26 Mar What are the 21st century risks of spine surgery?
The thought of any kind of surgery sends a chill down all our spines. For doctors like us, the process of convincing the patient about the positives of spinal surgery is as taxing as the surgery itself. Confidence only comes from experience. When prospective patients interact with others who have undergone spine surgery, they realize the benefits.
Paralysis after spine surgery is always a looming fear. What people don’t realize is that is very rare and often overrated by well wishers who slip it into conversation under the pretext of advice for the suffering patient. Chances of Paralysis after spine surgery (without any paralysis documented prior to surgery by doctors) are less 1% mostly and less than 3% in case of neck surgery.
The lack of this awareness blinds the patient to the more ‘real’ but correctable problems that might arise out of spine surgery as well as the issues that could get more complicated later if surgery is not performed.
Delayed Wound healing/Infection- As surgeons, we are always concerned and well aware of the complications that could arrive out of the surgery. Even though 3-8% patients do suffer from this, it is correctable. One of the most common causes of delayed wound healing are superficial infections caused by allergies due to the suture material used. However, the slightest doubt of a deep infection(especially where hardware like screws and rods are involved) and we, spine surgeons, take a decision to wash the wound thoroughly, inside the Operation theater and treat with specific antibiotics. Like they say, “a stitch in time saves nine”. On the fly actions like this help avoid critical deep rooted infections, especially with metal hardware implanted in the index surgery. Once again, all this is correctable, so no need to panic! We try to control the risk factors by taking various steps like controlling sugars, administering adequate antibiotics before starting surgery, reducing the time of surgery as far as possible etc. But its a known side effect of surgery. We try our best to prevent it as far as possible. In the likely scenario, we all are very aggressive in managing and containing it so that it doesn’t affect the outcome of our surgery. All surgeons and hospitals take supreme care to prevent infection after any surgery.
Revision of the screws- More spine surgeries are nowadays done with metal screws and rods which are approved internationally and skilfully done by most spine surgeons . These implants would rarely need a revision as they are too close in placement to a nerve or in a very rare instance, breakage or loosening of the rod from screws.
CSF leak(water cushion around nerves punctured)- The nerves in the spine are carried in a case of water..akin to noodles(nerves) in a water balloon. Some times, in up to 3% cases, the balloon gets punctured during surgery and the water (called CSF) starts flowing. (It’s not a matter of concern. The body produces it daily) This too is successfully managed by stitching the balloon where it has been punctured. If required we “seal” it with foams and patches additionally.( just like repairing a deflated tyre tube). The doctor might make you take full bed rest for a day or two after which the regular activities can start again. Managed correctly, it doesn’t affect the outcome of your surgery in most cases.
Blood clot forming in the wound and pressing on the nerves (wound hematoma)-
This side effect is a rather uncommon one where the clotted blood isn’t absorbed by the body and stagnates at the area of surgery- giving rise to pain. The easiest symptom of this is if you felt better right after surgery but started feeling severe pain after a few days (<7 days) after the surgery. The closest rival of doubt is infection as we discussed earlier. This too needs a 20 minute procedure of washing off the clot by reopening the wound in operation theater itself.
Recurrence of the same pain- this happens especially in the lumbar slipped disc surgery. One in ten patients might have this unfortunate event called the recurrent slipped disc. No satisfactory cause has been blamed for such an event although seen more in diabetics. Even the treatment of this isn’t always a surgery. It can be treated without surgery( tablets and injections) successfully.
These as we say are the probable side effects of spine surgery. Side effects and not complications because almost all the above can be reversed without affecting the surgical final result.
The bottom line is that paralysis after spine surgery should be the least of one’s concerns. The most common operations in spine do not cause paralysis. Patients do although have the right to give an informed consent for the surgery. All these are mentioned in the consent that you sign in your doctor’s presence. In some situations the doctor himself quotes a high risk for paralysis after the surgery. Those would be in severely deformed spines, tumor surgeries, fracture spines and in sudden severe compression on the spinal cord( progressivecaudaequina syndrome) The realistic risk of paralysis after spine surgery is low. The other things mentioned are best discussed on a case to case basis. Doctors generally give a 70 % chance of success after spine surgery. It is a surgery that improves quality of life and needs a motivated patient to take on the responsibility of maintaining himself after the surgery. Surgery is a medium to get back to life…maintain it to have long lasting results. That ‘maintenance’ happens by proper rehab after surgery.
Few other, rare but serious risks are of your patient requiring prolonged ICU(intensive care unit) stay, heart attack or even death due to same are associated with any surgery anywhere in the body.
Unexpected events- Blindness after surgery, clots in legs passing over to lungs or catastrophic blood loss from major blood vessels- again very rare but reported.