cervical discectomy adverse outcomes

This operation involves removing the disc in the neck which is protruding backwards into the tunnel (spinal canal) where the nerves to the arms run.  The operation is usually done for persisting "brachialgia" (pain in the arm) which is caused by the nerve in the spinal canal being irritated by a piece of disc.  It is NOT done with the hope of easing any neck discomfort although sometimes this does occur.

 The following list covers most of the common and/or serious risks of cervical discectomy.  However, you need to remember that the vast majority of patients have a good or excellent outcome from this operation and you need to keep in perspective the small chance of any of these events below occurring against the likely benefits of this operation. 

INFECTION: Infections can either be close to the skin surface (superficial) or deep in the wound (deep).  The risk of a superficial wound infection is approximately 5 in 100 (5%).  The risk of a deep infection is less than1 in 100 (1%).  There is a less than 1 in 1000 (0.1%) risk of an infection of the sac containing the nerves (dura) or in the fatty space around the sac (epidural space) or of the disc (disciitis).  Extremely rarely the build up of pus may cause nerve damage and require further surgery to drain the pus.

 NERVE DAMAGE:  The risk of direct surgical damage of the nerves or spinal cord is less than 1 in 1000 (0.01%).  Nerve damage can cause only slight numbness or weakness to total loss of function below the level injured. Permanent loss of nerve function is very unlikely.

 DURAL TEARS:  The sac (dura) containing the spinal cord is usually very strong.  However it can be torn during surgery.  Often the tear can be sutured or patched but you may be required to spend some days after the operation flat in bed.  Very rarely with persisting leakage of the fluid in the sac (CSF) a further operation may be required to stop this. There have been isolated reports of cerebral (brain) haemorrhage occurring after dural tears.

 ARACHNOIDITIS/EPIDURAL SCAR: Scarring occurs around the nerves and the sac (epidural scar) and rarely may cause ongoing brachialgia in a few patients (less than 1 in 100 (1%)).  The scarring can be caused by both the associated inflammation from the disc prolapse and from the surgery.  Less commonly (less than 1 in 100 (1%)) scarring occurs within the nerve itself (arachnoiditis).  Further surgery is unlikely to improve persisting symptoms from arachnoiditis and epidural scar.  Indeed if either of these problems occur treatment is limited.

 HAEMATOMA/EPIDURAL HAEMATOMA: Following any surgery excessive bleeding may occur.  The blood may then accumulate and form a clot (haematoma).  The risk of developing a superficial haematoma is less than 5 in 100 (5%).  The risk of a deep haematoma which surrounds the nerves (epidural haematoma) is less than 1 in 1000 (0.1%).  An epidural haematoma may press on the nerves and cause them to stop functioning properly and may necessitate further surgery to remove the blood clot.  A haematoma in the surgical wound may also very rarely press on the windpipe (trachea) in the first few hours after surgery and if severe may need urgent drainage.

 FAILURE OF FUSION: In around 2-3% of cases the bone graft fails to fuse across the disc space.  This may not cause any problems but sometimes further surgery may be required to get the fusion to succeed.

 MISCELLANEOUS:  The surgical access to the front of the spine runs past several other structures.  One of these is a nerve (recurrent laryngeal nerve) which supplies the vocal cords.  In a small percentage of patients this can stop working after surgery and cause a hoarse voice.  Extremely rarely this is permanent.  The swallowing tube (oesophagus) also runs in the front of the neck and there have been reports of damage to this structure requiring further surgery to repair it.  More commonly most people experience some throat soreness for a few days and mild difficulty swallowing for 2 to 4 weeks.  The carotid artery also runs nearby and can be potentially injured although this is extremely rare.  In older people there is a small risk of a stroke from the need to move the artery to the side during surgery.  A specialised nerve system (Sympathetic Nerves) can be damaged and lead to a Horner's syndrome (drooping of the eyelid and a dilated pupil on the affected side).

 DVT or PE: DVT (Deep Vein Thrombosis) refers to clots forming in the deep veins of the legs.  DVT's which cause symptoms occur in less than 5% (5 in 100) patients.  Clots may travel from the deep veins in the legs and lodge in the blood vessels in the lungs (PE or Pulmonary Embolus).  When this happens it may cause no symptoms at all but occasionally it can cause breathlessness and chest pain.  Extremely rarely ie, less than 1 in 1000 (0.01%) it can cause sudden death.

Please also note that it has been shown that smoking significantly increases the risks and complications of surgery and reduces the chance of a successful outcome.