Spinal Stenosis Surgery Complication Rate Dependent on Surgeon’s Experience

spinal stenosis surgery complications

Who's performing your spinal stenosis surgery?

A new study published in Neurosurgery suggests that the risk of spinal stenosis surgery complications is higher when the surgeon performs few such procedures. Less than four spinal stenosis surgeries a year seems to be the important marker, so would you rather have an overworked or inexperienced spinal stenosis surgeon when you go under the knife?

It has been accepted for many years that patients having high-risk cardiac surgery usually have a better outcome when more experienced surgeons perform their procedure but this may be the first time that the same effect has been observed in spinal stenosis surgery. Discectomy, laminectomy, decompression and spinal fusion are all becoming more and more routine but if your surgeon performs these less than four times a year, maybe it’s time to rethink your chosen facility.

Lumbar Spinal Stenosis Surgery Success

The study’s senior author Dr. Ali Bydon of Johns Hopkins University, looked at a large database of hospitalized patients and, with his team of researchers, looked at the outcomes of almost fifty thousand lumbar spinal stenosis surgeries. In-hospital death and the rate of complications was noted for surgeons and hospitals for three years through 2005-2008. The volume of patients was also recorded and each surgeon was given a volume rating based on the number of surgeries performed – ranging from very low (less than fifteen operations in four years) to very high (more than eighty-one spinal stenosis surgeries in four years). Hospital volume ranged from less than sixty-eight to more than 394 surgeries. The researchers then compared these rates against the incidence of spinal stenosis surgery complications and death, adjusting for other relevant factors.

Check Your Spinal Stenosis Surgeon

The complication rate for spinal stenosis surgery was found, in this study, to range from 11.6% to 8.6%, with those surgeons with a very low volume of surgeries having the higher complication rate compared to those performing more than twenty procedures each year. This works out to a 38% higher risk of spinal stenosis surgery complications if your surgeon performs less than four surgeries a year compared to a more consistently practicing surgeon.

Hospital Volume Less Important for Surgical Success Rate

The number of surgeries performed at the hospitals in total did not have a significant effect on the rate of back surgery complications. Nor was the hospital volume connected to the overall cost of the lumbar spinal stenosis procedures or the length of hospital stay required by patients. The analysis revealed no significant differences based on hospital or surgeon volume with the risk of death after back surgery.


Types of Spinal Stenosis Surgery

Spinal stenosis surgery may take place for a variety of reasons, such as having a back decompression procedure which removes a herniated disc or discs to free pinched nerves in the lumbar spine. Patients may also undergo discectomy with spinal fusion, or a laminectomy, laminotomy, foraminotomy, or other spine procedure to address spinal nerve compression. Spinal stenosis does not always require surgery and many patients are able to manage symptoms using back pain medications and/or other conservative and alternative treatments for back pain. Where severe spinal stenosis is present, causing problems such as cauda equina syndrome, or the loss of bladder and bowel control, patients are much more likely to require immediate spine surgery to relieve spinal cord compression.

Spinal Stenosis Surgery Complications

There are a variety of possible complications that could arise after back surgery for spinal stenosis. These can include spinal fluid leakage if the dura has been accidentally perforated during surgery, as well as nerve trauma or even the accidental cutting of a spinal nerve. Blood loss, epidural fibrosis (scarring), and fluid build-up can also cause problems after back surgery. Instrumentation may fail in cases of spinal fusion for spinal stenosis, or patients may reject bone grafts used in such procedures. Infections, permanent disability, and even death are also potential consequences of spinal stenosis surgery gone wrong. Thankfully, such eventualities are rare and rates have lowered as techniques have been refined.

Should You Have Back Surgery for Spinal Stenosis?

Patients scheduled to undergo spine surgery for spinal stenosis symptoms should pay more attention, according to this latest study, to the experience of their surgeon rather than the hospital in which surgery is to take place. Most surgeons performing higher volumes of spinal stenosis surgeries were found to practice at larger hospitals, many of which were university-affiliated. However, some 40% of the high volume surgeons worked at smaller, or rural hospitals, so it appears the experience of the surgeon is what affects the success of spinal stenosis surgery, not necessarily the access to a larger, academic medical center.

Reference

Dasenbrock HH, Clarke MJ, Witham TF, Sciubba DM, Gokaslan ZL, Bydon A., The impact of provider volume on the outcomes after surgery for lumbar spinal stenosis. Neurosurgery. 2012 Jun;70(6):1346-54.

1 reply
  1. Spine Surgery In India
    Spine Surgery In India says:

    The complaint of back pain is among the most common medical conditions. To begin on the positive side, patients must understand that most episodes of back pain resolve, and usually within a few weeks. Unfortunately, back pain can be among the most difficult and frustrating problems for patients and their doctors.

    Reply

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