What are the Risks of Spinal Fusion Surgery?

Spinal fusion surgery is an invasive procedure that requires cutting into healthy muscle fibers to fuse vertebrae with metal hardware, presenting many surgical risks.

• Muscle injury: Also known as muscle atrophy or fatty degeneration, muscle death occurs due to the surgical cutting involved and is the key source of pain after surgery.  That is due to loss of support, chronic inflammation, scar tissue, and tight fascia around atrophied muscles.  Recovery takes months, and the pain doesn’t always necessarily subside.  Additionally, there are other ways that fusion surgery can damage muscle: Paraspinal muscles may be cut, retracted for a long time, or have their nerve supply damaged. This can lead to loss of movement at one or more vertebrae, resulting in the muscle having less work to do and weakening quickly. Additionally, chronic disuse post-surgery can also reduce muscle activation, causing atrophy over time.
• Failed Fusion (Pseudarthrosis): This is a significant cause of pain. It occurs when the bones don't successfully fuse as intended. The bones don’t fuse completely, meaning the motion persists — causing ongoing discomfort and instability. This happens in up to 5-20% of cases, especially if the patient smokes, there’s poor bone quality (e.g., osteoporosis), or if the hardware loosens or breaks.
• Spinal Cord Injury: While spinal fusion is generally a safe and effective procedure, it does carry a small risk of complications, including a new or worsened spinal cord injury. This is a rare but catastrophic complication. The risk of SCI during spinal fusion surgery can be attributed to: 
• Direct mechanical trauma: The spinal cord can be injured by surgical instruments during the procedure. 
• Vascular compromise: The blood supply to the spinal cord can be disrupted, leading to an ischemic injury. This can happen due to excessive correction of a spinal deformity or stretching of the spinal cord. 
• Postoperative issues: In rare cases, a new SCI can occur after the surgery due to factors like postoperative hypotension or a delayed neurological deficit.
• Excessive Bleeding: Spinal fusion is a surgical procedure that carries a risk of significant blood loss, which can lead to various complications, including anemia. The amount of bleeding can vary depending on the complexity of the surgery, the number of vertebrae being fused, and individual patient factors. Causes of bleeding may include:
• Surgical exposure: The process of exposing the spine and stripping muscle from bone can cause bleeding from exposed muscle and bone surfaces.
• Bone bleeding: Procedures like laminectomy or osteotomy, which involve resecting bone, can cause substantial bleeding from the cancellous bone.
• Epidural bleeding: This is often the most problematic type of bleeding in spine surgery. The epidural venous plexus is a delicate network of veins that surrounds the spinal cord. Damage to these veins can lead to bleeding that is difficult to control without risking damage to nerves. 
• Large Blood Vessel Injury: A rare but catastrophic event, an injury to a major blood vessel near the spine can cause rapid, life-threatening bleeding.
• Adjacent Segment Disease (ASD): When vertebrae are fused, the segments above and below the fusion have to compensate for the lost mobility. This can put increased stress on these adjacent segments, leading to accelerated wear and tear and new pain. Fusing one level of the spine can put extra stress on the discs and joints above and below, leading to new pain and prolonged degenerative disc disease. When a segment of the spine is fused, the vertebrae directly above and below have to compensate for this loss of motion, leading to increased stress and strain on nearby segments, causing  accelerated degenerative disc disease that can lead to:c
• Spinal stenosis (narrowing of the spinal canal) that puts increased pressure on the spinal cord or nerves; 
• Disc herniation, where a disc can rupture, pushing out and irritating nearby nerves; or,
• Facet joint arthritis, in which the small joints that connect the vertebrae can become inflamed and arthritic.

