Complications are unfortunately a reality of surgery for a small subset of patients. Operations involving the spine are certainly no exception and the complications involved include the following:
Infection: The risk of developing an infection is between 1-2%. In the majority of cases, the infection is superficial and settles with a short course of antibiotics. In a small subset of patients, the infection can track in the deeper tissues and necessitate a longer course of antibiotics and occasionally further surgery on the spine.
Bleeding: The amount of blood loss is usually minimal with discectomy, spinal decompression, anterior cervical decompression/ disc replacement and quite small in spinal fusion, although there is a small risk of developing a haematoma (blood collection) which could cause pressure on the thecal sac and necessitate an evacuation.
Wound healing problems: Wound healing problems can be due to local wound factors such as: stitch abscess, maceration, necrosis and pressure leading to disruption of local blood supply. Systemic factors leading to delayed wound healing include: Diabetes, obesity, smoking, alcoholism and poor nutrition. In the majority of cases the wound will eventually heal but may take longer than expected to do so.
Nerve / cord injury: This can lead to loss of nerve function, with persisting limb pain, weakness, and numbness. It is possible that a nerve injury could affect your bladder and bowel function. Nerve injuries are rare occuring in less than 1% of patients and usually temporary, but may be permanent. Paralysis can happen in less than 0.03%.
Dural tear: Occasionally the lining to the nerve (the dura) can be damaged causing the leakage of the fluid that surrounds the nerves (the cerebro-spinal fluid). Some tears are managed conservatively, whilst others require surgical repair. Patients who have had a dural tear may be asked to stay in bed for a short period of time following their operation. Occasionally a persistent leakage of spinal fluid occurs which may require further surgery.
Recurrent disc prolapse ( in discectomy): A further disc material may prolapse through the same area of the disc as previous disc prolapse. This can occur at any time, but is most common in the first three months following surgery. A recurrent disc prolapse is treated in the same way as the original disc prolapse, and may require a repeat (revision) discectomy. The risk of a recurrent disc prolapse that requires further surgery is 5%.
Scar tissue: Scar tissue can form around the nerve and can mimic the symptoms of a disc prolapse. We will usually try to address this with injections rather than further surgery.
Failure to alleviate the pain: This can occur in less than 5% of patients and in less than 1% symptoms may get worse.
Further surgery on the spine: The degenerate disc may become a source of back pain in the future and spinal fusion may have to be considered.
DVT (deep vein thrombosis): The risk of developing a DVT in spinal surgery is low. We take specific measures to minimise this risk by applying thrombo-embolic deterrent stockings (TEDS Stockings) and mechanical pumps. Early mobilisation is encouraged as it decreases the risk of DVT.
General anaesthetic risks: These can be problems due to reactions to drugs, complications arising from general medical problems or issues related to the anaesthesia. Be sure to discuss these complications with your anaesthetist.
In addition, there are specific complications which could occur in patients undergoing lumbar fusion and these include:
Metal work failure, non-union, screw malpositioning, implant migration which may necessitate a revision procedure and a risk of developing adjacent disc disease which may require extension of the fusion.
With regards to anterior cervical decompression and fusion or disc replacement, there are additional specific complications to the above which include:
Injury to the recurrent laryngeal nerve resulting in hoarseness, damage to the esophagus or trachea resulting in infection and Horner's syndrome (a triad of decreased pupil size, drooping eyelid and decreased sweating on the affected side of the face).