So, spine surgery is not without complications and I think actually, it has more complications than other orthopedic surgeries. Rather, a big study from the database showed that long, degenerative deformity correction surgeries can have risk of minor and major complications up to 50%, which is a high percentage.
This included minor complications, which included leak of CSF fluid, and all those things too. So, they can be infectious, which is not a good thing to happen in spine surgery, at least. A lot of reoperations and antibiotics go into place then. Bleeding is definitely a complication that can happen. Injury to adjacent structures.
Dura, it happens many of the times with us. There’s a dural incidental durotomy rate of about 10%. They can be repaired primarily. Usually, they do not have much consequences. In the past there have been a lot of lawsuits around it, but they don’t go along because patients with durotomy do well. There’s an excess of one day of bed rest, essentially, and they do well after that.
There can be injury to the nerves and dorsal root ganglion, which we are working in the area. We are cleaning that up. This can lead to aggravation of the pain, burning and a lot of things. Injury to vessels is not one of the forgiving things.
These are essentially anterior to the spine. So sometimes working from the posterior or working from a lateral we can injure the spines or working the front, essentially when we work from the front for ALIF (Anterior Lumbar Instrumented Fusion), we have a vascular surgeon giving us the access.
Adjacent segment degeneration: This is one of the things which is a side effect of doing fusion. So when we do fusion, we make that segment stiff. So the segment above and below have to take the movement, increase the movement. So they increase mobility, they lead to degeneration and they can lead to failure.
So there is another though that they say, “Oh, those discs are already degenerating.” So they have to, but, a long term incidence of 2.5% per year failure rate has been found in a study of adjacent segment degeneration on the cervical and the lumbar levels.
And there are ways to prevent it, decrease it, but this is there. That’s why a disc replacement has come, especially for the cervical spine. There’s disc replacement for the lumbar spine also. It has been used not so much because the success has not been so great with them. For those done on the cervical spine, they do well.
They are very comparable to a gold standard, which is anterior cervical discectomy and fusion, the ACDF. Inadequate surgery can be a problem in which there is inadequate decompression. Patient is still symptomatic, may need revision.
Or even despite doing everything, the patient may still have inadequate recovery, as we know, nerves sometimes just don’t want to recover. The patient may have comorbidities, diabetes and all of which can lead to incomplete recovery.