whether you've undergone spine surgery recently or it's been a few years complications can arise and that can leave you with more questions than answers pain numbness lack of Mobility these are just some of the issues that can persist or emerge unexpectedly post surgery today we are going to highlight the symptoms discuss some of the causes and treatments and answer any questions you may have on this episode of ask the doc send in your questions to questions allhealth tv.com or allhealth go on Facebook or YouTube or visit the askthe do page on our website allhealth tv.com welcome to ask the dock the show where we encourage our viewers to send in their health questions I'm Dr gorgi Bru havan a minimally invasive spine surgeon and today we are going to be talking about postsurgical spinal complications with any surgery there's a risk of complications but when surgery is done near the spinal cord or the spinal nerves these complications can be very serious let's kick things off with a Facebook question from Orin who asks hi Dr Bruce aan what are some of the most common complications that can occur after spine surgery Orin I'm so glad you asked me this question thank you for reaching out I have become um a specialist in revision spine surgery about 70 to 80% of what I do involves helping patients who have already had spine surgery at another institution and who did not get better so complications come in shortterm midterm and long long-term sort of strata in other words the things that I usually see are things that occur in the mid to long-term time sphere because the short-term complications for these patients usually go back to their doctor their original spine surgeon so right after surgery an infection can happen and that's anytime you cut the skin implant migration can happen in which case the patient will report that they're feeling much worse right after surgery nerve injury same patient will wake up and say that their foot is numb or weak their upper extremity the hand may be useless and these are complications that occur due to something performed during the procedure you can get persistent pain and that's something that I see mid and longterm Hardware breakage that can occur with a very specific complication called a non-union and Dural tear that's where a spine surgeon inadvertently injures the covering of the nerves the things that I see most often can really be broken down into two types either it's a problem within the surgical field or it's a problem above or below an instrumented segment so I go through a painstaking process that has now become a bit of a protocol for my practice to figure out which is the problem that's causing the patient's pain and I'll tell you now most of these things the vast majority can be fixed and even if you've had a big spinal operation you don't have to continue living in pain our next question comes to us from Maxim who reached out to us on our very own website allhealth dtv.com Maxim asks do doctor do means good day in Russian thank you I played soccer from childhood through college and I guess I had one too many headers which necessitates neck fusion after surgery everything was fine for a while and now my neck is always stiff and I have a deep pain under my shoulder I think you mean shoulder blade why is that and what can I do about it Maxim first thanks for reaching out to us with this question and speaking of questions this is a really good one before I answer let's check out this video from the good Folks at Baptist [Music] Health so spinal fusion uh is a fairly common surgery it involves placing an implant into the disk space in order to essentially weld the two vertebrae together and by doing so it allows us to restore alignment allows us to restore the disc space height and also to restore the the size of the spinal canal and the size of the Fram which are the holes where the nerve Roots exit on the side so this is a really good video and uh Orin um sorry Maxim this definitely has to do with what happened with you a Fus spine is not a normal spine a normal spine is meant to move and that's particularly an issue in the neck in a cervical spine uh there's some great evidence that was originally published out of Thomas Jefferson University by Dr hilbrand and since then there's been multiple reports on this issue in that if you fuse a segment of the cervical spine 25% of patients every 10 years will come back to have another level done cervical spine has a lot of motion so when you immobilize a segment of the cervical spine other levels see a lot more stress in fact immediately after spinal fusion motion of the adjacent levels or other discs becomes altered so pain uh around c56 or pain that's emanating from c56 or c67 will be felt under the shoulder blade so coincidentally c56 and c67 are the most commonly fused segments so if you have a c56 Fusion reliably about a quarter of patients within 10 years will come back with this pain under the shoulder blade if it's the upper part of the shoulder blade it's c56 if it's the lower part it's c67 so that shoulder plane pain Maxim most likely comes from an adjacent level now don't despair that doesn't mean that you have to have more Fusion many patients get better with a proper injection uh but if you do have to have a revision ask your doctor about doing a dis replacement that procedure now has a great Testament of research and time and it avoids that same issue of having ajent level problems thank you again for that question Astrid reached out to us on Instagram her question for me is hi Dr B my father is about to get spinal surgery and they are going to be using augmented reality for the procedure what is augmented reality and how beneficial is it for spine