By J Tempest Mitchell
When considering whether to undergo surgery for treatment of CSM, one of the biggest questions that people want answered is what the risks are, and how likely they are to occur. Well, they’re in luck- a team from China have just completed a large-scale study, looking at previous research on the topic, to try and find out exactly that (1)!
Overall, the researchers looked at over 100 previous studies, and more than 8500 patients who underwent surgery to treat CSM, and found that just over 20% experienced some degree of complications from the surgery: in other words, twenty out of every hundred patients had some form of issues afterwards. Whilst this percentage may initially seem quite high, it is important to remember that CSM surgery can be life-changing, and that many of these side effects may be only temporary or minor compared to the damage that the disease itself can cause.
So what sort of complications did patients experience?
The most common of the complications examined in the study was difficulty or pain on swallowing, which nearly 17% of the patients studied reported on the first day after surgery (although the data doesn’t tell us how long this effect lasted beyond that first day). The next most common complication was axial (neck) pain, which was reported by 15.6% of patients.
Other problems seen after surgery were:
· Damage to the nerve C5, which supplies part of the upper arm (5.3%)
· Hoarseness (4.0%)
· Graft subsidence, an issue where the graft sinks into the bones of the spine, causing distortion (3.7%)
· Dislodgement of the graft (3.4%)
· Infection (2.8%)
· Failure of the bones in the spine to fuse (2.6%).
Two rarer, but potentially more serious complications seen were infection of the CSF (the fluid surrounding the spinal cord) in 1.9% of patients and epidural haematoma (bleeding between the outer lining of the spinal cord and brain, and the skull) in 1.1%.
These complication rates varied slightly, depending on the subtype of myelopathy from which patients were suffering, and also the exact operation type. In particular, patients with myelopathy caused by OPLL (a condition in where a flexible structure known as the posterior longitudinal ligament thickens and become less elastic) had a higher risk of damage to the C5 nerve and CSF infection after surgery.
This information is useful to allow patients to make an informed decision. It should be remembered that despite these possible problems, overall surgery for CSM has been shown effective to stop disease progression.
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