All back surgery carries some degree of risk, including the potential for surgical complications or other error. Technical errors may lead to the development of back pain, leg pain, and other symptoms during the recovery period. Experimental procedures, and surgery conducted by less experienced surgeons carry the highest degree of risk, along with surgery on patients in poor physical condition and with severe spinal pathology. Some surgeries are more risky than others, with traditional open laminectomy with fusion liable to cause significant muscle, and ligament trauma and increase the possibility of scar tissue formation. Conversely, minimally invasive spine surgery usually reduces the risk of nerve and tissue trauma and is considered less likely to result in pain development after surgery. New techniques do require the surgeon to be particularly skilled in using an endoscope and specialized surgical instruments however, and the often tiny surgical field can present a narrower margin for error. Procedures such as laminotomy may prevent the surgeon from accurately ascertaining, during surgery, the degree of decompression achieved, and the restriction in operating field may mean that not all of the compressing material is removed.
Back Surgery Nerve Damage
When operating very close to the spinal nerves, such as during a foraminotomy, discectomy, or TLIF procedure, the surgeon must remain cautious at all times as regards the potential for nerve trauma. Retracting the nerves to keep them out of harm’s way during the procedure can itself cause bruising to the nerve and a degree of pain after surgery as the nerve heals. It is possible that the nerve be cut due to surgical error during back surgery, and this may cause pain, weakness, or even paralysis. Severance of spinal nerves is, however, extremely rare during back surgery. Nerve damage during a back decompression in the lumbar spine or a lumbar discectomy is thought to occur in around one in a thousand cases. Some surgeons make use of somatosensory evoked potentials (SSEPs) during surgery to monitor patients’ nerve function and use electromyograms after surgery to ascertain if nerve damage has occurred or if re-innervation of the nerves has taken place after the pinched nerve has been decompressed. Impairment of a nerve may cause a new incidence of weakness in muscles, with numbness, pain, and paraesthesia. This may subside as the nerve heals from the surgical trauma, or may be permanent if the damage was severe.
Dural Tear or Dural Leak
Back surgery which involves the surgeon working close to the spinal cord, such as a laminectomy, can lead to the occurrence of a dural tear. The dura is the protective membrane covering the spinal cord and a tear can cause spinal fluid to leak, an infection to occur, and in some cases the development of spinal meningitis. This spinal cord infection can spread to the brain and result in serious symptoms such as paralysis, critical limb ischaemia, and even coma leading to death. Dural tear remains a relatively low risk and is usually noticed at the time and promptly repaired with no noticeable consequences. If, however, the tear goes unnoticed and/or does not heal of its own accord then infection can occur. Surgery such as the X-Stop procedure does not carry this risk as it is performed outside of the spinal canal, but more invasive procedures to removed discs, perform fusion, or clear osteophyte growth may result in a surgical slip. Headaches, stiffness, fever, and swelling are warning signs for infection and should be reported immediately for investigation. Patients may suffer from increased scarring if an infection requires additional surgery to drain fluid or remove necrotic tissue, and this, in itself, may lead to failed back surgery syndrome.
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