Listed below are just the main complications of spinal surgery but do not cover all spinal operations. Some are very specific to the condition (e.g. risk of tumour recurrence) or approach of the operation (e.g. going to the spine through the chest or abdomen. These are not listed here but the surgeon should explain these beforehand.
As soon as the skin is penetrated, even in so-called minimal invasive or percutaneous procedures, bleeding can occur. This can be just from the skin or muscles leading to a blood clot (haematoma) under the skin or from the wound, or major vessels. A deep seated clot can press on a nerve or spinal cord and cause neurological problems or in the neck might cause breathing difficulties. Bleeding can be difficult to stop in some cases and a patient might require a blood transfusion during or after surgery. If you do not consent to have a blood transfusion during or after surgery (e.g. if you are a Jehovah's witness or any other reason) you must raise this with your surgeon well in advance. In some operations, so-called cell savers can be used so you get your own blood transfused during surgery, but this is not always available and should be planned beforehand.
There are several factors which can influence this form specific medical conditions to taking certain blood-thinning medication such as Aspirin, Clopidrogrel and Warfarin. It is very important to discuss all the medication you take, even the 'baby-Aspirin' you might take just now and again, with your surgeon.
Any operation, as for bleeding, carries a risk of infection. For clean / elective, i.e. planned surgery, this should be small and well <5%. It can be higher in certain cases, e.g. if you had radiotherapy to a tumour in the same area before or in trauma. Certain medical conditions such as diabetes or a disease lowering the immune system can also make an infection more likely. The same applies for certain drugs/ medication including steroids. Therefore, it is important that you discuss all your medication with the surgeon.
CSF stands for cerebro-spinal fluid. It is in the sac (dura) containing the nerves and this sac can be injured during surgery or sometimes the underlying condition (e.g. a spinal fracture). Sometimes, the defect can be directly repaired during surgery but this is not always possible. A small leak might even go unnoticed and only causes a problem at a later stage. As long as the nerves or spinal cord inside this sac are not injured, it is usually not a problem but is likely to require a longer hospital stay. As long as the CSF does not come through a wound and is otherwise not causing symptoms like pain or nerve compression, it might not require any specific treatment. Occasionally, a patient needs to be taken back for further surgery or a repair.
If you notice any clear fluid leaking through a spinal wound you should get in touch with the surgeon or hospital urgently! This usually happens within the first 10-14 days, i.e. before the wound has healed. It can also manifest itself as a swelling underneath the skin. An excessive CSF leak causes headaches (it is in the end brain fluid) and if you experience this, get in touch with the surgeon.
Nerve or spinal cord damage
Any spinal operation has a risk or nerve or spinal cord damage, depending on the location / level of surgery. Spinal cord damage can cause a devastating and permanent paralysis , which can effect the arms and legs depending on the level of surgery. The risk depends also on the underlying condition and the surgeon should specify this for the operation you are having.
When removing discs or bone/ ligaments compressing nerves, it is possible to leave bits behind. Most surgery is carried out with the help of a microscope and special instruments are used to feel if a nerve is still under pressure. However, the patient is not in the same position on the surgical operating table than when standing for example and a disc might appear to be bulging less during surgery than in real life. Sometimes, the risk of damaging the nerve by retracting it to get to a fragment might be so great that the surgeon has to leave it behind.
Recurrent disc protrusion
During a lumbar discectomy, only the part which has protruded and obvious loose fragments, are removed. There is a small risk, that another fragment breaks loose inside before the ring of the disc has healed. This risk is about 5-7% and most commonly occurs within the first 3 months after surgery. However, it can also happen after many years.
Implant loosening, misplacement, failure /or breakage
Implants can fail for various reasons. If a spinal segment does not grow together with the bone graft often used, screws can become loose. Certain conditions such as osteoporosis weaken the bone and implants can pull out.
In surgery through the front of the neck, such as anterior cervical discectomies, the food- and windpipes need to be retracted. this can lead to some swallowing difficulties which usually resolves within a short period of time (days). It is very uncommon to suffer an injury of the food pipe (oesophagus).
A nerve (called recurrent laryngeal nerve) runs along the food- and windpipe and can be stretched or rarely directly injured during surgery from the front of the neck. This can lead to a hoarse voice which usually improves or resolves again unless the nerve has been severely injured.