Complications of Spine Surgery

Possible Complications of All Spine Surgery

All surgery has risks, and it is important to understand that the decision to have surgery weighs the risks, benefits, and alternatives to the operation. Dr. Bjerke will not recommend an operation unless he feels that the expected benefits outweigh the potential risks. Your anesthesiologist, medical doctor, or additional specialists (if necessary) may also assess the risks and will not proceed unless you are healthy enough for surgery. You should not proceed with any operation unless you feel that you have a thorough understanding of these risks, benefits, and alternatives. There is no replacement for a face-to-face discussion with your surgeon about the particular risks, benefits, and alternatives of any operation. An overview of some risks and complications of spinal surgery is below.

  • Anesthesia: All spine surgery requires general anesthesia and for you to be intubated. There are risks associated with intubation and the anesthetic medications. Your anesthesia provider will be able to discuss this with you further.

  • Infection: All surgery carries a risk of infection. The individual risk is determined by many factors. The most important factor is the patient's ability to fight infection. Smoking and diabetes both significantly increase risk of infection for all surgeries. It is important to avoid nicotine before and after surgery, and to maintain control of your blood sugar if you are diabetic. Some patients taking medications that decrease the immune system may be at a higher risk of infection. It is important to discuss with your provider what medications to stop taking before and after surgery.

    • Dr. Bjerke takes several additional measures to minimize infection. ​In addition to standard IV antibiotics before and after surgery, he also administers another antibiotic powder after all operations. This has been shown to significantly decrease the rate of infection in academic studies (References: [1], [2], [3], and [4])

  • Nerve Damage: Most spine surgery is close to nerves, and sometimes to the spinal cord. Often, spine surgery is performed near nerves that have already been damaged or are not working properly. Nerve damage from surgery is still relatively rare, but may lead to pain or weakness after the operation.

    • Dr. Bjerke uses special nerve monitoring during procedures with a relatively high risk of nerve damage. ​He also uses techniques to identify nerves by electrical stimulation and avoid them([5] and [6]) Whenever necessary, he uses an operating microscope to use and avoid these nerves.

  • Bleeding: Bleeding is a normal part of every operation. The risk of bleeding depends largely on where the operation is being performed. For this reason, all patients undergoing a spine operation will be asked to sign a consent for blood transfusion. 

    • Dr. Bjerke uses minimally invasive techniques whenever possible, which limits the amount of soft tissue damage[7] and bleeding[8]. He also uses IV medications (tranexamic acid[9]) during all procedures to safely limit blood loss. Using these techniques, the need for a blood transfusion following surgery by Dr. Bjerke is very low.

  • Urinary Tract Infection or Retention: A foley catheter is sometimes used during spine surgery to protect from damage to the bladder and kidneys. Although the catheter is often removed before the end of surgery, this may lead to a UTI or "retention" (inability to urinate) after surgery.

    • Using minimally invasive techniques, most operations by Dr. Bjerke are much quicker than open procedures and do not require a foley catheter. For longer operations, Dr. Bjerke will prescribe medications (Flomax®) to decrease the risk of retention[10]. He will also have the catheter removed as early as possible to minimize the risk of infection[11].

  • Dural tear: The covering over the spinal cord and nerves is in several layers, and the outermost layer is called the "dura mater," or simply "dura." A tear in this covering is known as a "dural tear" or a "durotomy." If this does not heal properly, this may lead to a "spinal fluid leak" or "CSF leak." This may also occur after an epidural steroid injection, spinal or spinal anesthesia, or after injection of "dye" for a CT myelogram or other procedure. Symptoms include nausea, headache, or dizziness that is relieved when lying down. Treatment for a dural tear involves lying flat for a period of bedrest to allow the tear to heal. Sometimes, injection of the patient's blood near the area of the dural tear is used to encourage healing, also known as a "blood patch." In rare cases, surgery may be required to repair the dura.

    • Dr. Bjerke uses an operating microscope to avoid injury to the dura. He is also trained in advanced techniques to repair dural tears if necessary.​

  • Failure of Surgery to Relieve Symptoms: Unfortunately, we can't always perfectly predict how well anyone will do after surgery. It is especially difficult to predict how much damaged nerves will recover, with or without surgery. Any surgeon who promises or guarantees a perfect result isn't being realistic.

    • It's important for any treating surgeon to have a long and ​individualized discussion of expectations after surgery. Dr. Bjerke will always take the time to carefully explain any procedure and what to expect afterwards. He won't offer an operation unless he feels that a patient has a realistic expectation of recovery that outweighs risks of surgery.

Specific Complications by Type of Spine Surgery

Fusion Surgery

  • Failure of Fusion: For any fusion procedure, there is a risk of the vertebrae not fusing, known as "pseudarthrosis" or "nonunion."

    • Dr. Bjerke uses advanced bone grafting techniques when possible and careful preparation of bone.

Anterior Cervical Surgery

  • Esophageal or Tracheal Injury: The esophagus and trachea need to be moved to access the front of the spine in the neck. Moving the esophagus may lead to "dysphagia" or difficulty swallowing. This is rarely permanent.

    • Dr. Bjerke works with the anesthesiologist to reduce the pressure on the esophagus, which has been shown to reduce difficulty swallowing.
  • Vertebral Artery Injury: The arteries that feed the brain run through the cervical spinal column, and are at risk during any neck surgery. With careful dissection, this risk is quite low.
    • Dr. Bjerke has trained extensively in this area, and always uses a surgical microscope to minimize risk of damage to nerves and arteries in this sensitive area.

Posterior Cervical Surgery

  • Infection: In this area of the spine, the risk of infection is higher.

    • Dr. Bjerke uses ​additional antibiotic powder in this area to minimize the risk of infection.

  • C5 Palsy: The C5 nerve root, or the nerve that controls the deltoid and biceps muscles, is at increased risk of injury in both anterior and posterior cervical spine surgery.

    • Dr. Bjerke will make additional ​room for this nerve if needed, and will always monitor nerves with intra-operative monitoring during any neck surgery.

Anterior Lumbar Surgery

  • Infection: In this area of the spine, the risk of infection is higher.

    • Dr. Bjerke uses ​additional antibiotic powder in this area to minimize the risk of infection.

  • Bowel or vascular injury: This operation is through the abdomen and places major vessels and gastrointestinal structures at risk.

    • Dr. Bjerke always works with a general or vascular surgeon to approach the spine in this area to minimize these risks.

Lateral Lumbar Surgery (XLIF®)

  • Nerve Damage: Nerves in the lumbar spine exit from the sides. Sometimes, these nerves need to be pushed aside to allow a "cage" to be placed in the disc space. This damage may result in pain in the front of the legs, or weakness extending the knee. It is usually temoprary. 

    • Dr. Bjerke uses ​an additional and specialized nerve monitoring system for this procedure.