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LindaRacine
06-23-2013, 09:13 PM
One member has requested a list of complications from scoliosis surgery. The following list is everything I've heard of.

Short-Term:
Infection
Pulmonary embolus
Epidural hematoma
Extreme blood loss
ileus
Trochanteric bursitis
Neurologic damage - minor
Neurologic damage - major
Death
Lymphedema
Leg swelling
DVT
Heart issues
Pneumonia
Blindness
UTI
Dural tear

Long-Term:
Significant neurologic damage
Minor neurologic damage
Infection requiring rehospitalization
Painful or prominent implants
Coronal or sagittal imbalance
Lymphedema
Blindness
Incisional hernia
Increased pain
Pseudarthrosis/failure to fuse, broken implants
Numbness
Pancreatitis
Gall bladder disease

kennedy
06-23-2013, 10:40 PM
Linda there one rare one Superior mesenteric artery (SMA) syndrome

susancook
06-24-2013, 01:17 AM
I had mild pulmonary atelectasis postop.
Susan

Singer
06-24-2013, 07:41 AM
Other than all that.....a piece of cake. ;^)

jackieg412
06-24-2013, 07:47 AM
Linda---do you have any information on fractures above the fusion,or juncional kyphosis, As this is what happen to me--I need the info for someone else. Also any info on a time line--such as is there a number of years later that a problem can come up.Thanks

JenniferG
06-24-2013, 06:13 PM
I was given this list at my surgeon's appt. and it very nearly did my head in. I set the date for surgery that day , but couldn't go ahead with it. I became depressed thinking about my miserable options. But after a while, I realised that each of these items on the list are rare and *most* are fixable. And life wasn't going so well for me as my scoliosis was progressing rapidly and my future looked increasingly grim. So I got as fit and healthy as I could to minimise my risks, and with that fitness came a new confidence. When I set my second surgery date, I had a completely different mindset.

It's a shock to see that list, but I think along with those risks should come a list of percentages of patients these risks actually happen to. All surgeries carry risks, unfortunately.

titaniumed
06-24-2013, 07:40 PM
Jackie

I sent you a few PJK links.....and as much as the PM system will allow....

I have to add to the long term list.....

Adhesions....(scar tissue) internal adhesions to be specific.

Ed

LindaRacine
06-24-2013, 11:04 PM
Jackie...

As you'll find, I assume, by looking at the links that Ed provided, that PJK is very common in adult patients, and probably increases with age. Fractures within or above the fusion are also common in patients with poor bone quality. A lot of surgeons have started cementing vertebrae at the top and bottom of the fusion for at risk patients.

As far as a time line, we think that PJK occurs early (between surgery and 6 weeks postop). I don't know the timeline for fractures. Everything else will present in the early postop period, with the exception of late onset infections, which while rare, can occur years after surgery.

--Linda

susancook
06-25-2013, 05:38 PM
Jackie...

As you'll find, I assume, by looking at the links that Ed provided, that PJK is very common in adult patients, and probably increases with age. Fractures within or above the fusion are also common in patients with poor bone quality. A lot of surgeons have started cementing vertebrae at the top and bottom of the fusion for at risk patients.

As far as a time line, we think that PJK occurs early (between surgery and 6 weeks postop). I don't know the timeline for fractures. Everything else will present in the early postop period, with the exception of late onset infections, which while rare, can occur years after surgery.

--Linda

What is PJK?
Susan

Pooka1
06-25-2013, 05:55 PM
http://www.scoliosis.org/forum/showthread.php?11645-Incidence-Risk-Factors-and-Classification-of-Proximal-Junctional-Kyphosis-(etc-)

susancook
06-25-2013, 05:57 PM
Other than all that.....a piece of cake. ;^)

Chris, you are so funny! If some of the side effects don't kill you, the recovery just might!

I also laughed since your comment came after my post about the pulmonary atelectasis. The pulmonary atelectasis wasn't as scary as the response team that came to my rescue. Postoperatively, I suddenly had chest pain and shortness of breath. I waited a few minutes trying to do some slow deep breathing, but the SOB continued as did the chest pain. I knew that pulmonary embolus was a post operative possibility, so I pressed the call button. The med assistant finally answered my call, and leisurely strolled into the room, then quickly pressed some call button to summon a rapid response team that supposedly assembles within 5 minutes. In short order, there were 2 MDs, a couple of RNs and I had an O2 mask on, an IV in, and they ordered an EKG and a chest X-ray which were done very quickly. Apparently, the team is timed for the response within 5 minutes and they all were proud, after the tests were done, that they had accomplished their goal. The whole thing to me was funny as it took the MA 10 minutes to answer my call bell! The X-ray just showed some mild atelectasis, so I ended up blowing a pressure controlled machine to expand that section of lung.