surgery I thought augmented reality was something for video video games with goggles hi as you great question and thanks for reaching out so I've tried augmented reality since I do minimally invasive spine surgery um and really what it is is just another way to navigate meaning a CAT scan is performed of the patient's body off the area that's going to be operated on and when instrumentation has to be placed instead of just using uh two plane x-rays we can use that CAT scan which provides you much more information now you can look at a mon and have three screens open or you can put on these goggles and uh I found the goggles to be fairly combersome and since I'm sterile I can't really adjust the position so I found the technology uh to be less than helpful but I know that some surgeons prefer using that it's just another way to say that your surgery is navigated which is an essential part uh of uh uh minimum invasive instrumentation make sure if you have to have a fusion you ask your doctor whether he will use navigation and then it doesn't matter which kind there's a robotic way to do it and then there's augmented reality way to do it if you're still curious about augmented reality use and surgery check out this video from our friends at the Mayo Clinic for people with severe back pain from arthritis or degeneration often the last option for Relief is spine surgery now doctors are using augmented reality to achieve less pain with fewer complications for patients Dr Miles Hudson a neurosurgery resident at Mayo Clinic explains the Innovation what it truly means is augmenting or enhancing your visual senses and your visual field and that's what the augmented reality does by combining patient scans and MRIs the technology allows the surgeon to see more without creating larger incisions using those scans our technologists can make the 3D models of the scan and then we can use the 3D models and pair that to our neuron navigation software and then by fusing those two together you get a navigated 3D model that we can overlay through different visual devices such as a headset or the surgical microscope itself just helps Elevate that safety to the next level by knowing where all the critical structures are and being able to actually see them through all the bone and soft tissue for the Mayo Clinic News Network I'm Joel Streed in case you miss it the first time here's another opportunity to find where to send in your questions send in your questions to questions at allhealth tv.com or allhealth go on Facebook or YouTube or visit the ask the do page on our website allhealth tv.com Rebecca just sent us a question from YouTube Rebecca's question is hi Dr B after putting off surgery for years it hurt too much to keep playing golf and that just wasn't acceptable so I bit the bullet and went under the knife I felt fine for a while after my disc ectomy but eventually I began to feel back pain again which is affecting my game again what can I do Rebecca I'm really sorry to hear that I can feel your frustration let's see what your options are and get you back on the course in general golfers and tennis players baseball players complain of pain related to the facet joints in the back of the spine if that's indeed the case which is pain that's sort of off midline in the lower back I can get these patients better us usually without surgery but if you had to have an operation and playing golf was just one of the things that was affecting you I would assume you also had problems sitting for a long time standing was painful and maybe even difficulty walking sometimes patients with this symptom constellation end up having a spinal fusion and if your surgery helped then there was a period of relief after you recovered from surgery and then your pain came back to me that's an indication of one of two problems either you've developed an adjacent problem and with classic spine surgery 36% of patients end up having a problem above the fusion above or below or it's something that changed within the the the operated field so a nonunion where the bones failed to knit together that may result in pain coming back after a while of relief um I hope I hope this answers your question and I would highly recommend that if you're suffering get a second opinion and your doctor may ask you to get both a CAT scan and an MRI CAT scan looks at bones MRI looks at soft tissues above and below the fused or operated field so don't be surprised if your doctor asks you to get more than one kind of Imaging thank you for your question another question from oldal tv.com you should really check it out when you get a chance to chalk full of really important information Roman asks hey Doc I remember playing Hoops with some friends by the beach I went up for a rebound and a month later I'm getting Lumber fusion surgery the pain went away for a few years but now it's back and I'm not looking forward to having surgery again I don't know what to do Roman I'm I'm sorry to hear that you're suffering let's talk about some of the options first of all it sounds uh it sounds um I don't like to hear that you had surgery for one month and you stra and you went straight for surgery it would be good to hear that your doc tried some conservative means injections perhaps physical therapy so whatever the reasons were you had an operation you got better and your pain is back after a few years so it would be important to understand exactly what was done during surgery the fact that the operation worked means that the goal of the operation was accomplished so the things that cause pain with a delay after surgery would most likely involve a problem above or below if the segment that was operated was fused or immobilized or it would