Complications of Spine Surgery (2022)

A Patient's Guide to Complications of Spine Surgery

Introduction

With any surgery, there is the risk of complications. When surgery is donenear the spine and spinal cord, these complications (if they occur) can be veryserious. Complications could involve subsequent pain and impairment and theneed for additional surgery. You should discuss the complications associatedwith surgery with your doctor before surgery. The list of complications providedhere is not intended to be a complete list of complications and is not a substitutefor discussing the risks of surgery with your doctor. Only your doctor can evaluateyour condition and inform you of the risks of any medical treatment he or shemay recommend.

Anesthesia Complications

The vast majority of surgical procedures require that some type of anesthesiabe done before the surgery. This is so that you will not feel, or be aware ofthe procedure. The simplest form of anesthesia is local anesthesia. Local anesthesiais done by injecting a medication (usually Novocain) around the area of thesurgical procedure that "numbs" the skin and surrounding tissue. The most complexform of anesthesia is general anesthesia. General anesthesia is where you gocompletely to sleep during the surgical procedure. Medications are given byintravenous lines (IVs) to put you to sleep. Special machines breathe for you,monitor your vital signs, and alert the anesthesiologist to any problems whileyou are asleep. You are kept asleep during the operation by a combination ofmedications given through the IV line and "anesthetic gases" that you inhalethrough special machines controlling your breathing. Most spinal operationsrequire general anesthesia. A very small number of patients may have problemswith general anesthesia. These can be problems due to reactions to the drugsused, problems arising from your other medical problems, and problems due tothe anesthesia. Be sure to discuss these complications with your anesthesiologist.

Thrombophlebitis

When blood clots form inside the veins of the legs, it is referred to as DeepVenous Thrombosis (DVT). This is a common problem following many types of surgicalprocedures. It is true that these blood clots can also form in certain individualswho have not undergone any recent surgery. These blood clots form in the largeveins of the calf and may continue to grow and extend up into the veins of thethigh, and in some cases into the veins of the pelvis.

The risk of developing DVT is much higher following surgery involving the pelvis,and surgery involving the lower extremities. There are many reasons that therisk of DVT is higher after surgery. First, the body is trying to stop the bleedingassociated with surgery, and the body's clotting mechanism is very hyperactiveduring this period. In addition, injury to blood vessels around the surgicalsite, from normal tugging and pulling during surgery, can set off the clottingprocess. Finally, blood that does not move well sits in the veins and becomesstagnant. Blood that sits too long in one spot usually begins to clot.

Why do we worry about blood clots? Blood clots that fill the deep veins ofthe legs stop the normal flow of venous blood from the legs back to the heart.This causes swelling and pain in the affected leg. If the blood clot insidethe vein does not dissolve, the swelling may become chronic and can cause discomfortand swelling permanently. While this may seem bad enough, the real danger thata blood clot poses is much more serious. If a portion of the forming blood clotbreaks free inside the veins of the leg, it may travel through the veins tothe lung, where it can lodge itself in the tiny vessels of the lung. This cutsoff the blood supply to the portion of the lung that is blocked. The portionof the lung that is blocked cannot survive and may collapse. This is calleda pulmonary embolism. If a pulmonary embolism is large enough, and the portionof the lung that collapses is large enough - it may cause death. With this inmind, it is easy to see why prevention of DVT is a serious matter.

Reducing the risk of developing DVT is a high priority following any type ofsurgery. Things that can be done to reduce the risk of developing DVT fall intotwo categories:

  • Mechanical - getting the blood moving better
  • Medical - using drugs to slow the clotting process

Mechanical

Blood that is moving is less likely to clot. Getting YOU moving so that yourblood is circulating is perhaps the most effective treatment against developingDVT. While you are in bed, other things can be done to increase the circulationof blood from the legs back to the heart. Simply pumping your feet up and down(like pushing on the gas pedal) contracts the muscles of the calf, squeezesthe veins in the calf, and pushes the blood back to the heart. You cannot dothis too much!

