Surgery of the spine encompasses a range of specific procedures on the bony spine, spinal disc, spinal cord or spinal nerves where each is designed to correct a certain pathology or condition. All spinal surgeries are complex and extremely delicate, and each procedure has its own associated risks and possible complications. Identifying those patients at high risk helps to ensure the success of the spinal surgery.
Purpose of Surgery
The purpose of spinal surgery is to correct a pathology or dysfunction which could not be treated by another, more conservative method. Spine surgery usually has three main objectives. The goal is to decompress a nerve root or the spinal cord; to reduce or correct a deformity or pathology; or to stabilize a bony or painful element with spinal fusion. By far, the most common reason for a patient to consider having spinal surgery is to alleviate pain.
Specific Procedures
According to the 2008 edition of "Wheeless' Textbook of Orthopedics," spine surgery covers a range of named procedures. A laminectomy involves removal of the lamina over the spinal cord to relieve pressure in conditions, such as spinal stenosis, spondylolisthesis, and the consequences of spinal cord trauma. A foramenotomy requires bone removal to relieve pressure on spinal nerves. Spinal fusion seeks to immobilize adjacent vertebrae that are unstable due to spondylolisthesis, or a result of nearby bone removal. Fusion also requires metal hardware, such as plates and screws. Discectomy is a common procedure for degenerative disc disease and alleviating the pain from disc herniation. Spinal disc replacement also is common and is used to treat certain forms of back pain.
Contraindications
A contraindication can be absolute or relative, and each depends largely on the type of spine surgery required. The June 2009 edition of the "Journal of Neurosurgery: Spine" states, for example, that if spinal fusion is required, then cancer, osteoporosis or infection of the bones being fused is absolutely contraindicated. Spine surgery usually is relatively contraindicated if there is a systemic infection, pregnancy, or if the soft tissues near the spine are infected.
Risk Factors
Not all patients are good candidates for surgery. Some are at higher risk for developing complications and undesirable outcomes. According to "Complications of Pediatric and Adult Spinal Surgery, 2004," most risk factors involve the patient's general health and ability to heal. Such considerations include whether there is a preexisting a chronic disease, such as diabetes, chronic obstructive pulmonary disease and emphysema. Preexisting cardiopulmonary impairments, such as mitral valve insufficiency, also are important risk factors. Other risk factors include systemic infection and osteoporosis, especially in the elderly. Age is also an important consideration since older patients do not heal as well or as quickly as younger patients. A history of smoking, alcohol or drug abuse, or mental illness increases the risks of surgery. Also, diminished ambulatory abilities can increase certain risks, such as lung infection and protracted pain.
Possible Complications
According to "Complications of Pediatric and Adult Spinal Surgery, 2004," spine surgery can have several potential complications. One is laryngeal nerve damage as a result of prolonged retraction during cervical spine surgery. This causes difficulty swallowing and hoarseness. Spinal cord damage resulting in sensory and motor loss also is also a serious complication. Deep vein thrombosis, phlebitis and ileus are relatively serious complications but are usually easily treated. Leakage of spinal fluid can occur if the membranes covering the spinal cord are pierced. These membranes also can become inflamed, producing fibrosis and painful adhesions. Pulmonary complications are not uncommon after surgery and can include lung infections, airway obstruction and diminished gas exchange.
References
- "Wheeless' Textbook of Orthopaedics"; C. Wheeless, et al; 2008
- "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
