Spine Surgery Risk Management

All medical procedures involve risks.  Anyone claiming 100% success rates with no risk should be viewed with a great deal of suspicion.  Even getting the flu vaccine carries some risk!

Generally speaking, all spine procedures carry some level of the following risks: Pain, numbness or clumsiness.  Impaired muscle function or paralysis.  Incontinence, impotence or impaired bowel function.  Unstable spine. Recurrence, continuation or worsening of the condition that required the operation or procedure.  Injury to major blood vessels. Hemorrhage.  Persistent back pain.  Bleeding/epidural hematoma. Infection. Brain damage. Permanent organ damage. Memory dysfunction/memory loss.

The procedures performed by North American Spine partner physicians carry these same risks.  However, many of the severe risks of traditional spine surgery – namely, paralysis or mortality – are significantly mitigated by the AccuraScope™ procedure.  In fact, we have no documented cases of these extreme complications.

Further discussion of some of these risks follows:

Infection

Any time the skin is punctured, there is a risk of infection.  The incision for the AccuraScope procedure is less than 1/4″ long, while our cervical procedure is performed through a needle-stick.  The risk of infection is much less than with many traditional procedures.

Headache

Whenever a physician is working around the spine, there is a possibility that the dural sac may be punctured.  If this should occur, a small amount of spinal fluid may leak out, potentially causing a headache commonly known as a “spinal headache”.  While not dangerous, this headache is quite uncomfortable.  Fortunately, there is a relatively simple remedy known as a blood patch which involves injecting blood (drawn from the patient’s arm) into the sac to allow its natural clotting action to seal the puncture.  To reiterate, this is a risk during any procedure involving the spine, including a labor epidural.

Nerve Damage

All spine patients are very concerned about nerve damage, and rightly so.  It is certainly a risk of all spine procedures.  However, there are several mitigating factors that act to minimize this risk to our patients.

1) Spinal Cord Stops above Lumbar Spine — The spinal cord that controls nervous system functions stops at the bottom of the Thoracic Spine.  It branches out into bunches of nerve roots which extend out into the lower body starting at the top of the lumbar spine.  The catheter for the lumbar AccuraScope procedure only extends up through the lumbar chain and thus does not present a danger to the “main” spinal cord.

2) Direct Visualization in HD — Because of our unique approach, the AccuraScope procedure allows the physician a unique view of the anatomy of the spinal canal through a fiber-optic endoscopic camera.  All of our physicians undergo a rigorous training program that enables them to distinguish between disc tissue, scar tissue, nerves and other matter.  No other procedure gives the physician a comparable image and subsequent ability to navigate the space.

3) Intra-Operative Nerve Monitoring — North American Spine’s procedures are performed under a “light” general anesthesia.  Patients breathe under their own power, and while they are essentially unconscious, the patient’s body can respond to stimuli.  As a result, if the physician comes anywhere near the nerve roots, the nerve response will register as an electronic signal on the sophisticated intra-operative nerve monitoring systems we use and the physician knows to move the instruments away from the nerve.  These systems electronically monitor nerve function and alert care providers upon the slightest disturbance of nerve roots.

4) Intermittent Laser — The laser that is used in the procedures described on this site has an extremely short range of dispersion and only fires a few millimeters.  In addition, it is fired in intermittent bursts by the physician using a foot pedal.  If he or she is too close to a nerve, the monitoring alarms will sound and the physician will adjust appropriately.  Even if the physician were to hit a nerve with the laser, the nerve monitoring system and the patient’s reaction would immediately tell him or her and most importantly, the nerve would NOT be severed.  If a physician makes a similar mistake with a scalpel, however, the damage would be permanent.  For this reason and the others described above, nerve damage is far less likely with our procedures than with most others.

Pain, Weakness, Numbness

Patients may experience post-surgical pain around their incision.  They may also have short-term pain in the lower back caused by irritation of the nerves during the procedure.

Further, many patients experience some short-term weakness or numbness in their legs for some period following the procedure.  This is believed to be caused by temporary inflammation of nerve roots due to renewed blood flow experienced when the nerve is decompressed.  A good comparison is the numbness and “pins and needles” pain you may feel when a limb that has fallen asleep experiences renewed blood flow, and resolves over time.  This associated leg weakness has been observed to last from a few days up to, in extreme cases, 6 months.  In some instances, these symptoms can persist indefinitely.

It is worth noting that patients with these post-procedure symptoms typically say they would have the procedure again, and that temporary leg weakness is a small price to pay for relief of their pain.

Foot Drop

Another risk that exists with all spine procedures, “foot drop” occurs when the patient loses dorsiflexion (the ability to bend the foot upward from the ankle joint) permanently.  Similar symptoms may occur on a temporary basis after the AccuraScope procedure, but resolve over time.  As a transitory effect, this is NOT true foot drop.  Permanent cases of this complication are very rare, but it is a risk.

In Closing:

We list these risks to educate our patients.  It’s important to state again that these risks exist with ALL spinal procedures.  If you are considering another procedure and are never informed of these risks, be wary.  This list is not comprehensive or exhaustive and we welcome your questions.  Please call 1.877.474.BACK today or click here to contact us.