Pulsatile stockings do the same thing. A pump inflates these special stockingsthat wrap around the calf and thigh every few minutes, squeezing the veins inthe calf and thigh pushing the blood back to the heart. Support hose, sometimescalled TED hose, are still commonly used following surgery. These hose workby squeezing the veins of the leg shut. This reduces the amount of stagnantblood that is pooling in the veins of the leg - and reduces the risk of thatblood clotting in the veins. Finally, getting you out of bed walking will resultin muscle contraction of the legs and keep the blood in the veins of the legmoving.

Medical

Drugs, which slow down the body's clotting mechanism, are widely used followingsurgery of the hip and knee to reduce the risk of DVT. These drugs include simpleaspirin in very low risk situations, and heparin shots twice a day in moderatelyrisky situations. In conditions that have a high risk for developing DVT, severalvery potent drugs are available that can slow the clotting mechanism very effectively.Heparin can be given by intravenous injection, a new drug called Lovenox canbe given in shots administered twice a day, and Coumadin can be given by mouth.Coumadin is the drug of choice when the clotting mechanism must be slowed formore than a few days because it can be taken orally.

In most cases of spinal surgery, both mechanical and medical measures are usedsimultaneously. It has become normal practice to: use pulsatile stockings immediatelyafter surgery, have you begin exercises immediately after surgery, get you outof bed as soon as possible, and place you on some type of medication to slowthe blood clotting mechanism.

Lung Problems

The success of your surgery includes taking care of your lungs afterwards.It is important that your lungs are working at their best following surgeryto ensure that you get plenty of oxygen to the tissues of the body that aretrying to heal. Lungs that are not exercised properly after surgery can leadto poor blood oxygen levels and even develop pneumonia (an infection in thelungs).

There are several reasons that your lungs may not work normally after surgery.If you were put to sleep with a general anesthetic for your surgery, the medicationsused for the anesthesia may temporarily cause the lungs not to function as wellas normal. This is one reason that a spinal type anesthetic is recommended wheneverpossible. Lying in bed prevents completely normal function of the lungs andthe medications you take for pain may cause you not to breathe as deeply asyou normally would.

You can think of the lung like a large sponge. All the small air pockets wherethe blood receives oxygen are like the small holes in a sponge. If the smallholes collapse, or squeeze together, no air can get into the holes to supplyoxygen to the blood. When we breathe deeply, the lungs expand and all the individualholes of the sponge fill with air. Coughing does the same thing because we increasethe pressure of the air coming into the holes of the sponge. Lungs that havecollapsed areas not only do not move oxygen into the blood, they cannot removethe fluids and mucous normally produced by the lungs. This can create an areathat is ripe for developing bacteria that can grow and produce a lung infection,or pneumonia.

After surgery, you will need to do several things to keep your lungs workingat their best. Your nurse will encourage you to take frequent deep breaths andcough often. He or she will be there to coach you. Getting out of bed, evenupright in a chair, allows the lungs to work much better. Therefore, as soonas possible, you will be allowed to get into a chair. The respiratory therapisthas several tools to help maintain optimal lung function. The incentive spirometeris a small device that measures how hard you are breathing and gives you a toolto help improve your deep breathing. If you have any other lung disease, suchas asthma, the respiratory therapist may also use medications that are giventhrough breathing treatments to help open the air pockets in the lungs.

Infection

Any time surgery is performed, there is a risk of infection. However, infectionsoccur in less than 1% of spinal surgeries. An infection can be in the skin incisiononly, or it can spread deeper to involve the areas around the spinal cord andthe vertebrae. A wound infection that involves only the skin incision is considereda "superficial" infection. It is less serious and easier to treat than the deeperinfection. Surgeons take every precaution to prevent infections. You will probablybe given antibiotics right before surgery - especially if bone graft, metalscrews, or plates will be used for your surgery. This is to help reduce therisk of infection.

If the surgical wound becomes red, hot, and swollen and does not heal, it maybe infected. Infections will usually cause increasing pain. You may run a feverand have shaking chills. The wound may ooze clear liquid or yellow pus. Thewound drainage may smell bad.

