The occurrence of postoperative complications after spine surgery is unavoidable. The frequency of the postoperative complications varies person to person. According to the “European Spine Journal”, the complications after spine surgery mostly depend on the underlying pathology and the procedure. Some other factors like technical failure, unexpected body response, or anatomical variation can also impact on the negative consequences after the surgery. But, the experts say that the patients of herniated disc not only experience the complications after the surgery, but also before and during the surgery.
Complications before Surgery
The patients of a herniated lumbar disc may experience the complications, even before undergoing the surgery. The most common preoperative complication is caudaequina syndrome (CES). The syndrome occurs when the disc material breaks in large portion and are pushed into the area of the spinal canal where the nerve responsible for the bowel and bladder control pass before it leave the spine. The ruptured disc fragment can put pressure on the nerves, causing damage to them. By chance, if the nerves get damaged, the patient loses the control of bowel and bladder, which is a very serious condition. If your health care provider suspects it, he will recommend for immediate surgery to make the nerves relieved from the pressure.
According to The Spine Journal, Caudaequina syndrome (CES) is a very rare but devastating preoperative consequences of spinal disorder, which can lead to paralysis, permanent loss of bladder and bowel function, and loss of sexual function.
Complication during surgery
The patients may have many complications during the spine surgery. The anesthesia related complication is common in almost any type of surgical procedure. Acute compartmental syndrome (ACS) is an unreported complication during the spine surgery. In extreme cases, it can cause permanent neuromuscular damage. According to a study, published in the Journal of Bone and Joint Surgery, this complication occurs as an effect of kneeling during the surgery, the so-called position 90/90 kneeling frame. The study says that the anterior compartmental pressure happens due to the elevated intramuscular pressures that results from the 90/90 kneeling frame position.
Apart from the ACS, the complications like nerve injury and dural tear during removal of the herniated disc are also common. In a research article published in the journalInjury, it is mentioned that incidental dural tear is the most frequently occurring complication during the spine surgery. It is also reported that about 1-17% surgeons underestimate the complication. It is very important to close the tear dural properly, otherwise it can cause the symptoms, like postural headache, posterior neck pain, vertigo, neck stiffness, tinnitus, nausea, blurred vision, etc.
postoperative complications of surgery
Postoperative complications of the spine surgery are quite expected, which can lead to additional pain, and may require additional surgery. One should always discuss about the postoperative complications with the doctor before undergoing the procedure. Some of the common post-operative complications are:
All the spine surgeries, performed under anesthesia. Anesthesia has a potential risk of producing some complications like an allergic reaction of the medications used, other medical problems, and the problems due to the anesthesia itself. It can cause life-threatening situations for the patients. Even though, it is a very rare condition, you should be aware of such consequences.
The surgeries which need incisions, has a risk of developing infection post-operatively. However, it is a very rare complication, and seen only in 1% of the patients. The infection may occur at the site of incision, bone graft, and around the spine. Basically, the antibiotics are used to treat the infection. But, it does not help, it may require one or more additional surgeries to drain out the infection.
- Damage of the blood vessels:
During the spine surgery, there are chances to cut the nearby blood vessels, and causes the damage, which leads to the weakness and numbness in the related area of the body. Usually, such type of symptoms disappears with time. The complication is seen in less than 1% of the patients.
- Damage of the spinal cord:
During the operation of the spine, there are chances of injuring the spinal cord, which can cause severe injury to the nerves or blood vessels and the outer covering of the spinal cord. Spinal cord is the main pillar, made up of nerves, that connects the brain to the whole body part. The nerve branches from the each part of the spinal cord and travels through the small opening in between the vertebrae, to connect to the different parts of the body. So, damage of the spinal cord may cause paralysis in some specific parts of the body. However, it is a rare complication.
- Graft migration:
Graft displacement or migration is considered as one of the most common problem, particularly after the anterior cervical discectomy and fusion. The bone graft moves out of the position, which usually occurs soon after the surgery, and before the healing process. If the graft moves too far, it requires a second surgery to stabilize it in the position. Migration of the graft towards the direction of the large vessels or spine may harm those structures.
Non-union means no fusion occurs between the vertebrae even after a successful surgery and placing a good bone graft. It is also called as pseudoarthritis. Basically, the surgeon will take an x-ray 3-6 months after the surgery to evaluate if there is any non-union. Usually, a non-union is corrected by a second surgery, if you complaint of pain, and other related symptoms. If you do not have a pain, surgery may not require. In case of the second surgery, most of the surgeons prefer to use screws or plate for the internal fixation.
- Sexual Dysfunction:
As the spinal cord or nerves transmits the nerve signals and the stimulus which helps your body to function and feel the sensation, which happens in the sex also. So, the damage of spinal nerves, particularly if the nerves are connected to the pelvic or genital area, it can lead to sexual dysfunction.
Throbophlebitis, or blood clot formation in the blood vessels is a common complication happens after the surgeries. The blood clots are also formed near the surgical site due to the tugging and pulling during the procedure, which does not move and remain in the vein, making them stagnant. Sometimes, the blood clots are formed on the inside of the veins of the legs, which is called deep vein thrombosis. In this condition, the normal flow of the blood from the legs back to the heart is stopped, which leads to the pain and swelling in the affected limb. So, it is important to treat the blood clot as early as possible to avoid the permanent swelling and discomfort. Your doctor may prescribe you some anti-clotting medication to treat the problem.
The above mentioned list of the complications are not a complete one. So, if you notice any unusual symptoms after any type of spine surgery, whether it is a cervical or lumbar spine surgery, contact your doctor without any delay. Your doctor is the best person to evaluate the condition, and plan the proper treatment.
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Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.