Patients having back surgery for spondylosis are at risk of all the usual complications of surgery such as infection (shallow or deep), blood loss, problems with anaesthesia, pain and soreness after surgery, thrombophlebitis, and the unfortunate fact that surgery may not resolve the back problem in any significant way. It is important that patients thoroughly understand these risks prior to signing a surgical consent form, and that they are aware of the other, more specific, risks that may arise from back surgery for spondylosis.
When working near the spine, surgeons are operating very close to spinal nerves and the spinal cord and it is possible that these may incur damage during the procedure. Of course, every care is taken not to impact these structures and patients will, on occasion, be prevented from having certain procedures if the surgeon considers the risk of such damage as being too high. An injury to the spinal cord or spinal nerves may lead to temporary or permanent neurological impairment, with pain, numbness, weakness, paraesthesia and even paralysis possible. Some surgeons will monitor a patient’s nerve function during a procedure using somatosensory evoked potentials or motor evoked potentials and abandon a back surgery if the nerves or spinal cord appear to be experiencing trauma in the operation.
Other considerations when undergoing spinal surgery include the risk of pseudoarthrosis (non-union) following spinal fusion and the lack of stability if this occurs. Some patients do not form a solid union between the bones but their symptoms are relieved anyway, whereas others continue to suffer symptoms of spondylosis despite forming a solid union. Failed back surgery syndrome can be quite high in degenerative conditions such as spondylosis, particularly as the level operated on may be just one of the areas of degeneration. Spinal fusion can also lead to adjacent segment syndrome where the newly fused bone transfers pressure to the vertebrae above and below the fused level(s) causing further degeneration.
The failure of hardware used during back surgery is very rare and is usually a result of structural abnormality rather than a problem with the hardware itself. In operations such as the X-Stop implant procedure, for example, the device itself has an excellent record with the only complications occurring when a patient has been fitted with the device in spite of their condition contraindicating its use. Some surgeons will find that a structural abnormality discovered during back surgery prevents them from safely inserting a device such as the X-Stop and they should then abandon the surgery and reconsider the options for treating the patient. An incorrectly fitted device is liable to move around when it shouldn’t and may cause fracture of the spinous processes leading to further pain and more back surgery being required.
Recovering from Spondylosis Back Surgery
Recovery from back surgery for spondylosis depends largely on the type of surgery conducted and the degree of invasion during that surgery. A patient in good general health having an X-Stop fitted may be ambulatory immediately after the procedure, which is usually performed under local anaesthetic, and able to return to normal activities within a matter of days as there is little tissue trauma involved in this operation. Conversely, a patient undergoing a laminectomy with fusion across several levels of the spine will often be in hospital for several days, have significant pain and soreness and take a lot longer to return to their daily routine. Close adherence to restrictions on activities while a fusion heals are extremely important in order to increase the chances of the surgery being a success. Fusion can take from three months up to a year and may continue after that time so patients should be aware that high impact physical activities can still affect their long-term prognosis even after their immediate pain and discomfort have abated.