Possible Surgical Complications

[rohrer01]

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]

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]

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]

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]

on the other hand Dr Bridwell

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]

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]

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]

http://www.scoliosis.org/forum/showt...yphosis-(etc-)

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

[susancook]

http://drlloydhey.blogspot.com/2011/...cuba-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]

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]

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]

Call me the 1%

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]

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]

PJF question for Linda

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]

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.co...y-ligaments-17

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

--Linda