Susan

Pooka1
06-25-2013, 05:57 PM
In August 2010, I performed a posterior thoracic laminectomy decompression and extension fusion with osteotomies to correct his kyphosis. This problem is called “PJK” -- proximal junctional kyphosis — and is a complication that can happen after spinal fusions, especially longer fusions. The reason for this problem is that there are higher loads at this junction point wear old fusion ends and unfused spine begins.

http://drlloydhey.blogspot.com/2011/07/mike-tells-us-of-amazing-scuba-trip.html

golfnut
06-25-2013, 07:40 PM
Yikes! What a scary list!

I asked Dr. Lenke about some of the most major complications (and I didn't even include "death") and his comment was "less that one per cent".

mabeckoff
06-25-2013, 08:05 PM
Yikes! What a scary list!

I asked Dr. Lenke about some of the most major complications (and I didn't even include "death") and his comment was "less that one per cent".

That is just what Dr Bederman said ; less than one per cent

titaniumed
06-25-2013, 09:30 PM
I was given this list at my surgeon's appt. and it very nearly did my head in. I set the date for surgery that day , but couldn't go ahead with it. I became depressed thinking about my miserable options. But after a while, I realised that each of these items on the list are rare and *most* are fixable. And life wasn't going so well for me as my scoliosis was progressing rapidly and my future looked increasingly grim. So I got as fit and healthy as I could to minimise my risks, and with that fitness came a new confidence. When I set my second surgery date, I had a completely different mindset.

It's a shock to see that list, but I think along with those risks should come a list of percentages of patients these risks actually happen to. All surgeries carry risks, unfortunately.

For newbie’s that are reading this “eye opening” thread.......... Jen explains things best with her post, I just had to comment on it.

Surgeons are required to notify you of certain complications, and they don’t want to scare you, but its something that we need to to know about. I remember my “discussions” with my surgeon, and it was an eye opener I must say. Its impossible to list all orthopedic complications, or when they “might” or “could” happen.....I walked out of that meeting a complete zombie. I mean, what the heck? Why am I doing this? and also why did I wait so long? Double trouble. Man-o-man.

I think that the bottom line when I went back into the office for discussions was hearing him say “It will help”. Those words sealed the deal. Nobody ever wants any of this stuff to happen, but the body is just TOO complicated.....things can happen, and they happen with the best of surgeons. Surgery is usually a last ditch effort, and this thread will help many understand this statement, or at least take their time in making a decision. Scoliosis surgery is serious surgery, its something that you just don’t rush into....but you also don’t want to wait till the door slams shut. It’s a tricky decision.

I was told to get online and join a scoliosis forum. Great advice I must say, I didn’t post before my surgeries but was reading here.

Deep down, I knew that it wasn’t going to be an easy thing.....I also knew that my “healing attitude” was going to have to be good. My success DEPENDED on it.

Children have this healing attitude “built in”....... As scared as they might be, they quickly realize that they have to get the job done. It essentially becomes a mission, and if something happens, they adapt quickly. They also have total trust in their surgeons. Maybe this is a good way to look at it, learn from the kids....they teach us so much.

Ed

rohrer01
06-25-2013, 10:19 PM
Linda,
Since your list isn't in alphabetical order, shouldn't DEATH be listed LAST under the short-term problems? Just a thought as it looks like you just kind of slipped it in there. It still stands out worse than a sore thumb.

leahdragonfly
06-26-2013, 12:09 AM
Death is actually a known or possible complication anytime someone undergoes anesthesia, even for minor surgery. It is not a unique complication to scoliosis surgery.

The one that really got me (first I heard of it was from the anesthesiologist as I was wheeled into surgery---yikes) was the risk of blindness. Holy shit.

Pooka1
06-26-2013, 05:44 AM
Death is actually a known or possible complication anytime someone undergoes anesthesia, even for minor surgery. It is not a unique complication to scoliosis surgery.

The one that really got me (first I heard of it was from the anesthesiologist as I was wheeled into surgery---yikes) was the risk of blindness. Holy shit.

