What are the risks of spine surgery, and what should I ask?

Risks that come with any operation

Reading a list of risks can be unsettling, and the aim here is only to describe what public sources say. MedlinePlus lists the risks of anesthesia and surgery in general as reactions to medicines, breathing problems, bleeding, blood clots and infection. The American Association of Neurological Surgeons (AANS) names similar items, including a possible adverse reaction to the anesthetic, unexpected blood loss and localized infections, and adds that this is true even for minimally invasive surgery with a small incision. It also says there is a small chance that a minimally invasive operation cannot be completed and a second procedure or open surgery is needed.

Risks specific to the spine

Mayo Clinic lists bleeding, infection, blood clots, nerve injury and a leak of spinal fluid as possible complications of laminectomy, an operation that makes more room in the spinal canal (see what spinal decompression surgery is). For spinal fusion, which joins spinal bones (see what spinal fusion is), Mayo Clinic lists infection, poor wound healing, bleeding, blood clots, injury to blood vessels or nerves near the spine, pain at the bone graft site and return of symptoms.

MedlinePlus describes nerve damage as possibly causing weakness, pain, loss of sensation or, in fusion, problems with the bowels or bladder. It says a spinal fluid leak can lead to headaches and may need more surgery. Both MedlinePlus and Mayo Clinic say that after fusion the sections of spine above and below are more likely to wear, which may mean more surgery later.

Some outcomes are about results rather than harm. MedlinePlus says surgery does not always improve pain and, in some cases, can make it worse. For disc removal (see what a discectomy is), Cleveland Clinic describes complications as rare, but says the disc herniates again in 5% to 15% of cases and that a person may get no change in pain. It also lists allergic reactions to anesthesia, infection, bleeding, blood clots, nerve damage, a cerebrospinal fluid leak and an unstable spine that may need more surgery.

What affects an individual's risk

Mayo Clinic says the chance of complications depends on many factors, including age, overall health and whether the person smokes. It also depends on whether other procedures, such as fusion, are done at the same time. Cleveland Clinic notes that nicotine can interfere with healing, and MedlinePlus says smoking can slow healing and increase the risk of blood clots. The timing question is covered in when spine surgery is considered, and the full set of pages is at surgery in outline.

Questions to bring to a clinician

Mayo Clinic suggests talking with a care team about the risks that apply to the individual, and asking when work, driving, lifting and exercise might resume. The list below turns those ideas into practical questions. It is not medical advice, and the answers belong to the person's own surgeon.

1. What exactly is the operation, and which symptoms is it meant to relieve: leg or arm symptoms, back or neck pain, or both?
2. Which nonsurgical treatments have been tried, and are any still open?
3. What improvement is realistic for someone like me, and what is that estimate based on?
4. Which risks matter most given my age, health, medicines and whether I smoke?
5. Will other procedures, such as a fusion, be done at the same time, and why?
6. Is a minimally invasive approach possible for me, and what would it change?
7. How long will I stay in hospital, and when can I drive, lift, exercise and return to work?
8. Which of my medicines, including blood thinners, should I continue or pause beforehand?
9. Which warning signs after surgery mean I should call, and who do I call?
10. What are the likely outcomes if I wait or choose not to have surgery?

When to get help

Practice varies by country and by clinician, so risk figures from one place may not match another. After surgery, Mayo Clinic advises contacting the healthcare team for signs of infection: a change in color around the wound, tenderness or swelling, fluid from the wound, chills that cause shaking, or a fever higher than 100.4 degrees Fahrenheit (38 degrees Celsius). Cleveland Clinic also lists severe or worsening pain, sudden numbness or weakness, difficulty breathing and difficulty with urination or bowel movements as reasons to contact a provider right away.