be something deep to the surgical field now if you had a disectomy which is the most thing I see people undergo after a sports related accident but your disc coincidentally was also degenerative then the ation would have relieved your leg pain but would have left you with some back pain and with time that back pain would get worse so patients like yourself perhaps say that they have a difficult time sitting in the car or the dinner table they stand up kind of flexed forwards they need some time to stand up straight when they say they're in the kitchen they say that pain has to build and build and build in the lower back so for these patients it's important to exactly understand where the pain is coming from we do this with proper Imaging usually in MRI and then certain targeted diagnostic injections which are a mix of lto cane and steroids lto cane gives you immediate relief if the spot that's injected is indeed the cause of your pain so you inject it you feel better if the relief doesn't last then you may be a candidate for what's called a dis replacement that would take care of the generative disc problems and patients feel much much relief without having to immobilize it with a fusion I hope this gives you some hope and I hope you talk to your doctor about having a disc replacement okay this next question is from YouTube and it is from Raven Raven she asks I had Sergio on my back a few years ago and ended up with a blood clot in my leg it swelled up and I was in a lot of pain both in my back as well as my leg I'm really sorry Raven I might have to have more surgery soon and I want to know what I can do to not get another blood clot this time is there any I can do either before or after surgery Raven thank you so much for sharing your story I'm I'm I'm I'm I'm thrilled to hear you're advocating for yourself and uh this is a question that's relevant to a lot a lot a lot of patients so a blood clot happens because of immobilization which is common especially after Classic spine surgery so it's important to avoid that and the best way to do that is to try to get up and go as soon as surgery is done the day of surgery I have my patients walking around and uh that's a reason to consider minimally invasive spine surgery where the surgical approach is less injurious where there's less Trauma from surgery the second thing is it's important for the surgeon to really stop all the bleeders in the surgical field to stop any kind of bleeding because that allows the surgeon to start you on some anti-coagulation therapy or therapy that prevents blood clots so that you can lower the risk of getting a blood CL now for those patients who have had blood clots in the past talk to your surgeon before spinal surgery about having what's called a vinaa filter placed that's an Interventional Radiology procedure where through a little tiny Nick in your thermal vein uh which is in your in your groin uh sort of an umbrella looking thing gets placed into the vinaa and then if a blood clust does happen this will catch it and won't allow that blood clot to go to your lungs and cause all sorts of really dangerous problems thank you again for your question okay if you've got questions we've got answers and just in case you missed it the first couple of times here's another chance to find out how to send us your questions send in your questions to questions at allhealth tv.com or allhealth go on Facebook or YouTube or visit the ask the do page on our website allhealth tv.com all right we got got a Facebook question from Anastasia coming to you Anastasia asks means hello in Russian I love that you're using Russian um I had the compression therapy about three years ago and now it looks like I might need more surgery can you explain the risks of reoperation if initial spine surgery does not resolve the issue pre Anastasia prev means high in Russian excellent question but I'm sorry to hear that you still suffering so how do you avoid void how do you lower the risk of reoperation what are the risks of reoperation and the biggest risk is having another spine surgery and not getting better so if a decompression surgery didn't work which is a very common uh story at least from patients who travel to see me then you got to wonder was there also a fusion if there was no screws placed then most likely what has happened is that the disc that's at that same segment that was decompressed has deteriorated so if you're having a difficult time sitting with pain going down the legs if you're having to fidget when you're sitting at dinner because nothing is comfortable car rides are horrible you get out of bed with a flexed forwards posture and when you walk you feel that pain going down the back or the side of the thigh that tells you that that dis is still irritating your nerves so how do you avoid the most common complication you got to make sure you have the right operation now there are risk inherent to any revision surgery because scar tissue forms after a decompression so if you have to revise the decompression if that's going to be your surgeon's Choice make sure that you talk to your surgeon about how comfortable he or she is going through the scarred area remember that a relationship with your surgeon is really like a marriage if a complication happens you have to make sure that this is not the kind of a dock that's going to abandon you that's going to run away so if you feel that the connection is is is is not great between you and your dock then I would not put my faith in that person's hands so ask your doctor about their complications maybe ask your doctor to talk to their past patients who have had a complications and some doctors will gladly volunteer that so that you feel more comfortable