Lumbar decompression surgery - Risks of lumbar decompression surgery

Like all surgical procedures, lumbar decompression surgery carries some risk of complications.

Some of the main complications associated with lumbar decompression surgery are described below.

Infection

One of the most common complications is an infection where the incision was made, which is estimated to occur in up to one in every 25 people who have lumbar decompression surgery.

In most cases, post-operative infections can be treated successfully with antibiotics.

Blood clots

There is a risk you could develop a blood clot after lumbar decompression surgery, particularly in your leg. This is known as deep vein thrombosis (DVT).  

DVT can cause pain and swelling in your leg and may lead to a serious problem called a pulmonary embolism in rare cases. This is when a piece of the blood clot breaks off and blocks one of the blood vessels in the lungs.

However, the risk of developing a blood clot can be reduced significantly by staying active during your recovery or wearing compression stockings to help improve your blood flow. Read more about preventing DVT.

Recurrent or continuing symptoms

Although lumbar decompression surgery is generally effective in relieving symptoms such as leg pain and numbness, up to one in every three people continue to have symptoms after surgery or develop symptoms again within a few years of surgery.

Recurrent symptoms can be caused by a weakened spine, another slipped disc, or formation of new bone or thickened ligament putting pressure on your spinal cord. Scarring around the nerves can also sometimes develop after surgery, which can cause similar symptoms to nerve compression.

Other treatments, such as physiotherapy, will usually be tried in the first instance if your symptoms recur, but further surgery may be needed in some cases. Repeat operations, however, have a higher risk of complications than first-time operations.

Unfortunately, there is no effective treatment for scarring around the nerves. However, you can reduce your risk of scarring by doing regular exercises as advised by your physiotherapist after surgery.

Dural tear and leakage of cerebrospinal fluid

During lumbar decompression surgery, there is a risk of accidental damage to spinal nerve lining (dura), which can lead to the leakage of cerebrospinal fluid (CSF).

If this is discovered during the operation it will be patched and repaired at the time with no serious problems. However, small leaks can sometimes only become apparent after the operation, causing problems such as a headache and leaking from the wound. In some of these cases, further surgery to repair this may be required.

Facial sores and blindness

As you are positioned face down for lumbar decompression surgery, you will be resting on your forehead and chin while the operation is performed.

The anesthetist will regularly check to make sure this isn’t causing any problems, but many people will wake up with slightly puffed up face which varies in severity. In some cases, a red sore can develop over the forehead or chin which could last several days.

In extremely rare circumstances (about one in every 30,000 cases), patients can slip during the operation and rest on their eye balls rather than forehead and chin, which could affect circulation to the eyes leading to partial or even complete, permanent blindness.

Nerve injury and paralysis

Around one in every 20-100 people who has lumbar decompression surgery will develop new numbness or weakness in part of one or both legs as a result of the operation.

Paralysis is an uncommon but serious complication that can occur as a result of lumbar decompression surgery. It's estimated to occur in less than one in every 300 operations.

Nerve injuries and paralysis can be caused by a number of different problems, including:

• bleeding inside the spinal column (extradural spinal haematoma)
• leaking of spinal fluid (incidental durotomy)
• accidental damage to the blood vessels that supply the spinal cord with blood
• accidental damage to the nerves when they are retracted during surgery

Paralysis caused by lumbar decompression surgery usually means you are no longer able to use your legs, you lose sensation in the lower half of your body and you lose bladder and bowel control (urinary incontinence and bowel incontinence).

If paralysis is the result of bleeding inside the spinal column or leaking of spinal fluid, it may be possible to reverse the problem with further surgery.

However, in cases where the blood vessels supplying the spinal cord are damaged, the paralysis is likely to be permanent.

Death

As with all types of surgery, there is a risk of dying during or following lumbar decompression surgery, although this is rare. A blood clot, bad reaction to anaesthetic and blood loss can all be life threatening.

The British Association of Spinal Surgeons estimates there is around one death for every 350 operations carried out to treat spinal stenosis and one death for every 700 operations carried out to treat a slipped disc.

The risk of death is higher for spinal stenosis as most people with the condition tend to be older and in poorer health than people with a slipped disc.