What is Complex Spine Surgery?
Complex spine surgery is a procedure that involves six or more vertebrae of the spinal column, requiring six or more hours of surgery to correct a spinal deformity. Complex spine surgery is very difficult to perform and demands the highest level of patient dedication to be successful.
Anatomy of the Spine
The spine consists of 33 vertebral bones stacked one on top of the other with cushioning discs lying between each vertebra. It is divided into 7 cervical vertebrae (neck), 12 thoracic vertebrae (mid back), 5 lumbar vertebrae (lower back), 5 sacral bones, and 4 coccyx bones. The sacral and the coccyx bones are fused and do not provide any movement in the spine. The spine plays a key role in the smooth movement, stability, and protection of the delicate spinal cord, and giving symmetry and support to the body.
Indications for Complex Spine Surgery
People requiring complex spine surgery usually have serious spinal deformities, major curvatures, severe spinal trauma, spinal tumors, or degenerative spine conditions, including:
- Spinal stenosis
- Disc herniation
- Degenerative disc disease
- Revision spine surgery
Preparation for Complex Spine Surgery
A preoperative assessment will be made before complex spine surgery to check your overall health and to ascertain your preparedness for the surgery. Your doctor will explain the pros and cons of the procedure in detail and discuss the anesthesia to be used. Make sure to inform your doctor about any medications or supplements you may be taking, especially medications that can thin your blood such as aspirin. Your doctor may recommend stopping these medications temporarily before your surgery. Advise your doctor about any allergies to medications or latex. If you are a smoker, inform your doctor, as nicotine prevents bone fusion needed for long-term spinal stability. Your doctor may provide you with options to help you quit. Your doctor will also discuss the need to avoid food and drink after midnight the night prior to your surgery.
What Happens During Complex Spine Surgery?
The steps involved in complex spine surgery usually include:
- Approaching the spine with a surgical cut down the back
- Removing the laminae, the bony parts of vertebral bone that jut out from the spine
- Implanting bone grafts between the vertebrae
- Placing hardware, such as bolts, screws or titanium rods, to grasp the vertebrae together in order to straighten the spine
- Taking images to ascertain everything is properly aligned
- Closing the surgical cut with removable staples or sutures
In some cases of spine deformity correction, the bone should be cut and realigned prior to placement of hardware. The hardware stabilizes the spine and holds everything in position for healing to occur. The bone grafts fuse with the spine to form solid bone during the healing process.
Postoperative Care and Instructions
Post-surgery, you will be transferred to the recovery area for close observation and care. You will be connected to various equipment, such as a pulse oximeter to measure oxygen level, IVs for fluids and medications, a catheter connected to your bladder, and compression stockings on your legs to prevent blood clots. You will experience significant pain and will be provided with pain medications, muscle relaxants, and ice packs to keep you comfortable. You are encouraged to participate in activities such as sitting in a chair, standing and walking, to aid in mobility and prevent stiffness. You will be advised to wear a back brace to protect your back from excessive bending and twisting movements and to allow healing of the spine. A customized physical therapy program will be designed as part of your recovery plan. You will be instructed on activity modifications, diet, wound and dressing care, bathing, driving, and the need to stay away from smoking as part of the healing and recovery process. Follow-up appointments will also be scheduled to monitor your progress.
Risks and Complications of Complex Spine Surgery
As with any surgical procedure, complex spine surgery involves potential risks and complications that include:
- Damage to nerves and arteries
- Persistent pain
- Anesthesia-related complications
- Blood clots or deep vein thrombosis (DVT)
- Spinal cord injury
- Hardware fracture
- Implant migration