No one thinks that a surgical complication will happen to them. During my spine fellowship, I witnessed a large number of major complications and I was sure that I was going to be better than them – even though they were considered some of the top spine surgeons in the world. I set out on a quest to go without any complications for a year. I did not give up easily but of course I failed. There is an inherent risk of any surgery with it rising with the complexity of the case. For example, there is a trend in the United States to perform multiple-level fusions, sometimes the length of the spine. The complication rate in adults is high and a significant percent are devastating. (1) Over 30 years of performing complex spine surgery, I have watched hundreds of patients, including my own, have poor outcomes – sometimes from a direct technical problem in surgery and often from medical problems that can occur from prolonged operative time and blood loss. Even without a complication the pain may persist or worsen. (2)
Do You Really Need Spine Surgery?
The purpose of this article is to admonish you to consider if you really need the surgery and will the benefits outweigh the risks? Every day in clinic I have several patients tell me that if they had just understood how much worse off they could be after surgery, they never would have undergone the procedure. Most of the time the surgery went well but their pain is worse. Add in a complication and the resulting situation can be intolerable.
What is making the current surgical environment harder for me to deal with is that we are seeing hundreds of patients go to pain free by them systematically implementing treatments that have been proven to be effective without significant risks. My book, Back in Control, does provide that framework, but any self-directed informed approach will work. The key is you taking charge of your own care, once you understand the nature of chronic pain. The worst part of this whole scenario, is that many of the patients who get stuck in this hole of a failed back surgery, had a normal spine for their age. Surgery should not have ever been offered to them since you can’t fix what you can’t see.
A life changing complication
I remember the moment my surgical life changed many years ago. I was in clinic about 11 o’clock in the morning when the ICU nurse called me and told me that my patient I had done surgery on yesterday couldn’t see. I had seen him earlier on rounds and he seemed fine. I rushed over to the unit and he was completely blind. He told me that he thought someone had placed a cloth over his eyes as part of his post-operative care. We had done an eight-level fusion on him for what we call, “flatback.” He had lost the curvature of his lower back from degeneration of his discs and he was tilted forward. He was experiencing a lot of pain.
The surgery had gone well and my colleague and I complemented each other on how well it went. However, one of the risks of any spine surgery in the face- down position is the blood supply to the eyes. For reasons that are unclear the flow was compromised and the nerves to his eyes were damaged. He never regained any of his vision. Needless to say, everyone was devastated. The only inspiring part of the situation was his attitude. He walked into my office about three months later and said, “This is the deck of cards life has dealt me and I am going to play it.”
He returned to see me about ten years later to have some of the hardware removed that was prominent. I was learning more about chronic pain and the effect that stress has on the body’s chemistry and perception of pain. I talked to him for a while and found out that just prior to his surgery, he was under extreme marital and family stress that eventually culminated in a divorce. I was so convinced that surgery was the answer that I did not pick up on it.
Didn’t need it
Today, in my practice, he wouldn’t have been a candidate for surgery. His flatback was not as severe as many I see rehab without surgery. I would have had physical therapy stretch out his hips and get him into the gym. His sleep and stress would have been addressed and he would have done well. As I didn’t know how successful a structured approach could be, I did not offer these options to him. I would have certainly waited until his life stresses calmed down. He is blind from an operation that could and should have been avoided.
“If I Were Your Spine Surgeon”
Please read this link to an article I wrote for the National Pain Report. This paradigm I describe of optimizing surgical outcomes has been evolving for a while. Specifically read the patients’ responses of those who underwent surgery and ended up worse – a lot worse.
It appears to me that many people put more effort in buying a car than they do making a decision about undergoing spine surgery. Although they are informed of the potential complications there is no way to comprehend how bad life can be trying to live with a failed spine surgery. You are the one with the pain. No one else can accurately make the final decision whether the pain you are experiencing is worth the risk. Video: Get it Right the First Time
BTW, is the pain you are trying to solve your mental or physical pain? Look at this link to a post I wrote, “Am I operating on your pain or your anxiety?” Anxiety does respond to the treatments outlined in my book. As the anxiety drops the nerve conduction slows down and your pain physically drops. (3) You also will quit reacting as strongly to your pain and it tends to be less disruptive.
Don’t play roulette with your life. There is no turning back on this decision and there is no need to gamble.
- Cho SK, Bridwell KH, Lenke LG, Yi JS, Pahys JM, Zebala LP, Kang MM, Cho W, Baldus CR. Major complications in revision adult deformity surgery: risk factors and clinical outcomes with 2- to 7-year follow-up. Spine (Phila Pa 1976). 2012 ;37(6):489–500
- Perkins FM and Henrik Kehlet. “Chronic Pain as an Outcome of Surgery.” Anesthesiology (2000); 93: 1123-1133.
- Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166-173.