Complications of Spine Surgery
In spite of continued advances in medical science, we have been unable to rid ourselves of complications
related to surgery. While the amount of literature pertaining to spine surgery has grown exponentially, the
number of well controlled prospective studies of large numbers of patients with adequate follow-up is
amazingly small. Studies specifically addressing morbidity and mortality number less than ten. As health
care resources become less and less plentiful we face increasing pressure from outside sources to improve
our success rates and therefore cost-effectiveness.
Complications can be divided into two types, those directly related to surgery and those which are indirectly
related, i.e. medical complications. The indirect complications are by definition those medical problems
which arise after or as a direct result of a surgical procedure. The rate of complications varies between
different procedures. The number and types of problems encountered in "simple" discectomy are different
from those found in procedures which incorporate fusion. Morbidity and mortality rates are also dependent
upon the patients' preexisting medical, psychological and social histories. In spite of the large number of
variables it is important to generate data which is as specific as possible regarding complications related to a
specific procedure. The following data have been gleaned from the literature.
I. Direct Complications. All surgical complications = 7% (3.3 - 19%).
A. Complication of prosthesis or graft = 10.8 % (1 - 37%)
B. Discitis = 1.8% (1 - 2%)
C. Iatrogenic aural tear/laceration = 1.5% (0.02 - 17%)
D. Hemorrhage or hematoma = 0.66% (0.09 - 4.43%)
E. Wound infection = 0.48% (0 - 4%)
F. Cauda equina syndrome = 0.14% (0 - 0.6%)
G. Wound dehiscence = 0.14% (0 - 2.5%)
H. Injury to nerve root or cord = 0.06% (0 - 0.62%)
I. Gut perforation = 0.04%
II. Indirect complications. All medical complications = 3% (0.21 - 3.6%)
A. Respiratory = 0.39% (0.11 - 0.88%)
B. Gastrointestinal = 0.33 % (0 - 0.93 %)
C. GU/renal Insufficiency = 0.30% (0 - 0.87%)
D. Cardiac = 0.22% (0 - 0.5%)
E. CNS = 0.14% (0 - 0.33%)
F. Sepsis = 0.06% (o - 0.07%)
III. Mortality = 0.07% (0 - 0.6%)
These figures are rough averages of those reported in the literature. They are probably UNDERestimates of
the rates when evaluated as a whole. These studies are primarily of patients undergoing discectomy for the
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first time. They tend to be young and healthy preoperatively and have few complications. In the largest
series, from Deyo et al, the rate of morbidity and mortality increase greatly with advancing age and with
fusion procedures. They found a total complication rate of 6.4% for patients aged 18 - 40 and 18% for those
over 7S. The total complication rate for procedures without fusion was 7.6% while that for any procedure
with arthrodesis was 17~o. Their patient population was comprised of all patients discharged from non
federal hospitals with a diagnosis of any spinal surgical procedure in the State of Washington over a 2 year
period.
One must be extremely cautious when drawing conclusions from data such as this. The reliability is
dependent upon accurate and complete coding of discharges. Incomplete input may skew the results. In
order to provide a full assessment of the complication rates, it is necessary to include as much information
as possible so that patients with different clinical syndromes/diagnoses are not grouped together in the
same group of results/complications. As anyone who cares for spine patients knows, all are not equal!
Bibliography
Deyo, R.A., Cherkin, D.C., et al. MORBIDITY AND MORTALITY IN ASSOCIATION WITH OPERATIONS ON THE
LUMBAR SPINE. , 74-A; 536-543. 1992
Stolke, D., Sollman, W.P., et al. INTRA- AND POSTOPERATIVE COMPLICATIONS IN LUMBAR DISC SURGERY.
Spine, 14;1, 56-59. 1989
Spangfort, E.V., THE LUMBAR DISC HERNIATION. A COMPUTER AIDED ANALYSIS OF 2504 OPERATIONS.
Acta Orthop Scand Supp, 142. 1972 Smith, E.B., DeBord, J.R., et al. INTESTINAL INJURY AFTER LUMBAR DISCECTOMY. SG&O, 173; 1, 22-24.
1991
Anda, S., Aakhus, S., et al. ANTERIOR PERFORATIONS IN LUMBAR DISCECTOMIES. Spine, 16;1, 54-60.
1991
Turner, J.A., Ersek, M., et al. PATIENT OUTCOMES AFTER LUMBAR SPINAL FUSIONS. JAMA, 268;7, 907-911.
1992
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