• Nerve Root Damage: The surgery takes place near the spinal cord and nerves. Post-operative swelling or the nerves adjusting to their new position can cause temporary irritation, leading to pain, numbness, or tingling. In some cases, nerve damage can be permanent, especially if the nerve was compressed for a long time before the surgery. If nerve roots were already damaged (or became scarred post-surgery), symptoms like pain, numbness, or weakness may persist despite fusion.
• Hardware Failure: The screws, rods, or plates used to stabilize the spine during the fusion process can sometimes loosen, break, or irritate surrounding tissues, causing pain, and may need to be removed.  This can lead to symptoms like persistent or worsening back pain, muscle spasms, and a feeling of instability. In some cases, patients may even be able to feel a bulge or a scraping/grinding sensation (crepitus) near the surgical site. Even if the hardware is securely in place, it can still cause pain. Misplaced hardware can irritate or press on nearby nerves, leading to symptoms such as sharp, burning pain, tingling, or numbness in the back, arms, or legs. Sometimes, hardware can also be prominent under the skin, causing discomfort and a painful bump. In rare cases, a patient may have a sensitivity or allergic reaction to the metal used in the hardware, which can cause it to loosen. Just the nature of drilling and seating metal hardware into healthy bone can cause permanent muscle damage, injury to internal organs, permanent muscle damage, permanent disability, or even death. 
• Spinal Infection: Although rare, an infection at the surgical site can cause pain, swelling, warmth, and a fever. Infections can occur due to a longer surgical duration, the use of hardware, or more extensive or complex procedures. The incidence of surgical site infections (SSIs) after spine surgery varies, with reported rates ranging as high as 18.8%, depending on the complexity of the procedure and patient risk factors.
• Scar Tissue Formation (Epidural Fibrosis): While scar tissue is a regular part of the healing process, a buildup of scar tissue around a nerve root can put pressure on the nerve and cause pain. While scar tissue itself doesn't have nerve endings and typically doesn't cause pain, it can become a source of discomfort if it forms excessively around a nerve root, leading to compression, inflammation, or irritation. This is a common cause of "failed back surgery syndrome" (FBSS), a condition where patients experience persistent or recurring pain after a spinal procedure.
• “Flat Back Syndrome” is a condition that can occur after spinal fusion surgery, particularly in the lumbar (lower) spine. Usually, the spine has natural curves: an inward curve in the neck (cervical lordosis), an outward curve in the middle back (thoracic kyphosis), and another inward curve in the lower back (lumbar lordosis). These curves work together to keep the body's center of gravity aligned over the hips and pelvis, allowing a person to stand upright with minimal muscle effort. So, Flat Back Syndrome is a type of "sagittal imbalance," which means there's an imbalance in the front-to-back alignment of the spine. If the spine heals in an abnormal position, it can lead to poor posture, long-term discomfort, and progressive back pain.
• Spinal Fluid Leak: A spinal fluid leak, also known as a cerebrospinal fluid (CSF) leak, is a potential complication of spinal fusion surgery. Cerebrospinal fluid (CSF) is a clear liquid that surrounds and cushions the brain and spinal cord. It is contained within a protective membrane called the dura mater. A CSF leak occurs when there is a tear or hole in the dura mater, allowing this fluid to escape. Spinal fusion surgery involves working near the spinal cord and its protective coverings. During the procedure, the dura mater can be accidentally torn, leading to a CSF leak. This is a known complication of spine surgery, and while the surgeon will attempt to repair any tear at the time of the operation, a leak can still develop afterward.
• Sacroiliac (SI) Joint Pain: The SI joint , located at the base of the spine, can experience increased stress after spinal fusion, leading to pain. The primary reason for SI joint pain after spinal fusion is a change in the way forces are distributed throughout the lower back and pelvis. When vertebrae are fused, the mobility of that segment of the spine is eliminated. This causes the adjacent joints, including the SI joint, to compensate for the lost motion. The SI joint, which usually has minimal movement, may be subjected to increased stress and strain, leading to several potential problems. Research has shown a significant percentage of patients with persistent back pain after spinal fusion have SI joint pain, with some studies reporting the incidence to be between 16 and 32 percent.
• Heart Attack: The risk of a heart attack during or after spinal fusion surgery is a serious but relatively rare complication. Studies have shown that the incidence of cardiac complications after spine surgery is low, but the consequences, including mortality, can be significant for those who experience them. While the event itself is rare, the 30-day mortality rate for patients who do have a cardiac event after lumbar fusion can be alarmingly high, with one study reporting a rate of 24.6%.
• Pneumonia: Pneumonia is a known risk and potential complication of spinal fusion surgery, and it's a concern that is addressed by medical professionals both before and after the procedure. The stress of surgery and the use of anesthesia can affect a patient's respiratory system. Anesthesia can alter lung volumes, reduce the drive to breathe deeply, and impair muscle function. This can lead to atelectasis (pulmonary collapse), where parts of the lungs don't inflate properly, creating an environment where bacteria can grow. After spinal fusion, patients are often limited in their movement, which can make it challenging to take deep breaths and cough effectively. Pain from the incision can also lead to shallow breathing, further increasing the risk of fluid and secretions building up in the lungs, which can lead to pneumonia. 

Deuk Spine Institute treats and cures back and neck pain.  If you’re looking for back pain relief, if you’ve been recommended for a spinal fusion, or are continuing to live with chronic back pain after failed fusion surgery, we can get your quality of life back and help you live pain-free. No cutting or compromising healthy bone, no hardware placement, no pain, and with a recovery time of less than three days.

How do we do it?  We use our Deuk Laser Disc Repair^® procedure, a patented, minimally invasive endoscopic laser spine surgery - and the only one of its kind in the world - to cure back pain.  An endoscope is placed through a 4mm opening in the spine at the affected level, and a laser is used to repair the tear and block the nerves in the back of the disc that is the root cause of the pain.  

The result? It takes less than an hour, and our patients walk out of our outpatient clinic a few hours post op with no pain and no need for addictive painkillers.  They come back to our clinic the next day for a post op review and are cleared to go back to living an everyday, complete life, free of pain.

Does it work?  Our success rate is 99.5% and we have treated thousands of patients who are now living pain-free.  It took 20 years and thousands of surgical hours to discover the root cause of chronic back pain and the effectiveness of lasers in treating it.  

We livestream with our patients' written consent, allowing you to witness our technique. Our goal is to provide complete transparency into our process and procedures to cure back issues, helping our patients and others suffering from debilitating back and neck pain get back to living their lives fully.

We know how destructive chronic back pain can be to your life.  As neurosurgeons and health care professionals, 

Take the first step to a pain-free life:  upload your most recent MRI to receive a free review and consultation with Dr. Ara Deukmedjian, M.D., the founder of Deuk Spine Institute, who developed the Deuk Laser Disc Repair^® procedure.  Members of our team will reach out so you can recapture your life.

Your back is one of the most vital sets of nerves, bones, and tissues in your body.  It’s why our entire staff is uncompromising in our commitment to providing the highest levels of patient care.  We hold each other accountable and set high expectations for every member of our team.

When you come to Deuk Spine Institute, you’ll be cared for by a team of healthcare professionals dedicated to curing your back pain forever. 

Upload your MRI for a free review to begin your journey to a pain-free life.  Feel free to reach out to us if you have a question about uploading your MRI: 1.800.FIX.MY.BACK.