People are afraid of spine surgeries. They not only fear that spine surgery will not give any benefit, but also feel that it can cause further deterioration in their existing condition. People feel a long bed rest will be required after spine surgery and there is possibility of paralysis. Some people even ask if they will be able to walk after the spine surgery.
Many of these fears are due to past experiences of the patients when a long bed rest after spine surgery was the norm. Due to lack of understanding about spinal problems and non-availability of effective treatments, spinal surgeries did not give satisfactory results in the past. However, last decade has seen a dramatic change in approach for spinal disorders.
No benefit after surgery:
A precise diagnosis, correctly chosen procedure and good execution of the surgery are bound to provide excellent relief to the patient. It is possible to diagnose exact cause of patient’s symptoms now with advanced diagnostic methods. Effective surgical procedures are available for majority of the spinal disorders. Spine surgeons are well trained now to execute the procedure perfectly. Occasionally, patients come very late for surgery. These patients may not improve after the surgery due to significant damage to spinal cord before the surgery. Surgery is primarily done to prevent further worsening in these patients.
Need of bed rest after spine surgery:
In the current era with advanced spine surgery techniques, patients are able to sit and walk very next day after the spine surgery. A minimally invasive spine surgery causes minimum soft tissue damage and minimal pain, which allows patient’s mobilization within few hours after the surgery. Many of these patients are discharged on same day/ next day after the surgery. Patients with pre-operative weakness in legs and osteoporotic bones might need few days of rest after the surgery.
Risk of paralysis:
Theoretically, damage to spinal cord during surgery can cause paralysis. However, in reality chances of having paralysis after spine surgery are extremely rare. Microscopic/ endoscopic surgeries provide magnified and well illuminated surgical field, thus providing a safe surgical environment. Improved spine surgery instruments helps surgeon perform his job with precision. Spinal neuromonitoring provides safety in high risk cases. Computer navigation allows surgeon to instrument spine safely in severely deformed bones.
Spine surgery causing future problems:
Another common questions asked by patients is whether spine surgery will cause any future problems. Spine surgery itself will not cause any future problem. Spine has multiple joints, a problems can occur at a different level after spine surgery. Unfortunately, symptoms of a new level problem might be same as the symptoms for which a surgery was done at a different spinal level. This creates an impression as if problem has recurred at previously operated level. Also, spine is a dynamic structure. Due to continuous movements and further ageing process, a level where previously decompression surgery was done may have recurrence of disc prolapse or increased disc degeneration causing symptoms of spinal cord compression or spondylosis (1-3% chance).
Usual (still uncommon) complications of spine surgery:
- Infection: Incidence of infection is similar to any other surgery (1-2%). Diabetics and people with low immunity (old age, history of cancer, poor nutrition) are more prone to have infection. A longer course of antibiotics is usually required. Occasionally, a wound-wash procedure to drain pus from surgical site is required.
- Dural opening: Dura is a thin layer of membrane covering spinal cord. This layer may tear during spine surgery (incidence 3-5%). It is more common in elderly and patients with long standing pressure on spinal cord, which causes thinning of dura. Usually dura is repaired immediately and does not cause any change in post-operative recovery. Occasionally, dural tears are not repairable. In these cases, patients are asked to take bed rest for 2-3 days and then gradually mobilization is started. In fact, dura is opened deliberately for intra-dural pathologies.
- Other rare complications: Blood clots may form in legs (DVT) and then go to lung/ heart/ brain. Somehow, this is not common in Indian population. Also, with immediate mobilization after the spine surgery, chance of developing DVT goes down drastically. In high risk cases, mechanical pumps are applied to legs and blood thinners are given to prevent DVT. Some patients may experience pain at surgical site, which is controlled by adequate doses of pain-killers.
Most of the patients have a very satisfactory result after spine surgery. Research has shown that majority of the majority of the patients who undergo spine surgery now, will not hesitate to recommend spine surgery to a friend/ relative. They would undergo surgery again if they develop similar type of problem in future.