Spinal stenosis is a condition in which the spine narrows and can cause spinal cord impingement resulting in symptoms such as pain and motor/sensory difficulties. Surgery is often the treatment of choice to relieve symptoms and like all interventions, carries its own risks that must be weighed by the patient before undergoing therapy.
Damage to the Nerves
The surgeon can directly damage the nerve during the procedure via direct trauma. This can result in altered sensations and motor disruptions such as weakness. The upper and lower limbs can be involved in varying degrees depending on the anatomic location of the surgery. Usually the surgeon will check the patient via a neurologic exam right after surgery and during the recovery process.
Damage to Blood Vessels
In a similar fashion to nerve injury, the surgeon can traumatically injure blood vessels during surgery as well. Many of these arteries are important sources of blood to the spinal cord and can result in nerve injury as well as normal side effects of blood loss such as low blood pressure and decreased blood flow to other organs. The neurologic exam should be done if damage to the blood vessels is suspected during surgery, especially major ones such as the vertebral artery.
Infection
This risk is common to all surgical procedures but is especially dangerous in the case of spinal surgery due to the pathogens potentially gaining access to the spinal cord. Damage done by infection is often irreversible and thus infection control is taken very seriously by the surgeon. Prophylactic antibiotics can be given in patients at higher risk of infection such as diabetics or those who have compromised immune function (AIDS patients, patients on immunosuppressant therapy).
Cerebrospinal Fluid Leak
This is an easily treatable complication of spinal surgery. Defects in surgical closure often result in the leak of the fluid in the spinal canal and the patient's own muscle or fat and even synthetic substances can be used to "patch" up the defect. Keeping the patient overnight for observation is usually enough for the complication to resolve.
References
- "Campbell's Operative Orthopaedics," 11th Edition, Canale & Beaty, 2007
- Orthopedic Clinics of North America. "Minimally Invasive Operative Management for Lumbar Spinal Stenosis: Overview of Early and Long-Term Outcomes." Asgarzadie F, Khoo L. Volume 38, Issue 3 (July 2007)
