I’ve heard that spinal fusion surgery is simple, effective, and low risk. But my mother just had this procedure and then had a stroke two weeks later. Why was she allowed to even have this surgery if there was a risk of a stroke?

If you have ever had surgery of any kind or even known someone else getting ready for surgery, one thing is always discussed preoperatively. And that’s the possible complications. Though most post-op problems are uncommon or even rare, it is still the responsibility of the health care provider to review all possibilities with patients. Infection, blood clots, heart attacks, stroke and even death are all listed for major spine surgery.

It is very unfortunate that your mother suffered a stroke following spinal fusion. Stroke is a rare complication after spinal fusion and not one that can always be predicted. In fact, there may not be a direct link between the surgery and the stroke. In other words, your mother might have had that stroke even if she had not undergone spinal fusion.

Since back pain can limit a person’s activity level, it is possible that spinal fusion could actually lower someone’s risk of stroke. That was one of several conclusions from a recent study from Taiwan. They investigated the risk of stroke following spinal fusion surgery — the very thing you are wondering about!

Taiwan has a unique study situation in that the entire one million population is covered by a government-run health insurance. Everyone has free and unlimited access to health care even if they are traveling or out of their own country and receive treatment overseas.

This type of system makes follow-up easier and more predictable. Even if a patient in a study like this goes somewhere else within the system, the records are still available for follow-up. Therefore, incidence rates calculated tend to be more accurate and estimates of stroke risk more reliable.

Out of one million people, there were 2,249 who had spinal fusion. This group was matched with a very similar group of 2,203 adults who did not have spinal fusion. When we say the groups were “matched” closely, it means they were the same ages, gender (male versus female), education level, income level, and living location (rural versus urban). They were also very similar in terms of general health and the presence of other health problems such as diabetes, high blood pressure, heart or lung disease, and so on.

The rates of stroke during a three-year follow-up were compared. They found no differences between the two groups (those who had spinal fusion surgery and those who did not). In fact, the spinal fusion group had slightly (though not significantly) lower rates of stroke.

The authors suggest some possible reasons for these results. As we already mentioned, stabilizing the spine reduces pain and improves function. Patients who were previously inactive or sedentary because of back pain can increase their activity and exercise after spinal fusion. This effect could reduce the risk of stroke.

Surgeons do screen patients before surgery in order to select those who are more likely to have a positive result. Anyone with significant health problems may not be accepted for surgery. The healthier and more active someone is before surgery, the more likely they will have fewer complications and better results after surgery.

Your mother would not have been approved for spinal fusion surgery if there were any obvious risks of stroke or other potential post-operative problems. This rare but still unfortunate outcome may have had nothing to do with the surgery.