if you feel like your surgeon is being very protective with the information very defensive I would get a second opinion I hope this helps you can never have too many questions people so keep them coming speaking of questions here's one on Instagram from shubash hello Dr branic I had spine surgery many years ago in which they used Hardware to secure parts of my spine my question is this how often do complications like Hardware failure occur after one asset spinal surgery and what are the signs shubash I appreciate you reaching out and sharing your story with us so um the rate of Hardware failure is variable because it all depends on the quality of the disectomy it all depends on the patient's own protoplasm ability to heal are they a smoker is there obesity involved and what kind of surgery neurosurgery minium invasive surgery that addresses both the front and back of the spine has a very very low Hardware failure rate versus classic spine surgery about 25% of patients have that either a failure of fusion um which would result either in screw breakage or Hardware or the rods breakage so patients will even say that they feel pop and ever since then their pain never stopped um your doctor may ask you to obtain a CAT scan or x-rays may not be enough to really understand why the hardware failed but usually the answer is that the bones did not knit together and fatigue failure or slow slow death by Thousand Cuts occur and metal finally breaks sometimes the metal doesn't break and the bone loosens patients really suffer with this they'll say that I have pain all the time and I see a lot of these patients coming to my office for help remember this is fixable you don't have to live with pain from Hardware failure I hope this helps let's see here looks like we have a question from Facebook this time it's from genev viiv and her question is hi doctor B my husband had spine surgery a couple months ago and he's still in pain but he can't tell if it's his body still healing from the surgery or if there are other issues my question is how can patients differentiate between normal postsurgical pain and a potential complication hyen aiv this might be the this might very well be the question of the day and and it's hard to know look classic spine surgery often times comes with a six-month period of Rehabilitation so how do you really know whether that six months of pain is normal or not and I really hope that you choose a proper surgeon who will answer these questions in general searing pain going down the legs that continues after surgery is not normal feeling worse for more than a few weeks is not normal but some classic operations really cause a lot more morbility than some of the newer operations generally with minimally invasive spine surgery you can be in the gym within a few weeks patients are usually usually driving within about a week and immediately after surgery vast majority say that they are pre-operating pain is gone so the big answer is if your preoperative pain is still there then you need to talk to your doctor and make sure that you didn't have a surgical complication I hope this helps and I'm sorry you're suffering I'm happy to help well um we have another question from Frank this one is through YouTube Frank asks what yoga poses should I stay away from if I have sciatica Frank this opens up U uh a very important question very important issue that I hear from patients all the time which is what can and can't I do so if you've never had spine surgery then the best thing to do is listen to your pain now with degenerative dis disease patients will often say that flexion based things cause them pain so they'll say that if they do exercises while seated especially if they load their head hands with weights the pain may get worse some patients say that running is difficult for them whereas others have no problem running now think of this as a sinusoidal curve meaning that the on the upside of the curve is you're most active on the on the trough of the curve is when you're sleeping or you are least active and there's a normal uh amount of activity that you as individual do on a day-to-day basis now if you were to go for a run and you've never gone for a run you may find that you are in a lot of pain but someone who is a runner who comes to my office and says that they suddenly have pain after years of running they'll say you know I'll tell them that running is normal for you and if your pain goes away you can go back to running so the most direct way to answer if you've never had surgery what can and can't you do is listen to your body let pain guide you if you not taking narcotics for pain then it is safe to listen to your body to use your pain feedback mechanism now after surgery it's a little different because with classic spine surgery patients have to be protected so that they may heal oftentimes with big wide open surgery doctors will prescribe their patients a brace or they will give them strict restrictions like no lifting no twisting no bending which may be an issue with some yoga poses so talk to your doc after surgery or even talk more importantly before surgery so you have a clear plan of action with minimally invasive spine surgery often times vast majority there are no restrictions but it's important that this information comes from your operative surgeon as opposed to uh someone like me uh just because it would have to be somebody who was inside and knew exactly what they did thank you again for visiting us on ask Doc and please please send us more questions I hope to see you soon thank you send in your questions to questions allhealth tv.com or allhealth go on Facebook or YouTube or visit the askthe do page on our website allhealth tv.com