I'm getting up the courage to have spinal surgery for a benign (not cancerous) tumor that is pressing on a nerve in the lumbar spine. Because of the location of the tumor, I'll have an anterior approach. As it has been explained to me by the surgical nurse, there are lots of potential problems that could occur with this operation. Would you go over these with me once more? I want to make sure I've given this the careful attention it deserves.
Complications, problems, or adverse events refers to anything that occurs during or after a surgical procedure that has a negative effect on the patient's outcomes (results). Any problems from the surgery that require additional treatment (e.g., blood clots, failure of the wound to heal, nerve damage) are also considered complications.
There are many different ways to classify or group complications. If we just look at it from a timeline point-of-view, then there's intraoperative (during surgery) and postoperative (anytime after surgery up to six weeks) complications.
But other categories of complications include problems that occurred as a result of the patient position, device-related (implants), or approach (anterior versus posterior incision).
The anterior approach is necessary when the risk of spinal cord or nerve root damage is too great using a posterior approach. In the case of tumors or infection, the location of the problem may dictate the use of an anterior incision. But there are a lot of organs, arteries, veins, and deep muscles that can get nicked (cut) by accident during the procedure.
Adverse events linked with the anterior approach tend to be vascular (damage to blood vessels), visceral (injury to abdominal organs including the bowel), and neural structures (traction or cutting of nerve roots or nerve groups).
Of course, every surgeon does everything possible to avoid procedure, patient, or device-related complications. The use of fluoroscopy, a real-time, three-dimensional) type of X-ray helps guide the surgeon. Even with fluoroscopy, ileus (paralyzed bowel) can develop.
When any type of problem does arise, the next best thing is to manage it well and prevent the need for additional surgery. Management depends on what the problem is. For example, bleeding complications such as uncontrolled bleeding can result in serious complications (e.g., paralysis).
Blood clots can cut off blood supply in the legs or travel to the lungs and cause death. Watching for and recognizing early signs and symptoms is a key to prevention fatal blood clots. Pulses in the feet, skin color, and oxygen levels are measured frequently to assure proper blood circulation.
Spinal surgeons do everything they can to prevent and avoid such problems right from the start. Patients must be warned what to expect should something go wrong as a result of the surgery itself. Fortunately such adverse events are rare and usually temporary. With quick intervention, the problem can be managed quite well.