My one kid (but not the other!) had blurry vision for 3-4 days after the surgery. I knew about the blindness thing which I believe is from being in the prone position too long or incorrectly or something. I was very worried and asked the surgeon about it but it cleared up. Pretty scary.

jackieg412
06-26-2013, 08:02 AM
Ed you always word everything so well. I wished I could have posted or talked to you before my surgery. I had 5 opinions from different doctors and all expressed the very nature of this type of surgery leaves many things to think about. I think another area to have concern about, is your job. As I lost both of mine after the surgery made it impossible to keep them. There is more to this but I can't post about it just yet. I have had some of these problems --the worst was the fracture of the t-9 level--it occured 6 days after the 1st surgery and wasn't fixed until 2 years later. Really tough to live with that pain that long.But the extention of the fusion helped me.
Another problem that I had was becoming diabetic{not in the true since}for the first week after the second surgery. It was interesting!

gardenia
06-26-2013, 12:44 PM
I found that during my first couple of visits with Dr Bridwell that he spoke to the xrays and his staff a lot more than to me. He answered if I asked a question. And, when spoke to me was in short summarized sentences. Then, we met with his nurse Bernie who has a bit longer time alloted to us.

Thank God that I was not looking for understanding but by evaluating the consult Dr Bridwell gave me total confidence that he was the right 'artist' 'plumber' professional to do the job.

My mind made up about the process, I had to purchase books and look thru the internet about what to expect at the hospital. Nothing would describe it. However, I knew that after the surgery it was all up to me to heal.

I had extremely good physical support from my husband but not until after the 7 months of recovery that I started falling into a myriad of little changes and pain returning in my back that I was freaking out. This is the mental and medical portion to which I had zero support.

I rested for the first 6 months and was almost a veggie. After my 6mos visit to St Louis, problems started. I was let to use the walker 50-50 and I chose later to about 90/10 big mistake. The new PT fellow was very young and told me all the goals I should achieve at the one year mark which to me meant I should go home and start building up (in less than a couple of weeks) that cause severe problem on my hip to sacrum then up the spine.

I was walking way too fast on the treadmill going from 1.2 to 1.8 in less than a week. I am back to .5 because for 3 weeks I was in so much pain.

Then I lost my sense of taste but not smell thus producing a gagging effect to food I put in my mouth. I starting biting the tip of my tongue and the side. I was having lots of indigestion like piercing holes. Read a lot on the internet and self medicated with zinc that made the first double dosis as bad as stepping into my coffin. But, my primary physician did a blood panel and nothing was missing.

I am happy that my girls are grown and on their own, I do not have a fulltime job, mu husband works from home and cooks all the meals. At a younger age I would have been really stress versus taking it easy every day.

A lot of the pain is caused by the brain and our own fears. Sometimes knowing too much can be as dangerous as our imaginations travel off road a lot specially if one does not have a support group (as in a GPS) to help you make decisions and discard crazy thoughts.

God Bless. It was a major sugery but after it is perfomed there is no trained personnel to hand hold us.

Confusedmom
06-26-2013, 11:30 PM
I like what Linda always says: "The complications don't matter, unless they happen to YOU."

I think to have this surgery performed, your daily life or apparent future daily life has to be so bad that you are essentially willing to take the chance that you will give it up in order to try to improve your situation. Otherwise, it would be impossible to live with the rare but existing complications like blindness and intractable nerve pain.

Then, as Jennifer said, do everything you possibly can to prevent the complications. Get the best surgeon possible. And get in the best shape possible. And calm yourself by keeping in mind that the serious complications really are statistically unlikely to happen to you.

susancook
06-27-2013, 12:17 AM
My one kid (but not the other!) had blurry vision for 3-4 days after the surgery. I knew about the blindness thing which I believe is from being in the prone position too long or incorrectly or something. I was very worried and asked the surgeon about it but it cleared up. Pretty scary.

Pooka, I had diplopia or double vision for about 5 days after surgery which made reading anything impossible. I attributed it to anesthesia/medication in general.

I agree w/ Gayle about the oh shit of blindness after surgery. That was my precise feeling. I did look it up in the medical literature at the time, but now everything is a fog that happened right before and after surgery.
Susan

susancook
06-27-2013, 12:23 AM
http://www.scoliosis.org/forum/showthread.php?11645-Incidence-Risk-Factors-and-Classification-of-Proximal-Junctional-Kyphosis-(etc-)

My specialty is OBGYN, so that article was as clear as mud. Thanks for taking the time to provide it.
Susan

susancook
06-27-2013, 12:36 AM
http://drlloydhey.blogspot.com/2011/07/mike-tells-us-of-amazing-scuba-trip.html

Thanks. I get it, finally. I am fused to the sacrum with fixation, so I don't think that load bearing will hurt the distal vertebrae.

Thanks for trying to increase my knowledge. Susan

LindaRacine
07-19-2013, 07:18 PM
I got a list of complications from one of the paper presenters at IMAST last week. This is super comprehensive.

