From the Guidelines
Lumbar surgery is generally considered a moderate-risk procedure rather than high-risk surgery. The risk level varies depending on the specific type of lumbar surgery being performed, with minimally invasive procedures carrying lower risks than complex spinal fusions or revisions. Factors that influence risk include the patient's age, overall health status, presence of comorbidities (especially cardiovascular or pulmonary conditions), obesity, smoking status, and the complexity of the surgical approach 1. Common risks associated with lumbar surgery include infection (occurring in 1-4% of cases), bleeding, nerve damage, dural tears leading to cerebrospinal fluid leakage, blood clots, and anesthesia-related complications. More extensive procedures like multi-level fusions carry higher risks than simpler decompressions. The surgical approach also matters, with anterior approaches potentially risking damage to major blood vessels. Patient-specific factors significantly impact risk assessment, with diabetic patients facing higher infection rates and elderly patients experiencing more complications 1. While serious complications are relatively uncommon, patients should have thorough preoperative evaluations and discussions with their surgeon about their individual risk profile before proceeding with lumbar surgery.
Some key considerations for assessing the risk of lumbar surgery include:
- Patient-related factors, such as age and comorbidities 1
- Operative factors, such as the complexity of the surgical approach and the type of procedure being performed 1
- Institutional factors, such as the hospital's infection control protocols and surgical volume 1
- The use of risk stratification models and calculators to predict infectious risks and optimize outcomes 1
It is essential to note that the risk of lumbar surgery can be minimized with proper patient selection, preoperative evaluation, and perioperative care. A comprehensive approach to infections across the surgical pathway is crucial to reducing the risk of surgical site infections and improving patient outcomes 1. By considering these factors and taking a comprehensive approach to infection prevention, patients and surgeons can work together to minimize the risks associated with lumbar surgery and achieve the best possible outcomes.
From the Research
Lumbar Surgery Risks
- Lumbar spine surgery is a frequently performed procedure with increasing surgical invasiveness, leading to higher postoperative complications 2.
- The incidence of perioperative complications and adverse events in lumbar surgery is significant, with 15.7% of operations experiencing complications 3.
- Elderly patients and those undergoing more invasive surgeries are at a higher risk of complications 3.
High-Risk Patient Considerations
- High-risk patients, such as those with ASA III classification, can undergo lengthy complex lumbar fusion surgery under spinal anesthesia with minor post-operative complications 4.
- Spinal anesthesia may be a suitable option for high-risk patients, as it can reduce systematic stress, blood loss, and post-operative delirium 4.
- However, the safe limits of spine surgery under spinal anesthesia remain undetermined, and further research is needed to define the temporal limits and etiology of post-operative complications 4.
Evidence for Lumbar Spine Fusion
- The available evidence does not support a benefit from spine fusion compared to non-operative alternatives for back pain associated with degeneration 5.
- The risk of serious complications and high cost burden associated with lumbar spine fusion surgery highlights the need for careful consideration and informed decision-making 5.
- Spinal anesthesia may be associated with better perioperative hemodynamic stability, lower costs, and a lower perioperative complication rate compared to general anesthesia in high-risk patients 6.