WHAT YOU CAN EXPECT AFTER YOUR SURGERY
The majority of cases are able to go home at day four or day five. The hospital stay may be longer for more extensive reconstructive procedures. In some cases some formal rehabilitation may be required.
Stitches are usually placed beneath the skin. The dressing on the wounds can be removed after five or six days. You can get your wound wet, but take care to dry it. I recommend you walk as much as you can for exercise as well as undertake the stretches the physiotherapist would have shown you in hospital. We usually organise for you to have a review appointment around six weeks after your surgery with an x-ray.
As with any surgical procedure there are potential risks and complications. The risks associated with posterior instrumented fusion include:
Infection rates from such surgery these days are pleasingly uncommon (in the region of half of one percent). If you get an infection, treatment ranges from requiring simple antibiotics through to needing further surgery to clean the infection out. Things to suggest an infection are post operative fever, chills or shakes, wound redness or discharge from the wound. If these occur please contact the rooms so we can review you.
There can be significant bleeding from spinal fusion particularly in association with decompressions. A machine called a cell saver will be used intra operatively to recycle any lost blood and give it back to you. We also use medications with the anaesthetic to try and diminish bleeding. On some occasions however (particularly with more extensive surgery) blood transfusions and other blood products may be required.
CAUDA EQUINA SYNDROME
The cauda equina is the name given to the nerves coming off the end of the spinal cord running through the spinal canal. Cauda equina is latin for “horses tail”. The nerves here go to the legs but also the bladder and bowel. Cauda equina syndrome is where a lump develops which squashes these nerves and causes compression of them causing loss of function of bladder and bowel. Following surgery this could be due to a blood clot or an abscess. The symptoms of cauda equina syndrome are numbness in the groin around the genitals and anus, inability to pass urine with dribbling and incontinence of faeces. If this occurs, it is an emergency that the pressure is relieved with further surgery otherwise the pressure can cause permanent loss of bladder or bowel function. The incidence of developing such a problem after surgery and it being permanent despite surgical drainage is in the region of one in eight or nine thousand.
IMPLANT MALPOSITION OF FAILURE
When screws are placed into the spine, they are placed into bones with small margins for error or around nerves and other important structures. If the screws are placed too far toward the middle or bottom of the bone they can irritate or damage the spinal cord of nerves. If the screw is placed through the front of the spine the body’s major blood vessels (aorta and vena cava) can be damaged. It has been reported rarely that screws can damage these vessels with potentially life threatening bleeding. It is possible that the screws can loosen in the bone or break requiring replacement.
ADJACENT SEGMENT KYPHOSIS
Once a section of the spine has been fused with screws and rods, it becomes stiffer than the spine either side of it. At times, there can be fracture of the vertebra above or below the instrumentation. In most cases the fracture will heal without consequence. On some occasions the fracture can result in worsening deformity, pain or even spinal instability and further surgery may be required to extend the fusion.