There are potential risks with any surgical procedure. Complications specific to a fusion surgery, while rare, include failure to fuse, hardware failure, infection, excessive bleeding and adjacent segment degeneration.
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We inform our patients of the specific risks and complications related to their particular surgery. Some generic complications include infection (1-3%), failure of fusion (2-5% per level), instrumentation problems (<1%), failure of pain to improve (% varies), nerve or cord injury (<1%), spinal fluid leak needing repair (<5%), need for future surgery (% varies), need for blood transfusion, and medical problems (heart, blood clots, ulcers, pneumonia, etc).
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Some fusions do not take; need to stop smoking.
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Really the major problem facing clinicians going forward into the future is in patient selection. Finding the patient that will benefit from the fusion surgery. To achieve a fusion now is reliable and predictable with the new improved implants. Complications can be a wound infection, but that is true in any surgery. It's more specifically in selecting the right level and selecting the right patient where your major complications will come from.
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The complications associated with fusion surgery could include bleeding. Most doctors use a vascular surgeon when they perform an anterior surgery so any type of blood vessel issues can be taken care of by the vascular surgeon. Spine surgeons are specially trained to work around the nerves and most of us have very few complications in working with them. As discussed above, the issue of males and retrograde ejaculation could be a very rare problem. Anterior surgeries have a very low rate of infection.
Despite all these potential complications, most patients should expect to go through fusion surgery with a relatively low risk of any long-term or permanent complications.
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The complications of spine surgery are related to the anesthesia and the procedure. The risks of the anesthesia are best discussed with you anesthesiologist. The risks of the fusion depend on the route of the approach. Anterior procedures run the risk of damage to the blood vessels, retrograde ejaculation, damage to the sympathetic nerves to the legs, damage to the motor or sensory nerves to the legs, damage to the internal organs, and failure of the fusion to become solid. Posterior procedures run the risk of damage to the nerves, scarring around the nerves, tearing of the lining around the nerve sack, damage to the muscles of the back and failure of the fusion to occur.
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The specific risks related to the fusion surgery are failure of the fusion to heal which can require a revision of the fusion or use of special braces or electrical bone stimulators to help the fusion heal.
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Like any other surgery, spinal surgery carries the risk of infection, bleeding, need for transfusions, nerve damage, bowel, bladder, and sexual dysfunction as well as medical complications, such as heart attack, stroke, blood clots, or death. There is always the possibility of worsening the pain and requiring additional surgeries. In the hands of a properly trained spinal surgeon, however, these risks can be minimized.
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Complications associated with fusion surgery include infection, bleeding, adjacent level degeneration, and lack of bone fusion.
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The biggest risk is that the fusion may not heal. Anytime you do a fusion there is a chance no matter what you do during that surgery no matter how good of a surgery is performed, that fusion may not heal. Now if it doesn't heal some patients will have no problems what so ever. But there are a sub-group of patients who do have continued pain, and they may need another surgery.
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Like any other surgery, it depends upon the skill of the surgeon, the health of the patient, and the specific situation. In general, the risks are small, and include infection, spinal fluid leakage, nerve injury, bleeding, failure to fuse, implant failure, and bone-graft donor-site pain. Incomplete pain relief and the need for additional surgery are also risks that need to be considered. Smoking is known to increase the complication rate in spinal fusion surgery.
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Truthfully, the risks of spinal surgery are too numerous to record here. However, in general, the risk of catastrophic event such as death, paralysis, loss of bowel or bladder or sexual function, and loss of limb are less than 5%. The risk of permanent morbidity such as weakness or impaired nerve function is less than 10%. The risk of transient morbidity such as weakness or impaired nerve function is as high as 20% pending the surgical procedure. Probably the greatest "risk" of spinal surgery is failure to accomplish the "wishful" long-term goals, especially from pain. UNIQUE risks to surgery are fusion failure and implant failure. Fusion failure is directly affected by the use of nicotine, and the implant failure is directly affected by the success of fusion and body habitus.
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The categories of risk often discussed include, but are not limited to: neurological injury (loss of function of strength, sensation, bowel/bladder, walking, loss of sexual function), infection, bleeding, lack of relief of pain or increase of pain, spinal fluid leakage, need for further surgery at this or other areas of the spine, failure of fusion, failure of instrumentation (pullout or breakage), risks related to positioning during surgery, risks related to anesthesia, risks of non-spinal medical complications, risks of transfusion, risks related to injuries associated with the approach to the spine (such as when the spine is approached through the abdomen) or death. Remember that the frequency of each risk must be taken in to consideration.
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Anesthesia, infection, failure of fusion, blood loss, nerve injury, pneumonia, urinary tract infection, persistent pain, loss of bowel and bladder; the potential list of complications is endless. A careful discussion of your particular procedure is critical to understanding which potential complication is a real risk for you.
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Again, the biggest risk of a fusion operation is the lack of adequate pain relief. In addition, fusion surgery may result in the premature breakdown, or wearing out, of the spine above and below the fusion.
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Complications can be pain from the donor site if your own bone is used. There can be injury to the nerves when removing the disc or putting in screws. There can be excessive blood loss. There can also be a non-fusion, or a fusion that failed. The implants can break, it is rare but possible that they break and have to be removed, and there is always risk of infection.
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The specific risks related to the fusion surgery are failure of the fusion to heal which can require a revision of the fusion or use of special braces or electrical bone stimulators to help the fusion heal.
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The most common complications associated with fusion surgery are loosening of the instrumentation, delayed union or pseudoarthrosis. In addition, there are the general complications associated with spinal surgery, which include infection, neurological damage, dural tear, and chronic intractable pain that are seen in any kind of spine surgery.
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The complications depend on the surgical approach. Fusion through the abdomen can result in problems with the muscles of the abdominal wall (hernia), injury to the bowel, urinary tract, major blood vessels to the legs, nerves to the legs, and the nerves to the bladder/bowel. Fusion through the back can result in spinal fluid leaks, blood collections, scarring of nerves, injury to nerves, fracture of some of the bones, and problems with the metal implants. Fusion from either approach can be complicated by wound or bone infection and nonunion (failure of the bone to heal). A common complication may be related to the bone graft donor site, usually on the pelvis, which may have chronic pain, infection, fracture, bleeding, and nerve injury. In addition to the complications specifically related to the fusion, there are always the risks of general anesthesia which include blood clots, heart attacks, strokes, and if extremely unlucky, even death.
Despite all these potential complications, most patients should expect to go through fusion surgery with a relatively low risk of any long term or permanent complications.
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