DISCUSSION OF SURGICAL RISKS for SPINE SURGERY:
Risks are potential outcomes that could happen, but we do not expect them to happen.
The idea of risk can be illustrated by using, as an example, an activity that you may do commonly, such as driving to the grocery store. There is risk involved, but you don’t think about it. Although you might expect to get there without incident, you must acknowledge that an unexpected outcome could occur, such as heavy traffic or a flat tire, or possibly even an accident. However, for this example which is a common event in most of our lives, we do it without second thought.
Stated simply, there will be one of three outcomes with surgery. You will wind up either better, same or worse. While the chance of being worse is small, surgical results cannot be guaranteed.
While the list of potential risks and complications is outlined below, it is important to understand that there is a very good chance of your being happy with your surgical result, and as part of prudent medical practice, risks must be outlined. Although there are many conditions listed below, the chance of any of them occurring is quite small. These risks will be outlined on the surgical consent you sign in the office, and my thought is that by listing them here, you can ask about any specific concerns before deciding finally that you would like to proceed with surgery.
POTENTIAL RISKS AND COMPLICATIONS INCLUDE, BUT ARE NOT LIMITED TO:
From a general standpoint:
- pneumonia/aspiration/lung collapse
- blood clots, possibly travelling to the lungs
- heart attack
- adverse drug or anesthesia reaction
- reactions to blood products (if transfused)
- wound healing problems
- incisional pain
- injury to nerves or blood vessels
From a spinal standpoint:
- nerve injuries causing tingling, weakness, or other dysfunction
- fracture of the vertebrae
- injury to dura (covering that keeps spinal fluid and spinal nerves in place)
- spinal fluid leak or fluid collection
- epidural bleeding
- sexual dysfunction (retrograde ejaculation)
- possible need for placement of a temporary spinal fluid drain
- recurrent disc herniation
- injury to adjacent body organ (including for cervical spine cases, hoarseness or voice change, laryngeal nerve palsy, difficulty swallowing)
- continued pain (operation might be unsuccessful)
- failure of the fusion (if one done) to heal
- loss of normal spinal alignment
- implantation at the wrong spinal level
- adjacent level degeneration (next level wears out)
- weakness, stiffness, or decreased range of motion of the extremities
- need for another operation for unforeen cause
- reaction to or loosening of metallic implant (if one implanted)
FOR SPINAL INJECTIONS:
The actual incidence of complications with spinal injections, especially in the lumbar region, is very low. From the standpoint of what might actually happen that is not an optimal outcome, there are really two main risks, and both happen very rarely:
1) That the injection doesn’t really help provide any relief
2) Inadvertent puncture of the dura (the thecal sac, the sac that holds the spinal fluid around the nerves), also referred to as a “wet tap.”
If you do have a wet tap, the main potential side effect is a headache, and the main treatment if that problem were to occur would be to lie completely flat for 24-48 hours (think of a garden hose full of water and what happens if you position the hose vertically…the water runs out). If the headache persists, we will have to arrange for you to have another procedure, usually done by an anesthesiologist or anesthetist, called a “blood patch,” which is very effective at stopping the leak.
Other risks that have been reported in limited case reports (and to date, knock on wood, I have never had any of these occur):
Infection (abscess, meningitis, discitis)
Epidural hematoma (blood collection within the spinal canal)
Other potential side effects:
Blood sugar changes (for diabetics)
Other medical problems could occur in association with your surgery, such as heart, lung, gastrointestinal problems, or stroke. Therefore, if you have any co-existing medical conditions, you will be advised to check with your primary care doctor to have a MEDICAL CLEARANCE prior to your surgery. This clearance is a check up to be sure that you are as healthy as you can be.
Again, the point of this information is not to scare you, but to make you an informed decision maker in your own medical care.
Please feel free to discuss with me what alternative treatments are available to you besides surgery.