Risks and Complications of spinal surgery
Spinal surgery is intricate and delicate surgery, with poteintial risks and complications.
This includes but is not limited to:
Anaesthetic/Positioning related complications
Nervous tissue injury
Whilst the risk is extremely low, there are meticulous steps undertaken to mitigate the risks. These include:
- “Circuit testing” of the spinal cord and nerves during the operation- neurophysiological monitoring
- Scroupulous attention to optimising cardivascular status including blood pressure
- Meticulous postioning
- Intraoperatrive illumination and magnification.
A durotomy is defined as a surgical opening of fluid sac around the spinal nerves.This can be deliberate ( i.e. in the case of pathology within the dural sac or incidental. The rate of incidental durotomy in the literature ranges for 1%-13% surgeries, with the rates being higher in revision surgeries. There is no evidence in the literature that a incidental durotomy results in an inferior long-term clinical outcome.
These can be early or late, superficial (adjacent to skin) or deep. The rate of wound infection following surgery of the spine is reported to be between 0.7-3% in the literature. Steps undertaken to reduce infection include: antibiotic theraphy during and after the operation and meticulous attention to medical conditions.
Non Unioun (Pseudoarthrosis)
Non union is defiend as a failure of bone forming between contagious vertebrae. There is a wide variance in the rates of non-union reported in the scientific literature, ranging from 10-85% across various scientific studies. Whilst all care is taken to optimise the surgical milieu, it is imperative that you maintain a balance nutritious diet, undergo activity within the recommended boundries and do not smoke ( smoking increases the non-union rates by a factor of 4 )
The main reasons for implant failure/revision include: biological reasons(i.e. osteoporosis) and adjacent segment pathology