Benefits and Risks of Spinal Fusion Surgery?

The benefits of spinal fusion surgery are a matter of some debate in the medical community. Despite its history dating back to the early years of the last century, and despite the fact that spinal fusion surgeries for all causes have doubled in the United States since 1993, recent surveys have shown that up to one third of spinal fusion patients remain dissatisfied with the outcome of their surgery—and that of the remaining two third who report satisfaction, most are not pain-free. In many cases, if pre-surgery pain is, for example, 7 on a scale of 0 -- 10, post-operative pain at a level of 3 or 4 is viewed as a successful outcome.

A highly regarded 2007 study in the New England Journal of Medicine concluded that patients with major disability or major spine trauma, and patients for whom surgery "may preserve life or function," are those most likely to benefit from spinal fusion surgery. However, "absent major neurologic deficits, patients with herniated disks, degenerative spondylolisthesis, or spinal stenosis do not need surgery, [although] the appropriate surgical procedures may provide valuable pain relief."

In short, patients considering spinal fusion surgery should discuss the risks and potential benefits thoroughly with their surgeon and set realistic expectations for managing the long recovery period required after surgery.

Potential Complications of Spinal Fusion Surgery

Any surgical procedure carries risks including adverse reaction to anesthesia and medications; bleeding; death; dehydration; diarrhea; heart attack; infection; injury to surrounding organs; lung problems (such as pneumonia and pulmonary embolism); nausea; pain; stroke; thrombosis (blood clots); and vomiting. These general risks are present whenever a patient undergoes major surgery and should be considered carefully with your doctor before deciding to proceed with spinal fusion surgery.

Specific risks of spinal fusion include:

• Clots may form in the legs which, in rare cases, can pass to the chest and become life threatening.
   
• Wound infection. Deep wound infection that does not respond to anti-biotic treatment is a serious problem that may require additional surgery.
   
• Despite a technically successful operation, pain may not improve and there is a small chance it may even become worse. Remember, one-third of patients are dissatisfied with the outcome of their surgery.
   
• A small chance of injury to the nerves. Severity can vary from a small degree of numbness to complete loss of strength in the muscles supplied by the nerve involved. Severe nerve injury is extremely rare.
   
• The risk of a new pain from the site from where the bone graft is taken.
   
• The bone graft may not fuse together and if it fails to do so could result in persistent pain and in rare cases a need to re-do the operation.
   
• If anterior spinal surgery is used (i.e. the spine is approached through the abdomen), there is a risk of injury to the large blood vessels that sit in front of the spine. In men there is a small risk of damage to the nerves that control ejaculation. This can render men temporarily sterile — but does not cause impotence. The nerves that control temperature sensation in the legs can be damaged resulting in one leg feeling cooler than the other.

The list of potential complications is both long and daunting. The vast majority of spinal fusion operations are completed without any problems. However, it is important patients understand the magnitude of the surgery and discuss potential problems thoroughly with their surgeon.