Although the risks associated with approaching the spine from the back are infrequent, they are certainly worth reviewing with your surgeon. Some of the specific risks to this approach include infection, bleeding, dural tear, pseudoarthrosis (failed fusion), and nerve injury. Revision surgery carries greater risks than primary surgery because of scar tissue.
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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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Well going in from the back you don't have a lot of the large blood vessels, but certainly you have the neural elements, which people would think of as the spinal cord. Those are the nerves that allow your body to move. And those nerves are in the way, and have to be careful retracted in order to do that fusion from the back.
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Dural leak, blood loss, pneumonia, infection, etc
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The risks of going in from the back include injury to the nerve and spinal fluid leakage.
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Some of the risks associated with the posterior approach include blood loss, muscle dissection, and additional pain.
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The posterior approach exhibits similar risks to going in from the front. You can still get some vascular complications, but the main risks are infection, dural tears, and nerve root damage. Most of these complications can be handled easily, but the spine surgeon compares the complications from the front that usually require the consultation of another specialist, either vascular, urology or general surgeon, in order to handle the complication. So most spine surgeons feel comfortable handling any complications from the posterior part in comparison to the anterior approach.
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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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Truthfully, the risks of spinal surgery are too numerous to record here. However, posterior lumbar spine approaches carry an increase risk to the nerves (foot drop), to the spinal sac (spinal fluid leakage), bleeding and hematoma, and delayed scarring to the nerves.
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Approaches from the back are generally safe, but there is a very small risk of spinal fluid leakage. Other risks also apply, such as infection, bleeding, failure to fuse, implant failure, and nerve injury. Incomplete pain relief or the need for additional surgery is always a concern.
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Fusion through the back can result in spinal fluid leaks, blood collections, scarring of nerves, and injury to nerves, fracture of some of the bones, and problems with the metal implants.
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The risk of surgery from behind in the lumbar region is nerve injury, stretch injuries to the nerves and a spinal fluid leak. Those are the main risk that I worry about. If there has been surgery before from behind, then you have to worry about scar tissue and injury to the nerve from scar tissue.
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The risks of going in from the back relate to exposing and injuring the nerves and risks of instability from disruption of the spine.
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Going in from the back, you have the risks of scar tissue in the spinal canal. You have the risks of injuring a nerve root through manipulation.
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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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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 risks of going in from the back relate to exposing and injuring the nerves and risks of instability from disruption of the spine.
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The risks from going from the back are disruption of the muscles around the spine, which results in higher blood loss and more pain following the surgery. In addition, muscles moved aside to allow exposure may permanently be damaged resulting in a loss of a normal muscle function.
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The risks of a posterior (back) surgical approach include: nerve damage, bleeding, infection, cerebral spinal fluid leakage, failed hardware and fusion failure.
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