Complications
There is a risk with any surgery. Simply cutting the skin exposes the body to infection and bleeding. Obviously the more complicated the operation, the greater the risks.
For all surgery, risks will include the possibility of infection and postoperative bleeding. While intraoperative bleeding can be a problem, the major risk is after surgery when bleeding can recommence. Both infection and bleeding may require reoperation, which may need to be done urgently.
I tell every patient that there is a risk of death or paralysis with any brain or spinal operation, although either is quite rare.
Risks of cranial surgery
Infection
This may simply be an infection of the scalp which requires some dressings, removal of a stitch and/or antibiotics. Deeper infection can affect the bone, which may need to be removed and a plastic plate inserted after about six months. Deeper still, infection may affect the CSF (cerebrospinal fluid) around the brain, which is called meningitis, and requires hospitalisation and intravenous antibiotics.
Bleeding
Postoperative bleeding is the greatest concern that we have following cranial surgery. When an operation is completed, there is no bleeding and it is then safe to close. However, delayed bleeding can occur, most often within the first 24 hours after surgery. This may occur if the blood pressure gets too high, if the patient is on blood thinning drugs (which should have been stopped preoperatively), if the patient gets agitated or for no obvious reason. Postoperative bleeding can be an emergency with the patient becoming unconscious or developing a deficit such as arm and leg weakness. This will usually require an urgent trip back to theatre to prevent a permanent deficit (or stroke).
Stroke
Injury may occur to the brain or to a major blood vessel supplying the brain, resulting in a stroke. This means that a part of the brain will not work normally. Often this improves, but may be permanent - e.g. impaired speech, weakness of an arm and leg.
Epilepsy
The condition that requires surgery (e.g. a tumour) or the surgery itself may result in seizures or fits arising from a part of the brain. This is called epilepsy. This can usually be prevented by the use of a drug, often Dilantin (also called phenytoin), used before and after surgery. If epilepsy continues after surgery, it can usually be treated with drugs. For many (but not all) operations on the brain, a patient may be advised to not drive for three months because of the small risk of postoperative epilepsy. If epilepsy does occur before or after surgery, the patient will not be allowed to drive until the epilepsy has been completely controlled - that is, no seizures for usually at least a year or possibly two.
Cerebrospinal Fluid (CSF) leak
The brain and spinal cord are surrounded by CSF, which looks like water and is salty. When the head is closed at surgery, the outermost layer of the meninges (= the three outer coats of the brain and spinal cord), called the dura, is closed. CSF can leak through the dura and then through the skin and this will need to be fixed, otherwise there is a risk of meningitis. Just like a leak in the roof, there only needs to be a small hole to let water through and this can sometimes be troublesome to repair, but is virtually always correctable. Repair may require a simple skin stitch, a spinal drain tube inserted in the low back to drain the CSF via another route, or a trip back to theatre. Occasionally a CSF leak can be less obvious by leaking through the nose or ear - e.g. if there has been a skull opening into the paranasal sinuses or into the ear canals.
Deep Vein Thrombosis (DVT)
DVT means a blood clot developing in the leg. The patient may notice a painful swelling of the calf but a DVT may not be noticed. This clot may dislodge and travel to the lungs and heart to block the circulation, which is known as a pulmonary embolus (PE). A PE can be fatal and usually occurs about 1-2 weeks after surgery, or 1-2 weeks after a patient has commenced being confined to bed. Increased risks for DVT and PE are bed rest, prolonged surgery, obesity, cancer, past DVT, paralysed leg/s and heart failure. To prevent DVT, the patient is encouraged to get out of bed as soon as possible, usually the day after surgery. Before this, the patient can wiggle the toes and move the legs around in bed as soon as wakening from the anaesthetic. Prior to surgery, the patient will have elastic stockings put on. While in surgery the patient has leg pumps to improve the circulation. After surgery, blood thinning injections are commenced - I like to use Clexane injections into the stomach each morning until discharge from hospital.