Infection
• Major
o Deep
o Pneumonia
o Sepsis
• Minor
o Superficial
o UTI
o C Diff infection

Implant
• Major
o Hook dislodgement
o Interbody fracture
o Interbody migration
o Rod fracture
o Rod dislodgement
o Screw fracture
• Minor
o Painful implants
o Prominence
o Screw malposition
o Interbody subsidence
o Crosslink dislodgement
o Set screw dislodgement
o Screw bone interface loosening

Radiographic
• Major
o DJK
 Not requiring surgery
 Requiring surgery
o PJK
 Not requiring surgery
 Requiring surgery
o Pseudoarthrosis
• Minor
o Coronal imbalance
o Curve decompensation
o Heterotopic ossification
o Sagittal imbalance
o Adjacent segment degeneration

Neurologic
• Major
o Visual deficit/blindness
o Brachial plexus injury
o CVA/Stroke
o Spinal cord injury with incomplete deficit
o Spinal cord injury with complete deficit
o Nerve root injury with weakness
o Retrograde ejaculation
o Bowel/Bladder deficit
• Minor
o Neuropathy or sensory deficit
o Pain (radiculopathy)
o Peripheral nerve palsy
o Delirium

Mortality
• All major

Cardiopulmonary
• Major
o Cardiac arrest
o Pulmonary embolism
o Respiratory arrest
o DVT
o Congestive heart failure
o Myocardial infarction
o Reintubation
o Acute Respiratory Distress Syndrome
• Minor
o Coagulopathy
o Arrhythmia
o Pleural effusion
o Hypotension
o Congestive heart failure

Vascular
• Major
o Vascular injury
• Minor
o coagulopathy
o Thrombophlebitis

Gastrointestinal
• Major
o Obstruction
o Perforation
o Bleed requiring surgery
o Pancreatitis requiring surgery
o Cholecystitis requiring surgery
o Liver Failure
o SMA Syndrome
• Minor
o Ileus
o Bleed not requiring surgical intervention
o Pancreatitis not requiring surgery
o Cholecystitis requiring surgery

Renal
• Major
o Acute Renal failure requiring dialysis
• Minor
o Acute Renal failure requiring medical intervention

Operative
• Major
o Retained sponge/instrument
o Wrong surgical level
o Unintended extension of fusion
o Vascular injury
o Visceral injury
o EBL >4L
• Minor
o Dural tear
o Fixation failure (hook/screw)
o Implant failure
o Pedicle fracture
o Posterior element fracture
o Vertebral body fracture

Wound Problems
• Major
o Dehiscence requiring surgery
o Hematoma/seroma with neurological deficit
o Hematoma/seroma, no neurological deficit requiring surgery
o Incisional hernia
• Minor
o Hematoma/seroma not requiring surgery
o Hernia

jackieg412
07-21-2013, 03:18 PM
Thanks Linda for posting the update. It is what I needed but I do not know if they will accept it from me or not. I did send you a PM explaining more I hope you read it. Thanks Again,Jackie

susancook
10-21-2014, 05:32 PM
Yikes! What a scary list!

I asked Dr. Lenke about some of the most major complications (and I didn't even include "death") and his comment was "less that one per cent".

Just wanted to add another postop problem to the list that was alluded to previously, is an extension of proximal Junctional kyphosis which is "proximal Junctional failure". This can play out as a fracture or in my case, as a spinal cord injury. So, guess that I am in that magical 1%. Hmmmmmm, why don't I feel special?

Susan

LindaRacine
10-21-2014, 06:44 PM
Hi Susan...

I'm unclear about the spinal cord injury. Is your surgeon saying that the injury was caused by the screw plowing through your bone? Or, was the screw placed badly in the first place? If the screw plowed through the bone, than the culprit is actually bone quality instead of surgery. BTW, proximal junctional failure is, essentially, PJK that requires treatment.

--Linda

leahdragonfly
10-21-2014, 08:10 PM
Hi Linda,

I did a little reading about PJF on PubMed…it mentions that PJF is due to either fracture or from soft tissues…the fracture part I get, but can you elaborate on how the soft tissues could be related to or cause PJF?

Thanks,

Gayle

LindaRacine
10-21-2014, 10:53 PM
Hi Gayle...

I believe it's the ligaments, which are disturbed during surgery. I'm actually not very versed in the way of ligaments, but I suspect that one of the big problems is that the posterior ligaments are cut, so it's easier for the anterior ligaments to pull down. Here's a drawing that shows all of the soft tissue:

http://www.coloradospineinstitute.com/subject.php?pn=anatomy-ligaments-17

I'm going to a cadaver course in a few weeks, and my goal is to understand how the ligaments work.

