Spinal fusion , medically called spondylosyndesis and spondylodesis, is a type of surgery performed to join two or more vertebrae. The process is typically performed to reduce the pressure and pain in the back that occurs due to degenerative disc disease and other back issues such as spinal stenosis, kyphosis, spondylolisthesis, spondylosis, scoliosis, and spinal fractures.
The process involves placing a bonelike material or bone in the space between two spinal bones. The surgery can take a few hours and require extensive care. However, it’s generally considered safe and has a very high success rate. Yet, some complications may occur.
Spinal Fusion Complications
It doesn’t matter how experienced or skill your surgeon is, there’s always the risk of something going wrong. Here are some of the most common spine fusion complications:
Spinal fusion is considered a safe procedure with a success rate as high as 90 percent. However, it often goes down to 70 percent based on where the surgery is performed. This means that there is a 30 percent chance that the surgery may fail, i.e.: you may not get your desired results.
The risk is higher with fusions of three or more levels. Your surgeon will typically let you know your chances of success before you decide on the procedure. This outcome is called ‘failed back surgery syndrome’, however it isn’t really a syndrome and is just a misnomer.
Infections after a back surgery are common and they usually start to occur about three days after surgery but some people may not see any signs of an infection even two months after surgery.
Infections can be of a variety of types with vertebral osteomyelitis being the most common form of infection. It develops from bacteria, direct open spinal trauma, and infections in surrounding areas.
Risk factors include advanced age, diabetes, cancer, intravenous drug use, and malnutrition. Treatment for infections depends on factors such as the type and severity of the situation. Oral medication, including antibiotics, may be used.
Your doctor will ask you to visit for regular checkups and may inspect the area for signs such as wound drainage, swelling, tenderness, or redness near the incision. Some other signs of an infection include severe back pain, chills, fever, weight loss, spasms, difficult urination, and neurological deficits such as weakness or numbness of legs and arms.
Make sure to visit a doctor if you see one or more of these signs. Also, remember that just because you have any of these signs doesn’t mean there’s an infection as they may also be due to other health issues.
About 10 percent of people may end up with the vertebrae not fusing together how it is supposed to. This condition is called pseudoarthrosis and there is no way to predict it; however, modern technology has reduced the risk to a great extent.
Also called a ‘failed fusion’, this condition tends to manifest with radicular or axial pain even months after the surgery. Treatment involves another fusion surgery. It is recommended that the patient goes for a second opinion as a new approach is typically needed to avoid the same issue from happening.
Complications may arise due to the use of pedicle screws. They may become loose or break, thus forcing the patient to undergo another surgery to remove the screws and revise the rods.
Radiological approaches, including CT scans and X-rays, are used to detect the problem. The process to remove loose or broken screws can be complicated and require the patient to remain on the bed for additional days.
Blood loss is a part and parcel of a back surgery. It averages over 800 ml for non-instrumented fusions to 1,517ml for instrumented fusions; however, some people may report higher numbers, which is a complication linked to spinal fusion.
A little bleeding is common for a day or two but excessive bleeding or bleeding that continues for a longer period of time can be a sign of issues such as an injured blood vessel. It is very important to not reflect this sign as bleeding can result in infections.
Visit your doctor for an examination. You may have to undergo imaging tests, such as MRIs and CT scans to find the cause of the bleeding. Moreover, the doctor may use tricks such as putting pressure on the incision or sewing up or cauterizing the incision. Moreover, in some complicated cases, another minor surgery may be needed.
Furthermore, it is common for the patient to be given medicines to stop the bleeding. Lastly, a blood transfusion may be recommended in very severe cases.
Subsiding or Migrating Grafts
In some rare cases, anterior cages and grafts may subside or migrate, thus requiring another spine surgery. This usually occurs because the length of a fusion segment begins to decrease a few weeks after instrument-assisted ACF. To avoid this issue, the surgeon has to be very careful and ensure multilevel cervical constructs are carefully constructed. Yet, it may still occur.
The revision can be a little complicated and usually requires a different technique than what was originally used. For example, if the anterior devices were originally placed from the front, then the revision would involve an approach from the back.
Nerve damage is another spine fusion surgery complication. It can result in a loss of strength, loss of bladder or bowel control, and anterior fusion, which refers to difficulties with ejaculation. The condition occurs due to the presence of nerves found in front of the L5-S1 disc space. These nerves are linked to ejaculation and, if disturbed, can lead to issues. However the situation only impacts 1% of patients and usually resolves on its own in about six to eight months.
These were some of the common issues people face after spinal fusion surgery. There, however, is now a new method to solve back issues, including spinal stenosis. Presented by Premie Spine, TOPS is a safer and more reliable system with fewer risks and complications. Know more about how Premia Spine TOPS System works and the conditions it reverses.