Recognizing and Preventing Post-Surgical Complications

With advanced procedures performed by highly trained and experienced surgeons, spinal surgery today boasts highly successful outcomes. Yet, complications can (and do) occur during the post-surgery recovery process.

The spinal surgery patient can serve as the first line of defense against these complications by taking an active role in managing his or her recovery. To ensure a successful recovery, patients need to prepare for the procedure well in advance. 

In this article, we’ll discuss everything that patients need to know before undergoing spine surgery, including the precautions to take and the complications to be aware of. 

What to Do Before Spine Surgery

Before spine surgery, you should prepare for the recovery process and follow all of your surgeon’s instructions. This will involve preparing your body for the procedure by:

  • Stopping medications that could interfere with the surgery and/or recovery process, including blood thinners like Aspirin, Eliquis, Plavix, and Coumadin, as well as monoamine oxidase inhibitors (MAOIs). 
  • Completing all of the recommended physical exams and lab tests, such as a complete medical history, EKG, chest x-ray, and/or urine test. 
  • Bathing with antimicrobial soap, as recommended by your surgeon, to reduce the risk of postoperative infection.  
  • Stop eating and drinking eight hours before surgery, or as advised by your surgeon. 

What Is the Most Important Thing to Do Before Spine Surgery?

The most important thing to do before spine surgery is to stop taking medications that could interfere with the procedure. Continuing to take these medications could alter the effects of the anesthesia, impede the recovery process, and lead to medical complications.

While this is one of the most important things to do before spine surgery, you should follow all of your surgeon’s recommendations to ensure a safe, successful procedure and recovery. Some patients will need to take particular pre-operative steps to account for underlying conditions, such as diabetes. 

What Precautions Should Be Taken Before Spine Surgery?

Before spinal surgery, take the following precautions:

  • Quit smoking at least four to six weeks before the procedure. Nicotine suppresses blood flow throughout your body, which can significantly inhibit your healing process. In fact, quitting smoking four to six weeks before surgery and remaining smoke-free for a month afterward can cut your rate of wound complications in half. 
  • Stop taking certain medications, as aforementioned. Your surgeon will advise you on which medications to stop taking before the procedure, so make sure to tell them about all of the drugs and supplements you’re currently taking.
  • Consider donating your blood to account for possible blood loss during the procedure. Your surgeon can walk you through the pros and cons of giving your own blood, rather than using blood from a different donor. You may need to take an iron supplement before the procedure if you choose to donate your blood. 

What Is Included in a Pre-operation Checklist?

A pre-operation checklist includes the steps and precautions that patients should take before surgery to ensure a successful recovery. These steps generally include:

  • Completing a physical exam and lab testing with your PCP, along with any other recommended medical appointments (such as an exam with a cardiologist)
  • Completing any other required blood tests that weren’t completed by your PCP
  • Determining which medications you need to stop taking before the procedure, and when to stop taking them
  • Arranging transportation from the hospital to your home and, if needed, at-home care for the first few days after the surgery
  • Preparing your home for the recovery process by:
    • Temporarily relocating your bedroom so that it’s easily accessible (for example, moving your bedroom to the ground floor will spare you from having to use stairs in the early stages of your recovery)
    • Purchasing any tools that will help you complete simple tasks as your spine heals (i.e. a grabber tool)
    • Move all of your essential items, such as paper products, books, snacks, TV remotes, and toiletries, to hip-level. Patients are typically advised to avoid reaching, bending, and twisting after spinal surgery. 
    • Meal prep as much as you can, or purchase ready-made meals, as cooking will be difficult after spinal surgery. You can also ask a loved one to prepare your meals during the early stages of your recovery. 
    • Prepare clean laundry before the surgery, as patients generally can’t do laundry in the first few weeks after surgery. We recommend setting out comfortable clothes to wear around the house after you return home from the hospital. 

What Is the Risk of Complications From Spinal Surgery?

There is a risk of complications from spinal surgery, as there is with any surgical procedure. Since spinal surgery involves operating around the spinal cord and nerves, there is a risk of nerve injury and paralysis. Although serious nerve complications are rare, it’s important to discuss this risk with your physician before planning to undergo spinal surgery.

