Complex Spine Surgery: Your Questions Answered

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So, you just found out you need to undergo complex spine surgery. What makes it complex, exactly? And, isn’t all spine surgery complex? In truth, spine surgery varies more than you may think, and some procedures are much more complicated than others. In this article, we tapped the expertise of SpineUniverse Editorial Board member Joshua M. Ammerman, MD, to help us understand more about complex spine surgery.

pensive woman considers her optionsSpine surgery varies more than you may think, and some procedures are much more complicated than others. Photo Source:

What does complex spine surgery mean?

A: Complexity in spine surgery is a relative term, but it generally refers to surgical cases that involve one or more of the following:

  1. Revision of prior back or neck spine surgery
  2. Scoliosis
  3. Surgery across more than three spinal segments (or levels)

What diagnoses may require a complex spine surgical procedure?

A: Diagnoses that are complex to treat are scoliosis, deformities of the adult spine, remote fractures of the spine, tumors of the spine.

Do all spine surgeons perform complex spine surgical procedures?

A: No. As spine surgery has evolved, the surgeons performing this surgery have subspecialized.

What should a patient look for in a surgeon who performs these procedures?

A: Patients should look for surgeons with experience in these complex procedures and a reasonable annual volume of such cases. They should also inquire if the facility has experience and capabilities to manage post-operative care.

What types of complex spinal procedures do you perform?

A: I focus on patients with degenerative conditions of the spine (such as disc herniation, spinal stenosis, degenerative disc disease, and spondylolisthesis) in association with a deformity (such as scoliosis). These are known as degenerative deformity cases. This is in contrast to patients where the deformity alone is the primary issue.

How does a spine surgeon prepare for a complex procedure? How does it differ compared to a simpler surgery like a discectomy?

A: Before the operation, the surgeon reviews multiple diagnostic images (such as MRI, CT, and x-rays) to gain a complete understanding of the patient’s anatomy and pathology. The surgeon then develops an operative plan to address as many problems as possible.

Compared to simple surgeries, complex cases have much greater variability in terms of the patient’s anatomy and the pathological problem. As such, planning takes on greater importance compared to more routine cases. 

Are the potential risks or complications greater in complex spine surgeries? Do age, smoking, being obese, or having diabetes increase risks?

A: Yes. The more complex cases are often associated with greater complications in terms of bleeding, infection, and nerve injury. Additionally, many patients who need these procedures have a chronic condition, such as diabetes, heart disease, or osteoporosis, which increases the risk of a complication. It also increases the chances that the procedure will fail to deliver an excellent outcome for the patient.

Can complex spine surgery be performed using minimally invasive techniques?

A: Yes. Some surgeons, including myself, are now applying minimally invasive principles and techniques to increasingly complex spine surgeries. The use of intraoperative navigation systems has dramatically increased the safety profile, reduced the radiation exposure to the surgical team, and reduced the operating room time for these procedures, resulting in safer patient care.

Do complex spine surgical procedures always involve spinal instrumentation and fusion?

A: In general, yes. The complex cases most often involve some sort of deformity or malalignment of the spine that requires movement of the bones into a more favorable position. Implants and instrumentation are generally required to reposition the bones and keep them in place while the spine heals. 

Does complex spine surgery require being hospitalized a day or longer?

A: While hospitalization time and recovery time continue to decline with the use of minimally invasive techniques, the vast majority of patients still need a few days in the hospital and a few weeks to recover from the surgery. The need for post-operative inpatient rehab has also declined, as many patients are now able to complete their post-operative rehab at home or on an outpatient basis.

Updated on: 04/19/19
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6 Topics to Help You Talk with Your Spine Surgeon
Joshua M. Ammerman, MD
Washington Neurosurgical Associates
Washington, DC
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