Complications after back surgery can range from mild pain to serious spinal cord injury, paralysis and even death. How can you reduce your risk of complications and promote a healthy and swift recovery after spine surgery? While surgeons cannot guarantee a good outcome they do offer guidance on how best to prepare and heal from your procedure. An important first step is knowing what kinds of complications can arise and ensuring processes are in place to deal with such possibilities.
Most back surgeries, however minimally invasive, will require some kind of anaesthetic to numb the pain and sensation of cutting, scraping and removing of problematic spinal tissues. Local anaesthetics numb the area through injection with Novocain or similar medication and these do not usually cause significant problems for patients, wearing off quickly after the procedure and having few, if any, systemic effects. Conversely, general anaesthesia involves intravenous lines being put in place through which drugs are given to put the patient to sleep. Patients are then kept asleep during the procedure through further medications fed through these lines and with anaesthetic gas.
Patients under general anaesthesia have their breathing monitored and other vital signs continually assessed throughout the procedure, and are attached to machines that regulate breathing. Problems can arise when patients have an adverse reaction to the anaesthetics used during surgery, although such problems are rare. Any patient who has previously had problems with anaesthetics should ensure their physician is aware of this prior to spine surgery being scheduled.
Lowering Risk of Surgical Complications
Patients with existing breathing difficulties, problems with general health, or who are severely overweight are at a higher risk of problems with anaesthesia, particular as regards difficulties maintaining breathing. Some such patients will not be able to undergo surgical procedures requiring general anaesthetic and may, instead, be offered endoscopic surgery using carefully controlled local anaesthesia. It is extremely rare for a patient to die during back surgery but it is still a risk, as is brain damage caused by a lack of oxygen to the brain when a patient stops breathing for a significant period of time. Maintaining a healthy weight, improve general cardiovascular fitness, quitting smoking and following pre-surgical guidelines can all help reduce risks of back surgery complications.
Blood Loss and Blood Clots
Whenever the body is stationary for a long period of time, such as during back surgery under general anaesthesia, the blood will begin to pool in the lower limbs (known as thrombophlebitis). Pooling blood may then lead to the formation of blood clots in the large veins of the calf, the thigh and the pelvis and these clots then travel back in the direction of the heart.
The blood vessels through which the blood travels on its return journey to the heart are often narrower than the large leg veins and it may be that the blood clot actually blocks a blood vessel and causes ischaemia (the cutting off of the blood supply). Deep vein thrombosis may then lead to an ischaemic heart attack, a stroke or other complication such as a pulmonary embolism. This is where the blood clot lodges in the lung tissue, blocking the blood supply to that part of the lung, damaging the tissue and causing part of the lung to collapse. When a large part of the lung is affected it can cause serious breathing problems and even death.
Blood clots in the deep veins of the legs can also block circulation back to the heart, creating a further pooling of blood and stagnant conditions for increased clot formation. The legs may swell and become painful, with such symptoms having the potential to persist, causing chronic discomfort and, eventually, tissue necrosis as circulation is impaired.
Why Surgery Increases Blood Clot Risks
Although such blood clots can form at any time it is increasingly likely during surgery as the body responds to incisions by increasing clotting factors to try to seal the wound. In an attempt to stop the bleeding, the blood may clot elsewhere in the body. Clots may also form around the wound due to the tissue trauma of back surgery, with these clots breaking away from the surgical site to travel through the circulatory system until they either break up or get lodged in a blood vessel elsewhere.
Ways to reduce the risks associated with the formation of blood clots during back surgery include mechanical and medical interventions.
Blood clots and anaesthesia problems are major causes of back surgery complications but they are not the only things that can go wrong during back surgery. In our upcoming posts we take a look at surgical errors and why a slip of the knife can cause permanent paralysis, as well as the problems that come with hardware failure and infection.