1. Know the Whys of Spinal Surgery
Spinal surgery, whether of the cervical, thoracic or lumbar spinal regions, is typically performed to relieve pressure that is being exerted on the spinal cord or its nerves. This pressure can be from a sudden bulging or ruptured disc, bone spur formation, bone fragments from trauma or from a chronic degenerative process. There are various procedures that make up spinal surgery, and the procedure should fit the pathology. Spinal surgery is typically performed to remove offending agents that are pressing upon different spinal nerves, which govern the functions of many organ systems and extremities.
2. Risks from Positioning
Most spinal surgical procedures are performed with the patient lying in the prone, or face-down, position. In this position, there is a risk of pressure to the eyes as well as pressure to nerves located near bony prominences, such as the ulnar nerve, the nerve that governs function and sensation of the ring and little fingers, at the elbow.
In the face-down position, care must be taken to avoid excessive turning of the neck to avoid disruption of circulation to the brain, which can cause a stroke. Other risks in this position include respiratory depression, pressure sores and skin breakdown, and nerve/artery injury from hyperextension of the shoulders, known as brachial plexus injuries.
3. Risks from Bleeding in the Spinal Canal
No surgical procedure is risk-free from bleeding, although every attempt is made to avoid or minimize blood loss. In spinal surgery, the greatest risk of bleeding occurs at the spinal sac, or dural membrane level, where there are large vessels just external to this sac, called epidural vessels. These vessels, mainly venous, can bleed profusely when damaged, and can be difficult to bring under control at times.
There is also a risk of bleeding from the tissue of the paraspinous muscles that run adjacent to, and connect to the vertebral structures. This tissue can become damaged, and is occasionally stripped away during surgery.
4. Not all Risks are Medical
One of the risks of spinal surgery, as with any procedure, is the risk that the procedure will fail to improve the symptoms or the complaint. Surgery is not an exact science, as we all know, but it is highly successful for the vast majority of those who receive it. Occasionally, however, there is a patient for whom the procedure brings no meaningful relief, or worse yet, causes worsening of the symptoms. While this is a rarity, it is entirely possible, so be sure the procedure is performed by the best person for the job, and that clear and realistic goals are established.
5. The Risk of Functional Loss
Functional loss from spinal surgery is a rare, but real risk. Depending upon the pathology and problems the patient is encountering before surgery, functional loss can range from mild, transient partial loss of sensation or movement, to a serious loss of basic bodily functions. An example of this would include partial to complete loss of voice from injury or damage to the nerve responsible for the function of the vocal cords during cervical neck surgery from the anterior, or frontal, approach.
