Cervical Spine Surgery Risks & Complications

The overall risks, complications and mortality rate of Cervical Spine Surgery are usually low. There is, however, a dramatic increase in the risks and complications associated with the cervical spine surgery as a person ages. Patients aged above 70 years will have 4 times the more chances of risks and complications from cervical spine surgery when compared to a patient who is aged between 20-35 years. The risk of complications is more after surgery done for cervical spondylosis with myelopathy and after combined anterior and posterior procedure or just a posterior procedure.

Cervical spine surgery complications can occur in early postoperative stage or they can be delayed and occur later. Sometimes, complications of cervical spine surgery are limited only to the approach of the surgery.

Given below are some complications involved in a cervical spine surgery:

There is a slightly higher rate of infection in case of a posterior cervical surgery than anterior cervical surgery. Patient develops superficial infections usually within the initial 10 days after the cervical spine surgery. Treatment for this can be done with the use of local wound care and oral antibiotics. Careful monitoring of the wounds should be done and if they do not respond to treatment, then irrigation and debridement should be done.

In case of deep infections, aggressive and early surgical debridement should be done to avoid late-onset osteomyelitis, meningitis, epidural abscess and catastrophic instrumentation failure.

This is the most damaging complication of cervical spine surgery. Neurologic deficit can occur from an intraoperative incident like injury to the spinal cord, displacement of the graft or posterior strut. Failure of the construct can also cause neurologic deficits in the patient. Detailed examination of the patient should be carried out and plain radiographs help in identifying the problem. In case of a lesion which has been missed, patient can have worsening of the neurological deficit. In such cases, a full series of imaging tests of the cervical, thoracic and lumbar spine should be taken. If it looks like patient needs postoperative CT or MRI scan, then they should be done immediately. Titanium implant is recommended as it is MRI-compatible. Postoperative imaging tests help in assessing the placement of the plate, screw, graft placement, and to check whether there is any impingement on the nerve roots, spinal canal or vertebral arteries.

If the hardware is the cause of the neural deficit in the patient after cervical spine surgery, then it should be removed immediately.

Dural tears occurring as a complication from cervical spine surgery can be identified perioperatively; and whether the tear is iatrogenic or traumatic, it should be repaired first. If the dural tears are irreparable, then the surgeon places and sews a fascial graft on the tear. Antibiotics should be started in case of dural tear and a wound drainage system should be avoided. However, a subarachnoid lumbar drain can be placed if there is a persistent leak. If there is still leakage, then re-exploration and repair of the tear needs to be done to avoid a spinal-cutaneous fistula from forming.

This is a false joint or nonunion of joint and it occurs when the graft bone interface fails to unite. Treatment of anterior Pseudoarthrosis, which produces symptoms in the patient can be done with fusion and posterior instrumentation fusion or a repeat anterior surgery.

If the fusion of the bones fails, then the implant also fails eventually and if there is an infection, then it speeds the process. Early hardware failure may be related to constructs, which are not sufficiently stable. If there is extrusion of the anterior plate or graft, then patient will have difficulty in swallowing and in serious cases, there may be airway compromise.

Late hardware failure (screw breakage) is commonly associated with nonunion. Patient may or may not have symptoms and may or may not need treatment.

This is a less frequent complication of the anterior cervical surgery and occurs due to damage or injury to the sympathetic plexus that can occur as a result of overzealous retraction of the prevertebral muscles. Patient has symptoms such as drooping of upper eyelid (ptosis), constriction of pupil (meiosis), and lack of sweating on the affected side of the face (anhydrosis).

This is difficulty in swallowing and it is the commonest complication occurring in about half of the patients who undergo cervical spine surgery with anterior approach. Dysphagia is often temporary and gets relieved in some days.

Patient experiences dysphonia, which is inability to speak due to problem with the vocal organs, tongue, mouth and throat. This complication of cervical spine surgery with anterior approach may occur in about 5% of the patients. Risk factors for this complication include revision surgery and exposure below the level of C5.