Death
Death on the operating table is very rare. Death can occur with any surgery and usually occurs after the operation. The most common reasons are myocardial infarct (heart attack) due to the stress of the surgery, a rare reaction to a drug (anaphylaxis) or pulmonary embolus. I mention the risk of death or paralysis (stroke) to any patient having an operation, no matter how minor the procedure.
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Risks of spine surgery
Infection
This may simply be an infection of the wound which requires some dressings, removal of a stitch and/or antibiotics. Deeper infection may require a return to theatre to drain the collection of pus. Infection may also affect the CSF (cerebrospinal fluid) around the nerve roots and spinal cord, which is called meningitis and requires hospitalisation and intravenous antibiotics, but is virtually always curable. Infection of an operated disc space or of bone often requires initial hospitalisation and intravenous antibiotics, and then several weeks or months of oral antibiotics, often supervised by an infectious diseases doctor.
Paralysis
Prior to surgery, there may already be some nerve or spinal cord damage causing muscle weakness. A nerve or the spinal cord may be already squashed and at increased risk of being injured because of the manipulation needed to try to free the nerve or spinal cord. Nerve or spinal cord damage may also affect control of the bladder and bowel.
Cerebrospinal Fluid (CSF) leak
The brain and spinal cord are surrounding by CSF, which looks like water and is salty. CSF leak occurs if the outermost layer of the meninges (= the three outer coats of the brain and spinal cord), called the dura, is not completely closed watertight. CSF can leak through the dura and then through the skin and this will need to be fixed, otherwise there is a risk of meningitis. Just like a leak in the roof, there only needs to be a small hole to let water through and this can sometimes be troublesome to repair, but is virtually always correctable. Repair may require a simple skin stitch, a spinal drain tube inserted in the low back to drain the CSF via another route, or a trip back to theatre.
Deep Vein Thrombosis (DVT)
DVT means a blood clot developing in the leg. The patient may notice a painful swelling of the calf but a DVT may not be noticed. This clot may dislodge and travel to the lungs and heart to block the circulation, which is known as a pulmonary embolus (PE). A PE can be fatal and usually occurs about 1-2 weeks after surgery, or 1-2 weeks after a patient has commenced being confined to bed. Increased risks for DVT and PE are bed rest, prolonged surgery, obesity, cancer, past DVT, paralysed leg/s and heart failure. To prevent DVT, the patient is encouraged to get out of bed as soon as possible, usually the day after surgery. Before this, the patient can wiggle the toes and move the legs around in bed as soon as wakening from the anaesthetic. Prior to surgery, the patient will have elastic stockings put on. While in surgery, the patient has leg pumps to improve the circulation. In most cases prior to surgery, blood thinning injections are commenced - I like to use Clexane injections into the stomach each morning until discharge from hospital.
Wrong spinal level
This sounds unbelievable but it can be easily done. Spine surgery can be like trying to find where your car has been parked in a multilevel car park - all the levels and areas look similar. There are 33 bones in the spine and they mostly look similar. They don't have labels on them telling the surgeon which level is which. All patients vary and different anatomy can be confusing to the surgeon. This is particularly the case when a patient has an L5 vertebra joined to the sacrum. In this case some doctors will call the lowest disc L4/5 while others call it L5/S1 or, even more confusingly, L5/6. Don't worry if you don't understand this - this is for the surgeon to work out. Perhaps a simpler example is that some people have 11 or 13 instead of 12 ribs. It then becomes confusing as to what you call the next lumbar vertebra - T12 or L1.
Death
Death on the operating table is very rare. Death can occur with any surgery and usually occurs after the operation. The most common reasons are myocardial infarct (heart attack) due to the stress of the surgery, a rare reaction to a drug (anaphylaxis) or pulmonary embolus. I mention the risk of death or paralysis (stroke) to any patient having an operation, no matter how minor the procedure.
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