Complications of Surgery
Almost all spinal operations are performed under general anaesthetic, and thus are liable to the same risks as other operations:
ALLERGIES. If patients are truly allergic to a drug it is important that we know so we don't give it or them. Death can occur due to such allergies. Often allergies to Penicillin or Morphine are not true allergies but occasionally are. Previous reactions to anaesthetic drugs are important as is a family history of such reactions.
ABDOMINAL PROBLEMS ileus, the intestines may be slow to start working after an operation especially in older patients having longer operations. Dont order a big plate for your first meal after surgery.
Constipation may be worse with pain-relieving drugs such as Morphine. We usually give patients Lactulose (an indigestible sugar) to help this. Getting out of bed early after surgery also helps. If you normally take medication for your bowels let us know.
Hepatitis and abnormal liver function tests. Many anaesthetic drugs can affect the liver ¡V we test the liver function with a blood test before surgery. If you have had hepatitis please tell us. Paracetamol and alcohol can affect the liver.
BLADDER AND URINARY PROBLEMS. In patients having operations likely to last over two hours, or in older patients, we will often insert a catheter into the bladder to drain the urine. This stops the bladder getting distended (which can damage it) and helps us monitor urine output. There is a small risk of infection and occasional problems inserting or removing the catheter. Sometimes they have to be reinserted
BLEEDING AND CLOTTING. Only rarely do patients having spinal surgery require transfusion (occasionally in multilevel fusions) stopped before surgery. Some homeopathic drugs and garlic pills may make bleeding worse and should be stopped before operation. Patients with heart conditions taking aspirin drugs, eg Cartia should continue to take them but patients taking Warfarin will have to stop it. Drugs given to prevent DVT (deep venous thrombosis clots in the leg veins) e.g., Heparinor Fragmin have an increased risk of bleeding around the spine (epidural haematoma) which can cause nerve or spinal cord injury.
We do accept Jehovahs Witnesses for surgery.
CHEST INFECTIONS such as atelectasis, bronchitis and even pneumonia can occur. Smokers should quit before surgery ¡V see SMOKING.
CONFUSION AND DISORIENTATION can occur especially in the elderly and in patients who drink a lot of alcohol.
DVT AND PULMONARY EMBOLUS. Can cause death. Rare in spinal surgery. We commonly use intermittent calf compression devices and / or TED stockings to reduce this risk. Occasionally we use anti-clotting drugs such as Warfarin or Heparin and its derivatives but these have their own complications see above especially a risk of epidural bleeding, cauda compression and paralysis.
INFECTION. We usually give a prophyllactic antibiotic such as Kefzol or sometimes Gentamicin especially in patients with artificial joints. Patients may develop thrush (Candida infection) because of this. Spinal wound infection is rare in my experience. Patients having repeat surgery, Diabetics and patients on steroids have an increased risk.
SPECIFIC RISKS OF SPINAL SURGERY:
WRONG SIDE OR WRONG LEVEL errors have rarely occurred and have required further surgery. We often take X-rays in the operating room to check levels but even this does not always eliminate the problem.
NERVE INJURY due to direct trauma by scalpel, traction or the insertion of screws. Injury to the lining of the nerve (dura) is usually repairable but may require a longer period of bed rest following surgery. There is an increase risk of meningitis in such cases (I have had three cases of meningitis).
NON-UNION fusion is a biological practice, analogous to healing of a fracture and bones do not always unite.Smokinginterferes with bone healing and should be completely stopped before surgery. Excessive activity may prevent fusion, Non-steroidal anti-inflammatory drugs (NSAIDs) such as Voltaren, Cataflam also slow down bone fusion.
EPIDURAL HAEMATOMA. Bleeding around the spinal nerves or spinal cord. See Bleeding above. This can cause a cauda eqina syndrome see GLOSSARY. This requires urgent re-operation and removal of the clot.
POSITIONING PROBLEMS. Many operations on the spine are performed with patient lying prone (face down) on a special four poster frame which supports the shoulders and pelvis but leaves the chest and abdomen free. This reduces bleeding. We try to keep the spine in the normal anatomical position (as though standing erect) to reduce the risk of FLAT BACK SYNDROME see below. The head also sits in a special padded frame for the brow and chin. The arms and legs rest on pillows. Despite all this occasionally the patient may have some numbness in the front of the thighs or little finger/s afterwards which usually settles.
DEATH. I have had one fatality due to pulmonary embolus.
BLINDNESS. Partial or complete blindness has occurred. I have had one case of partial blindness, probably due to an air bubble getting into a vein.
NERVE DIVISION. Two cases, both having repeat surgery where the nerve was covered with scar.
SUMMARY OF COMPLICATIONS. With over 30 years experience of surgery and a high degree of care and concern I have been able to reduce the incidence of complications to a minimum but complications can and will occur with any operation.