Contact your doctor immediately so the wound can be treated and antibioticmedication can be prescribed if necessary. The superficial wound infection canusually be treated with antibiotics, and perhaps removing the skin stitches.The deeper wound infections can be very serious and will probably require additionaloperations to drain the infection. In the worst cases, any bone graft, metalscrews, and plates that were used may need to be removed.

Hardware Fracture

In many different types of spinal operations, metal screws, plates, and rodsare used as part of the procedure to hold the vertebrae in alignment while thesurgery heals. These metal devices are called "hardware". Once the bone heals,the hardware is usually not doing much of anything. Sometimes before the surgeryis completely healed the hardware can either break - or move from the correctposition. This is called a "hardware fracture". If this occurs it may requirea second operation to either remove the hardware or replace the hardware.

Implant Migration

Implant migration is a term used to describe the fact that the implant hasmoved from where the surgeon placed it initially. This usually occurs fairlysoon after surgery - before the healing process has progressed to the pointwhere the implant is firmly attached by scar tissue or bone growth. If the implantmoves too far, it may not be doing its job of stabilizing the two vertebrae.If it moves in a direction towards the spine or large vessels - it may damagethose structures. If you have a problem with implant migration, your surgeonmay have to perform a second operation to replace the implant that has moved.Your doctor will check the status of the hardware with X-rays taken during yourfollow-up office visits.

Spinal Cord Injury

Any time you operate on the spine, there is some risk of injuring the spinalcord. This can lead to serious injuries to the nerves or the covering of thespinal cord - the dura. The spinal cord is a column of nerves that connectsyour brain with the rest of your body, allowing you to control your movements.The nerve fibers in your spinal cord branch off to form pairs of nerve rootsthat travel through the small openings (foramina) between your vertebrae. Thenerves in each area of the spinal cord connect to specific parts of your body.Damage to the spinal cord can cause paralysis in certain areas and not others,depending on which spinal nerves are affected.

Persistent Pain

Some spinal operations are simply unsuccessful. One of the most common complicationsof spinal surgery is that it does not get rid of all of your pain. In some cases,it may be possible to actually increase your pain. Be aware of this risk beforesurgery and discuss it at length with your surgeon. He or she will be able togive you some idea of the chance that you will not get the relief that you expect.

Some pain after surgery is expected, but if you experience chronic pain wellafter the operation, you should let your doctor know.

Sexual Dysfunction

The spinal cord and spinal nerves carry the nerve signals that allow the restof your body to function, feel sensation - and even have sex. Damage to thespinal cord and the nerves around the spinal cord can cause many problems. Ifa nerve is damaged that connects to the pelvic region, it could cause sexualdysfunction.

Transitional Syndrome

One of the interesting things about how the spine works is that it behaveslike a chain of repeating segments. When the entire spine is healthy, each segmentworks together to share the load throughout the spinal column. Each segmentworks with its neighboring segment to share the stresses imposed by movementsand forces acting on the spine. However, when one or two segments are not workingproperly, the neighboring segments have to take on more of the load. It is thesegment closest to the non-working segment that gets most of the extra stress.This means that if one or more levels are fused anywhere in the spine, the spinalsegment next to where the surgery was performed begins to take on more stress.Over time, this can lead to increased wear and tear to this segment, eventuallycausing pain from the damaged segment. This is called a transitional syndromebecause it occurs where the transition from a normal area of the spine to theabnormal area that has been fused.

Pseudoarthrosis

The term "pseudo" means false and "arthrosis" refers to joint. The term "pseudoarthrosis"then means false joint. A surgeon uses this term to describe either a fracturedbone that has not healed or an attempted fusion that has not been successful.A pseudoarthrosis usually means that there is motion between the two bones thatshould be healed, or fused, together. When the vertebrae involved in a surgicalfusion do not heal and fuse together, there is usually continued pain. The painmay actually increase over time. The spinal motion can also stress the metalhardware used to hold the fusion. The screws and rods may break, leading toan increase in pain. A pseudoarthrosis may require more surgery to try to getthe bones to heal. Your surgeon may add more bone graft, replace the metal hardware,or add an electrical stimulator to try to get the fusion to heal.

Copyright © 2003 DePuy Acromed.

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