What kind of problems can crop up with lumbar spinal surgery? I’m going to have a fusion where the surgeon comes in from the side rather than the front of back of the spine. This is supposed to avoid any problems running into organs, blood vessels, or the spinal cord (or so the surgeon tells me). I understand this is a new way to do the operation so I’m doing some checking on my own to find out what could go wrong. I trust my surgeon, but you know, it’s always good to be prepared.

Before performing the fusion, your surgeon will review problems that can develop as a result of any surgery and specifically for this particular procedure. Perhaps you have already heard some of this but let’s start with general complications. There is always a risk of blood clots and infection with any procedure. Poor wound healing or delayed wound healing is also possible.

Some complications are strictly dependent on the type of surgery being performed. In the case of a lumbar fusion, failure to form a solid bone fusion can result in movement at the spinal segment that is not supposed to move. If hardware such as metal plates, cages, screws, or pins are used, they can come loose and migrate or move.

Each approach to spine surgery (anterior from the front, posterior from the back, or lateral from the side) comes with its own potential problems. For example, entering the spine from the back increases the risk of dural tears, nerve damage, and even paralysis from spinal cord injury.

Dural tears refer to damage of the very thin lining around the spinal cord. This can be a serious complication resulting in cerebrospinal fluid (CSF) leaking out. Cerebrospinal fluid is the fluid that bathes and protects the brain and spinal cord. Any leakage can lead to much more serious problems. Dural tears were most often reported in association with posterior lumbar fusion.

Trying to reach the spine from the front of the body means moving large blood vessels like the aorta out of the way and avoiding organs such as the kidneys, bladder, or intestines. The risk of bleeding is much higher with an anterior approach to fusion.

A lateral approach means the surgeon enters the body and spine from an angle between the front and back. A new twist on reaching the spine from the side is called the extreme lateral approach. The surgeon comes in from the front and side of the spine. A special tube is placed through the lateral abdomen, through the psoas (anterior hip muscle), and to the spine. With this portal (pathway), the surgeon avoids major blood vessels, organs, the spinal cord, and nearby spinal nerve roots.

There can still be some problems with the lateral approach. The most likely one associated with the extreme lateral approach is thigh pain and muscle weakness from a psoas abscess. The psoas muscle is a hip flexor that the surgeons pass their instruments through when using the extreme lateral approach. Fortunately, most patients who have this problem recover fully within the first two months after surgery.