Nausea and vomiting can occur from anesthesia and are usually treated with medications. Anesthesia affects how the lungs work. A tube is inserted into the throat to give lungs oxygen; this tube may cause soreness after surgery. In rare cases the tube can harm the vocal cords. Before spinal surgery, you should meet with an anesthesiologist about possible complications.
Any spine surgery has risks of unexpected bleeding. Spinal surgery can involve major vessels and while the doctors are extremely careful to avoid harming blood vessels, a risk exists. Your blood will be typed and screened so that the surgical team knows what type of blood you may require if blood needs to be replaced during the surgery.
In the post-operative time, many surgeries carry an increased risk for developing a blood clot in the large veins of the calf. This is called deep venous thrombosis (DVT). Blood clots may continue to grow and extend up into the veins of the thigh, and in some cases into the pelvic veins. The body attempts to stop any bleeding associated with surgery by increasing the body’s natural clotting cascade. This is why the risk for a DVT is higher following surgery.
DVT prevention is taken very seriously during the operation and in the recovery time. There is a risk that a blood clot could break off from the vessel and travel through the veins to the lung. This is called a pulmonary embolism and can harm the blood supply to the lung and even cause part of the lung to collapse. It is important that after surgery you begin moving your legs and walking as instructed by your surgical team. You will also likely be wearing special stockings around your calves that pulsate to help squeeze your leg muscles allowing blood to move. You may also be placed on a medication while in the hospital to slow down the blood clotting mechanism. It is important you follow all post-operative instructions as these measures reduce this risk.
Your spinal cord and nerves are covered by a thin tissue called the dura matter. A tear in this covering can occur during spine surgery. If the tear is noticed during surgery, it is surgically repaired and commonly heals well. If the tear does not heal, it may leak spinal fluid. This leak can cause a spinal headache. If the tear does not heal quickly on its own, a second operation may be necessary to repair the dural tear.
After any surgery with general anesthesia it is important to exercise your lungs. Lying in bed reduces your lung function and pain medication can also cause you to not breathe deeply. It is important that your lungs are working their best. Lungs that are not working at full function can lead to poor blood oxygen levels and an increased risk for pneumonia.
You will be encouraged to take frequent deep breaths and even cough often. You will be encouraged to get out of bed, sit upright in a chair, and use a special breathing device called an incentive spirometer to improve deep breathing. Follow the instructions from your surgical team to help your lungs after surgery.
There is a risk of infection with any surgery. Our surgeons take infection control very seriously and use best practices to prevent infections. Usually antibiotics are given right before surgery to reduce the risk of infection. An infection can range from a simple skin infection to a deeper, serious infection. Infections may be treated with antibiotics or may warrant an additional operation to drain the infection.
Contact your doctor immediately if you suspect that you have an infection. Here are some signs that you may have an infection.
- A surgical wound that is red, hot, swollen and not healing
- Clear liquid or yellow pus oozing from the wound
- Any wound drainage that smells bad
- An increase in pain
- Fever and/or shaking chills
Spine surgery carries a risk of injuring the spinal cord or nerves. This can lead to nerve damage. This can happen from instruments used during surgery, from post-operative swelling, or from scar formation. The nerves in each area of the spinal cord are responsible for different parts of your body. Damage to the spinal cord or nerves can cause pain, sensation changes, strength changes and even paralysis in certain areas depending on what nerves are affected.
The spinal cord and spinal nerves carry the nerve signals for your body to function. Retrograde ejaculation is a risk to any spine surgery that uses an abdominal approach. With the anterior approach, small nerves travel directly over the disc space and control a sphincter valve that causes semen to be ejaculated outwards. If this nerve is damaged or temporarily stops working semen flows towards the path of least resistance and instead travels up to the bladder. The risk is small and many cases resolve over time. If permanent, this can be a cause for male infertility. Retrograde ejaculation does not change the experience of an orgasm or the ability to have an erection.
A nonunion occurs if a fusion does not heal as planned. Nonunion rates are higher in certain patients. Nonunion is increased in smokers, obese patients, diabetics, multiple level fusion surgery, and patients with a history of radiation exposure. A nonunion may require a second operation to get the bones to heal. If the joint is stable and there are no symptoms from the nonunion, more surgery may not be required. Smoking is a major contributor to the bone’s healing potential. All of our patients are strongly encouraged to quit smoking well before any surgery.
Spinal instrumentation is used in many surgeries to stabilize the spine as the bones heal. This may include metal screws, plates, and rods. Once the bone heals, the instrumentation has served its purpose. Usually, instrumentation is not a problem in patients however; sometimes it can break or move before the surgery is completely healed. This is called an instrumentation fracture and a second operation may be needed to repair this. Occasionally the instrumentation may cause discomfort, especially if it is prominent and irritates surrounding muscles or skin. When this happens with a solid fusion, the instrumentation can be safely removed and provide pain relief.
Implants, or intervertebral cages, are designed to stay in place. It is possible for this cage to move soon after surgery. In the early healing stages, the cage is not firmly attached by bone growth. If the cage moves too far, it may no longer be stabilizing the intended vertebrae. This may require a second surgery to replace the migrated cage. We check the status of your instrumentation with X-rays taken during follow-up office visits. It is important you follow all post-operative restrictions your surgical team gives you.