Surgery of the spine is performed for a wide variety of reasons, such as correcting bony alignments, tumor removal, disc resection and spinal cord decompression. All surgical procedures have risks involved with surgery in general, such as infection. However, surgery on the spine is associated with very specific complications due to the complex anatomy of this region.
Neurologic Injury
There is a risk of neurologic injury depending on the area of the spine being operated upon. This usually results from inadvertent damage to the spinal cord. Since the spinal cord mediates all sensory and motor functions between the brain and the body, potential damage can range from a minor deficit to a total loss of sensation or movement. Sometimes the functions recover spontaneously, either completely or incompletely.
Dysphagia and Dysphonia
Difficulty swallowing and hoarseness are complications of cervical spine surgery. There is a risk of damage to the laryngeal nerves when the operation is near the esophagus, or if there is postoperative swelling in that area. This can also result in loss of voice due to vocal cord paralysis. These may recover spontaneously, either completely or incompletely.
DVT and Phlebitis
Phlebitis, or thrombophlebitis, is an inflammation of blood vessels, and usually results in blood clots near the skin surface. It can be treated with anticlotting drugs. Deep vein thrombosis is similar but occurs deeper in the tissues, and usually occurs as a result of direct damage to blood vessels. This also leads to clot formations, which can dislodge and travel to the lungs or brain. Anticlotting drugs can treat the condition.
Ileus
Ileus is characterized by diminished gastrointestinal motility, or movement. This complication is most often associated with lumbar spine surgery, and there can be many reasons for its cause. It is generally associated with anesthetic use, and treatment depends on the symptoms.
Leakage or Hemorrhage
Spinal fluid leakage is a complication resulting from penetrating the dura mater which covers the spinal cord. This can happen with a sharp instrument of from a bone fragment, particularly when bone screws are used or during a laminectomy requiring bone removal next to the dura mater. Repair often requires another surgery. Hemorrhage also is caused by many factors. These include inadequate control of bleeding or relaxation of previously spastic vessels. The degree of hemorrhage dictates the treatment, which can range from drug administration to another surgery.
Pulmonary Complications
Abnormal breathing, lung infections such as pneumonia, airway obstruction and atelectasis, or diminished pulmonary gas exchange represents a wide array of discrete pulmonary complications. Most are associated with inadequate respiratory effort after surgery, usually due to pain, or to swelling near the airways. People at risk usually have a history of smoking, immobility or chronic respiratory disease. Treatments such as using medicines and artificial ventilation are used according to the particular complication.
Meningeal Complications
The meninges are the covering layers of the spinal cord. After spinal surgery, these coverings can become irritated and inflamed. One result is epidural fibrosis which is scarring after surgery, where the scar adheres to nerves. It often is associated with pain and can occur months after surgery. It may require additional surgery to correct. Arachnoiditis is inflammation of the membranes close to the spinal cord. Most of the time no pain is felt but sometimes severe cases result burning pain, sensory loss or urinary dysfunction. Treatment options depend on the severity and location of the condition.
References
- "Journal of Neurosurgery: Spine"; Complications in spinal surgery: comparative survey of spine surgeons; J. Ratliff, et. al.; June 2009
- "Complications of Pediatric and Adult Spinal Surgery"; A. Vaccaro, et. al.; 2004
