Complications

Complications: Image

With any form of surgery there may be complications. Serious complications are rare, but Mr. Lau will always discuss these potential problems with you prior to you deciding if you wish to proceed with surgery.

Pre-op assessment

Every surgical candidate undergoes pre-assessment and it is important that you accurately answer questions related to your medical history, allergies, medication regimen, and lifestyle choices, as these can help us understand your potential surgical risks. Factors that can affect your risk for a surgical complication include:

Overall health
Age
Allergies
Previous operations and complications
Coexisting medical conditions (e.g. Diabetes)
Smoking status
Osteoporosis

Infection

The risk of infection following spinal surgery is small in most patients. An infection may be superficial (in the skin incision only), or it can spread deeper to the areas around the spinal cord and vertebrae.

Common signs of infection include:

A redness, heat, and swelling
Increased pain
Fever, sweating and rigors (uncontrollable shivering)
A discharge from the wound
A foul-smelling odour at the wound site

A superficial infection may require some dressings, removal of a stitch and a short course of treatment with antibiotics. Deeper infections are much less common and occasionally necessitate a further operation to wash out the infected operation site. Infection of an operated disc space or of bone may require a course of intravenous antibiotics, and then several weeks or months of oral antibiotics until the infection is controlled.

Bleeding

Significant blood loss after spinal surgery is very rare. When deemed high risk, a cell salvage machine may be used. On occasion, continued post operative bleeding that is not evacuated by a drain may compress the spinal nerves and require a small operation to remove the blood collection.

Complications: FAQ

Paralysis and nerve damage

This is always the complication most feared by patients, and although the risk does exist, it is extremely rare. The risk varies with the complexity and level of spinal surgery. In the lumbar spine, the risk of paralysis is less than one in a thousand. Nerve damage may also cause numbness, weakness or affect the control of bowel and bladder function.

Dural tear

A dural tear occurs when the thin protective covering over the spinal cord and spinal nerves is breached during the operation. This is usually detected during surgery and repaired immediately. Most dural tears heal without incident but may require the patient to lay flat in bed to facility healing of the tear. If the tear does not heal, then spinal fluid can leak out and cause a spinal headache.

If you experience a persistent headache after spinal surgery, then seek urgent medical advice.

Re-operation

Further surgery may be required if there is a post-operative complication. This could be due to a blood collection compressing the spinal cord, a persistent fluid leak from a dural tear, repositioning instrumentation or if fusion has not been achieved.

Complications: FAQ

Blood clots

After surgery, the body’s clotting mechanism is heightened because it is trying to stop the bleeding caused by the operation.

Clots can form in the large veins in the calf, and they may continue to grow and extend up into the veins in the thigh (deep vein thrombosis). If part of the clot breaks free, it can travel through the veins to the lung and cut off blood supply to the part of the lung that is blocked (pulmonary embolism). It is a potentially life-threatening condition and will require urgent medical attention.

Warning signs of a possible clod clot include:

Swelling in the calf, ankle, and foot
Pain and redness in the leg
Pain in the calf

Warning signs of a pulmonary embolism include:

Sudden onset of chest pain
Shortness of breath
Cough

Blindness

Because patients are laying on their front for spinal surgery, increased pressure can be placed on the eyes. Blindness is a known but very rare complication. The length of surgery, patient positioning and pre-existing eye problems are all important contributory factors.

General risks of surgery

All patients undergoing spinal surgery are at risk of medical complications. The risk is dependent on the patient's health and past medical history. The relative risks should be discussed by Mr. Lau, the anaesthetist and pre-assessment team prior to deciding to proceed with surgery. Risks include heart attacks, strokes, spinal strokes and even death.

Complications: FAQ