Other possible complications from spinal surgery to be aware of include:

  • Infection

Infection is one significant postoperative risk. The rate of infection varies significantly depending on the type of spinal surgery, ranging from 0% to 18%. The patient’s underlying health also impacts his or her risk of infection.

You’ll be prescribed antibiotics as part of your post-operative recovery regimen. You’ll also be instructed on how to care for your surgical incision as it heals. Proper wound care is crucial to prevent infection – you’ll need to keep the wound clean and dry until it’s fully healed.

It’s important to carefully follow all of your physician’s directives to minimize the risk of infection. Infections inhibit the healing process and, if they spread, can affect other tissues and organs. 

  • Shock

Shock is a possible complication of spinal surgery. It occurs when the patient’s blood pressure severely falls, leading to a serious reduction in the body’s blood circulation. 

Infection, blood loss, metabolic issues, and brain injury can trigger shock in spine surgery patients. This complication can be treated by curbing the blood loss, assisting breathing, limiting heat loss, supplementing blood, fluids, or oxygen, and implementing medications that increase blood pressure. 

  • Adverse reactions to anesthesia

Allergic reactions to anesthesia are rare but can occur. These reactions can range from mild to severe. The most severe type of reaction to anesthesia is known as malignant hyperthermia, which can be fatal without immediate treatment. 

Most side effects from anesthesia are mild, including vomiting, nausea, sore throat, chills, and temporary confusion. 

  • Blood clots

Blood clots in the leg are a potential complication of spinal surgery. Known as deep vein thrombosis, or DVT, this complication causes pain and inflammation in the leg. If the condition escalates, it can lead to a severe condition called pulmonary embolism. 

The risk of DVT after spinal surgery is low, especially with minimally-invasive surgical techniques. 

  • Pneumonia

Pneumonia is another post-surgery risk. It’s a lower respiratory tract infection that causes symptoms including cough, chest pain, trouble breathing, and fever. Again, taking an active role in your recovery is the best way to avoid pneumonia and other respiratory problems.

Risk factors for postoperative pneumonia include:

  • Older age
  • Excessive alcohol consumption
  • Smoking
  • Limited mobility before or after the procedure
  • A suppressed immune system
  • Recent viral infection
  • Known respiratory disease
  • Prolonged ventilator use (longer than 24 hours)

Post-operative respiratory difficulties are exacerbated by inactivity and shallow breathing. The sooner you get up and about, the lower the risk of postoperative pneumonia. Talk to your doctor about how to safely remain active after spinal surgery. 

  • Fusion failure

Patients who undergo spinal fusion back surgery are at risk of the bone graft not healing property, known as a “failure of fusion”. 

Spine fusion surgery is typically performed to stabilize the spine after spinal decompression surgery. During spinal decompression, the surgeon removes tissue that’s impinging on the spinal nerves to resolve conditions such as spinal stenosis, spondylolisthesis, and herniated disc. Spinal fusion may be done to stabilize the spine after this procedure. 

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The chances of fusion failure are greatly increased for smokers or patients who use nicotine in any form, including nicotine patches. Some hospitals perform urine tests on patients before spinal fusion to ensure that they have no nicotine byproducts in their systems.

  • Adjacent segment disease

Adjacent segment disease is another possible complication of spinal fusion. It occurs when the vertebrae surrounding the fused segment break down more rapidly than usual. This condition develops because the adjacent vertebrae must bear added impact to offset the fusion. 

Avoiding the Complications of Spinal Fusion

Today, the TOPS (Total Posterior Solution) System provides an alternative to spinal fusion for patients undergoing spinal decompression surgery. The TOPS System has been proven in clinical studies conducted globally to produce superior clinical outcomes and fewer complications than spinal fusion. It’s a dynamic implant device that moves with the spine in all directions while preventing instability.

The more you know about the surgical options available to you, the more you can minimize your chances of post-surgical complications. Talk to your spinal surgeon to learn more about preparing for your spinal procedure.