The usual surgery of the lumbar disc herniation is the discectomy with laminectomy. During the procedure they open the blade (the back of the vertebra) and access the disc hernia by removing the remains of the disc. During this gesture, which may seem simple, complications can occur. These risks are usually put in a document that is called informed consent and that we must sign before the intervention. Today I want to comment on the complications that may occur.
There are also situations where the result is not expected or cannot solve the hernia or reproduce, but that will be discussed in other posts. I’m going to limit myself today to talking about complications.
To be operated on in the lower back area we are very likely to be put on a general anesthetic, ie, they sleep us whole with a series of drugs and put on a respirator. This device breathes through us while we are anesthetized through a tube and into the airway. To this must be added the surgical aggression itself.
A person can have diseases or alterations that increase the possibility of a complication. If I have hypertension, I am diabetic and besides I have had a heart attack recently, it is clear that the stress of the surgical process can hurt me. In contrast, a young, healthy person is less likely to have general health problems during surgery. Today these types of problems are minimized because anesthesiologists evaluate the patient’s health before surgery to see the feasibility of the same.
Nerve Root Injury
In the approach path, ie, where the surgeon enters to operate, there are other structures besides the disk that can be injured. One of the most important are the nerve structures that in the lower lumbar area are the nerve roots. Instruments are used to separate and to cut and these materials could in some occasion to damage the nerve roots. This root damage could lead to leg pain, loss of sensation and even partial paralysis of some muscle groups.
That being said, the most frequent occurrence is that the nerve is irritated by the manipulation around it. This inflammation causes leg pains that remind us of our sciatica. With medication and time this is palliated. There may also be symptoms in the leg due to the damage that the hernia caused in the root prior to the intervention. This is explained in the post about leg pain after surgery (leave a link).
Dural sac injury
Nerve roots leave the marrow. The marrow is surrounded by a structure that contains all the cerebrospinal fluid so to speak that is called dural sac (the layer is called dura mater). It is a closed structure filled with fluid that is communicated throughout the central nervous system, ie, brain and spinal cord. The nerve roots up to their exit from the spine are surrounded by this dural sac. During surgery it is possible that this dural sac will break accidentally when acting on the area.
When the dura is broken, there is a leak of the cerebrospinal fluid due to the defect that has been created. This gives mainly symptoms of headache when we are standing or sitting and is relieved when lying down. The mechanism explained in detail in the post about headache after epidural infiltration (leave link).
If the defect is not sealed alone and communication persists, a new surgery may be necessary to resolve the problem.
When opening with a scalpel we give access to microorganisms that can directly access deep tissues. Infections can be superficial in the area of the scar (most frequently) or even affect deep areas that require reopening to clean and avoid major evils.
In the previous section we talked about the rupture of the dural sac. If this happens and an infection occurs, we may end up suffering from meningitis with more serious consequences.
Hematoma or bleeding
The problem comes when bleeding occurs in deep structures that can compress and damage nerve roots. The most serious a priori consequence would be the appearance of a ponytail syndrome. This situation requires urgent surgery to evacuate the hematoma.
Pulmonary thrombosis and thromboembolism
This complication is common to many types of surgeries. When we are operated on or if we are in bed for a long time, the chances of the blood flowing thrombi (usually in the legs) increase. These thrombi can obstruct the venous flow and may swell and injure our leg. They can also detach themselves and go out of the way through the circulation in the form of emboli that obstruct the arteries that go to the lung. This causes the death of parts of the lung and can lead to death of the patient.
It is a very serious complication but it has decreased enormously with the medicines that exist. To prevent this, we will be pricked daily with a small syringe containing an anticoagulant. This we put it subcutaneously in the gut habitually.
I have flown over the different complications that can occur in lumbar disc hernia surgery. In future posts I will speak longer and tended of the complications that arouse interest.
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