Overview of Spine Surgery Complications
The good news is that spine surgery has become much safer in the last decade due to a multitude of systems and technological surgical advances.
In regard to systems improvements, the Joint Commission on the Accreditation of Healthcare Organizations mandated that hospitals comply with the JCAHO Universal Protocol – that is, the surgical site must be marked and a “time out” must be called before the incision is made. A “time out” is essentially a rocket launch “systems check” for the patient about to undergo a surgical procedure. All members of the OR team must review important patient and surgery related information such as patient identification, surgical procedure for which the patient has been consented, allergies, pre-operative medications given, and availability of all necessary imaging studies and surgical equipment. Although we have never experienced a wrong site surgery, wrong patient surgery, or wrong procedure, having such measures in place only further assures that we won’t experience such catastrophic occurrences in the future.
A multitude of technological surgical advances have occurred over the last decade or two, making spine surgery much safer and drastically improving success rates. The following are several examples of such advances. First, we now can utilize a Cat Scan device in the operating room, thereby allowing 3-dimensional imaging to guide us as we realign the spine or place instrumentation in a fusion surgery. Second, Navigation Stealth technology uses an infra-red beam to track our instruments, similar to a GPS system. When utilized with our O-Arm (intra-operative Cat Scan device), seamless integration of our instruments with the patient’s anatomy allow for efficient and safe placement of the instrumentation often through “minimally invasive” incisions. Third, high powered microscopes have improved the safety of the decompression work we perform near delicate structures like nerve roots and/or the spinal cord. Fourth, instrumentation systems have improved making placement easier and safer, fusion rates much higher, and displacement much less likely. Fifth, the advent of recombinant Bone Morphogenic Protein (RhBMP-2) has revolutionized spinal fusion surgery. BMP is a genetically engineered protein that recruits bone making cells to the fusion region, and furthermore, stimulates the patient’s stem cells to become bone making cells. Use of BMP has essentially eliminated the need for harvesting bone graft from the pelvis in a vast majority of patients, thus reducing pain, surgery time, and risk of graft site infection. The risk of non-union (when the fusion does not fully unite or grow together) has been nearly eliminated. Finally, pre-operative diagnostic studies such as MRI and CT have become extremely precise. When used in conjunction with a careful history and physical exam, the accuracy of diagnosis has improved tremendously. These highly accurate studies greatly decrease the risk of an unfavorable surgical outcome as the true pain generator can be addressed while other non-problematic areas can be left untouched.
In addition to systems and technological advances leading to safer surgery, advances in pre-operative assessment and preparation have also led to reduced risk of surgery. Advances in diagnostic studies such as Cat Scans and MRI, as mentioned above, limit risk of surgery by enhancing the surgeon’s to more efficiently address the true area of concern. The ‘let’s look around’ factor, although relatively rare for years, has now been essentially eliminated. Better research is now available regarding true pain generators so that, once again, the surgeon is enabled to more reliably address only the pain generator rather than other non-problematic regions. Pre-operatively, we ask your primary care physician or internist to help identify any potential medical conditions that could complicate your surgical care such as underlying heard disease. Diagnostic studies such as nuclear stress tests, echocardiograpy, and Cat Scan angiography have become much more precise and thus allow your physician to mitigate surgical risk by identifying such medical conditions prior to surgery and treating them accordingly. Multiple advancements in anesthesia care have occurred as well. These include improvements in anesthesia medications that decrease intra-operative and post-operative side effects, improvements in technological equipment to more safely place Intravenous lines and intubation tubes, and improvements in monitoring equipment available during your surgery.
However, similar to eating a meal, getting in your car, walking outside in a thunderstorm, skiing down a mountain, walking across the street, or riding your bike, there does exist an inherent risk with having a surgical procedure. Any patient undergoing spine surgery should be given a basic understanding of the potential risks and complications, and furthermore, be comfortable with the notion that in his or her particular case, the potential benefits of having such surgery outweigh the risks. It should be comforting to know that most complications of spine surgery are quite treatable and do not leave patients with permanent pain or disability. Furthermore, the more devastating complications of spine surgery typically feared by most patients are exceedingly rare. Nevertheless, spine surgery, like any surgical procedure, does indeed carry some risk. We believe that all patients should have an understanding of the specific risks and potential complications. The following is an ‘easy to understand’ description of some of the potential risks and complications that can occur either in surgery or after surgery. The list is not intended to cover every single potential risk and complication – it is important to further discuss the risks of surgery with your doctor prior to surgery.