I am a cancer survivor facing spinal surgery for metastases to the spine. Before I head into this, I want to compare thes surgery with all its risks and complications versus not having surgery and taking my chances with the cancer spreading. I think I have a pretty good idea about the cancer side of things. What can you tell me about the risks involved with the surgery?

There’s no doubt complex spinal surgeries come with a whole host of potential complications and post-operative problems. Cancer metastasizing (spreading) to the spine is a particularly challenging problem. Without knowing the details of type of cancer (e.g., fast versus slow-growing) and location (e.g., vertebral bones, spinal cord, spinal column), we won’t be able to be specific.

But a recent report from Canada cataloguing intra- and post-operative problems associated with complex spinal surgeries might give you some of the information you are looking for. The thing that makes this study unique is the use of a spinal specific tool to measure all complications from minor to major and chart the severity of those problems.

Data was collected on 942 patients undergoing complex spinal surgeries before, during, and after spinal surgery. Some examples of the intraoperative “adverse events” include allergic reactions, heart attack, blood loss, pressure sores, nerve root injury, or other organ injury. Intraoperative refers to complications and problems that developed during the operation.

Pre- or post-operative adverse events ranged from heart failure, blood clot, and wound infection to delirium, pneumonia, urinary tract infection, and cerebrospinal leak. In both categories (intraoperative and pre- or post-operative), surgeons could report and record “other” complications and provide a description of what that was.

The grade given each problem ranged from the number one (event does not require treatment and has no adverse effect) to six (adverse event resulting in death). Deaths were more likely to occur in patients requiring emergency surgery for gunshot wounds, cancer, traumatic neck injuries, and spinal infections. Older adults with traumatic injuries were at the greatest risk of death during spinal surgery.

Four per cent of the total group had to have a second surgery. There was a variety of reasons for this including infection, nerve pain, problems with hardware, and the need for additional decompression of disc herniations. Infection was the number one reason why patients were readmitted to the hospital during the first year following the primary (first or initial) surgery.

Not surprisingly, the types of adverse events were different during surgery compared with after surgery. Blood loss, dural tears, and anesthetic-related problems were the most common intraoperative complications. After surgery, electrolyte imbalances, problems caused by medications, heart complications, urinary tract infections, and spinal deformities were among the most problems reported.

Patients who had to have emergency surgery for metastatic disease had a slightly higher morbidity (complications) and mortality (death) rate compared with those who had elective surgery. Patients with metastatic tumors of the spine were also more likely to develop significant problems due to deep infection.

Knowing that morbidity and mortality surrounding spinal surgeries is much higher than previously reported will give surgeons an opportunity to address this problem. Having the specifics about type of adverse events, severity of complications, and subgroups of patients most likely to be affected will also help direct prevention and treatment efforts.

Given this information, you may be able to come up with some questions for your surgeon that will better help you evaluate your own situation.