What are the risks of spinal surgery? 

Deciding to undergo spinal surgery is a significant step that requires a balanced understanding of the potential benefits and the inherent risks. In the United Kingdom, spinal procedures such as microdiscectomies and fusions are common, and the vast majority are performed successfully without major complications. However, as with any invasive procedure, there are risks ranging from minor post-operative issues to rare but serious complications. Understanding these risks helps you work with your surgical team to make an informed decision and prepare for a safe recovery. 

What We’ll Discuss in This Article 

• General surgical risks like infection and blood clots 

• Specific neurological risks, including nerve damage 

• Long term considerations such as fusion failure or adjacent segment disease 

• Rare but serious complications like dural tears 

• How lifestyle factors influence your individual risk profile 

• NHS and NICE standards for surgical safety 

General Surgical Risks 

Any major operation carries a baseline of general medical risks. These are often managed by your anaesthetist and nursing team throughout your stay in hospital. 

• Infection: Superficial skin infections occur in approximately 2 to 4 percent of cases and are usually treated with antibiotics. Deep spinal infections are much more serious but fortunately occur in less than 1 percent of patients. 

• Blood Clots: Known as Deep Vein Thrombosis (DVT), these can form in the legs due to immobility. If a clot travels to the lungs (Pulmonary Embolism), it can be life-threatening. The NHS uses compression stockings and early walking to reduce this risk significantly. 

• Anaesthetic Complications: While modern anaesthesia is very safe, there are rare risks of allergic reactions, heart problems, or breathing difficulties. 

Specific Neurological Risks 

Because spinal surgery is performed near the delicate nerves of the spinal cord, neurological complications are a primary concern for both patients and surgeons. 

• Nerve Injury: There is a small risk that a nerve may be bruised or damaged during surgery. This can result in new numbness, tingling, or weakness in a leg. In the vast majority of cases, these symptoms are temporary, though they can take months to resolve. 

• Dural Tear (CSF Leak): The dura is the watertight sac surrounding the nerves. If it is accidentally nicked, cerebrospinal fluid (CSF) can leak out. Surgeons usually repair this immediately, but it can cause severe headaches and may require a few days of flat bed rest after the operation. 

• Paralysis and Bladder/Bowel Issues: These are the most serious and fortunately the rarest complications. The risk of permanent paralysis or loss of bowel and bladder control is typically estimated at less than 1 in 300 operations for standard decompression. 

Long-Term Structural Risks 

Some risks only become apparent in the months or years following the procedure, particularly with more complex operations like spinal fusion. 

• Failed Back Surgery Syndrome: This is a general term for when pain persists or returns after surgery. While leg pain is often fixed, back pain can be more unpredictable. 

• Adjacent Segment Disease: Fusing two vertebrae together puts extra stress on the levels above and below. Over time, these nearby segments can wear out faster than they otherwise would have. 

• Metalwork Problems: If implants like screws or cages are used, there is a small risk they could shift or break, potentially requiring a second operation to correct. 

• Pseudarthrosis: This occurs when the bones fail to fuse together as intended. This is one of the most common reasons for revision surgery in fusion patients. 

Factors That Increase Your Risk 

Individual health and lifestyle choices play a massive role in the safety of your surgery. Your surgeon will assess these factors during your pre-operative consultation. 

• Smoking: This is perhaps the single biggest controllable risk factor. Nicotine prevents bones from fusing and significantly increases the risk of infection and poor wound healing. 

• Diabetes: Poorly controlled blood sugar can impair the body’s ability to fight infection and slow down the healing of nerves. 

• Revision Surgery: If you are having surgery on a part of the spine that has been operated on before, the risks of dural tears and nerve damage are higher due to the presence of scar tissue. 

• Weight: A high Body Mass Index (BMI) can make the surgery technically more difficult and increases the strain on the heart and lungs during anaesthesia. 

Conclusion 

While the risks of spinal surgery can seem daunting, it is important to remember that most patients experience a significant improvement in their quality of life. The most common complications, like minor infections, are manageable, while the most serious risks remain rare. By choosing a healthy lifestyle and following your post-operative physiotherapy plan, you can significantly tip the scales in favour of a successful outcome. If you experience severe, sudden, or worsening symptoms, or if you lose control of your bladder or bowels, call 999 immediately. 

Authority Snapshot (E-E-A-T Block) 

This article examines the clinical risks and complications of spinal surgery within the UK healthcare framework. The content is written by the MyPatientAdvice Medical Writing/Research Team and reviewed by Dr. Rebecca Fernandez to ensure accuracy regarding NHS outcomes and NICE clinical safety standards. Our goal is to provide honest, balanced, and evidence-based education for patients.