--Linda

susancook
10-22-2014, 12:50 AM
Linda, explain it to me! Susan

susancook
10-23-2014, 12:14 AM
Hi Susan...

I'm unclear about the spinal cord injury. Is your surgeon saying that the injury was caused by the screw plowing through your bone? Or, was the screw placed badly in the first place? If the screw plowed through the bone, than the culprit is actually bone quality instead of surgery. BTW, proximal junctional failure is, essentially, PJK that requires treatment.

--Linda

Linda, as I understand it, the kyphosis increased and thus pulled away from the hardware. By pulling away, the screw went into the thecal sac since the screws are screwed into the vertebrae at an angle. The screw was placed correctly, but the kyphosis of course was not anticipated. Osteoporosis, of course doesn't help the situation. Susan

LindaRacine
03-09-2016, 09:40 PM
Podium presentation on complications (http://www.abstractsonline.com/Plan/ViewAbstract.aspx?mID=3885&sKey=d1b8999e-9de7-4a85-a281-0b2a1528e85e&cKey=fa4d9425-0ee5-4d82-a258-233a70e352b9&mKey=d5dc0d6c-c6d9-4cb4-acb2-5b30d308f410)

1801

ksmom0611
04-25-2016, 11:26 AM
I hate to add to the list of issues here, but I had severe bleeding during the surgery, losing over 5 liters of blood. My kidneys shut down and I was in the ICU for 9 days (don't remember much). Things finally started to improve, I was in the hospital another 5 days, and my kidney levels were close to normal at 1 month post-op. We were completely unprepared for this. How could you be? Just beware that sometimes, sometimes, issues can arise. This was the second time at a major NYC hospital that this had occurred - only the 2nd time over decades. Lucky me!

LindaRacine
04-25-2016, 08:00 PM
It's already on the list (vascular).

Back-out
07-17-2016, 05:18 PM
I had mild pulmonary atelectasis postop.
Susan

Referring to your surgical history and measurements.
What scares me is your measurements are almost the same as mine are now, to a T, including the DDD and stenosis. Except that my tentative plan plus neurological monkeying around, is to go all the way to the pelvis.

You didn't mention your surgeon (at least, I didn't find the name). Were all the surgeries by the same person, and do you think that might have been a factor in the problems?

If approved, I will be operated on by Frank Schwab at HSS.
Quite worried about some neurological issues affecting my excretory functions - will start a separate thread about my surgery.
So sorry for all your troubles! I seem to recall seeing your story on a "regrets for surgery" thread but I may misremember.

Amanda

Back-out
07-17-2016, 05:26 PM
Susan, my measurements (with signature) are out of date.

Amanda

PS Hoping a duplicate entry (above) doesn't post too. Don't know what I did wrong.

Jjohnsonphd
07-17-2016, 05:34 PM
I woke from surgery with my eyes unable to work at the same time. If I open them both up, one will laze to the side and I have double vision and blurry vision. I can see fine with squinting one eye shut. I still have this almost 5 weeks later and I am petrified. I am finally (barely) able to go see an opthamologist And should go sometime next week. He said he has heard of this lazy eye after back surgery. I will keep you all informed as I get an actual diagnosis. I was so worried about paralysis, I never saw vision issues as a threat. This is obviously a rare complication. If he tells me I need surgery, I may lose my mind! Ack. Breathe.
Jana

susancook
07-18-2016, 03:05 AM
Referring to your surgical history and measurements.
What scares me is your measurements are almost the same as mine are now, to a T, including the DDD and stenosis. Except that my tentative plan plus neurological monkeying around, is to go all the way to the pelvis.

You didn't mention your surgeon (at least, I didn't find the name). Were all the surgeries by the same person, and do you think that might have been a factor in the problems?

If approved, I will be operated on by Frank Schwab at HSS.
Quite worried about some neurological issues affecting my excretory functions - will start a separate thread about my surgery.
So sorry for all your troubles! I seem to recall seeing your story on a "regrets for surgery" thread but I may misremember.

Amanda

Hi, Amanda: My shorthand seems to be confusing. My scoliosis was discovered when I was age 65, not 65 degrees. My curves were 24*, 36*. My fusion is to the pelvis.

Dr. Hu did my original surgery, Dr. Hiratzka my 2nd emergency surgery, and Dr. Hart my 3rd-5th surgeries.

I gratefully accept your "sorry for your troubles". I am in the "glad that I had surgery" section , but I have thought about posting in the "sorry" section, but I am grateful. If I had not had my original surgery, I would probably be on Dilaudid in a wheelchair by now. I was in a lot of pain and all of the alternative treatments did little to relieve the discomfort.

I wish you smooth sailing through your surgery.

Susan