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Old 04-22-2005, 10:19 AM
Alastair Alastair is offline
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**These are the Alphaklinik FAQ`s** on complications of anterior abdominal approach in disk prosthesis and spinal fusion surgery. How these apply to other hospitals I don`t know


Back pain or leg pain is still there
This is the most feared complication. The lumbar spine has five lumbar segments and where is the pain coming from? Therefore an accurate intake with questionnaires, x-rays, MRI , muscle testing and discography is so important and decisive. With an exact diagnosis and meticulous implantation technique, the risk of enduring complaints is low, mostly depending on the condition and age of the spine. During the anterior removal of the bad disc, most dorsal impediments near the spinal canal will also be removed to give room to the underlying nerve roots. If there is too much distraction of the spinal segment after implantation, or in case of a remnant of disc material in the neighbourhood of the nerve root, leg pain could continue. In that case the normal movement of an artificial disc could be a disadvantage. Also an irritated nerve root can remain irritated.
Your chances will be discussed beforehand.


Possible disturbance of the intestines
The surgery is done via the abdomen. The intestines are pushed away to the right and down. Only the hand pressure on those intestines can �shock� them by lowering their contractility in performing digestion. This burdens the intestines only temporary. To prevent overloading of the intestines during surgery, a nasal-gastric tube is draining the stomach. This tube will be removed before wake up. Most of the time the operation is of a short enough duration that the shock effect is not severe. Directly after the operation one does not receive anything to eat. No extra bed rest, early mobilisation will wake up the intestines. If the intestinal noises in the abdomen are heared again, that is a signal that the intestines have begun to work normally, and one can receive something light to eat. Most of the time one can eat almost normally the second day. Rarely the intestines stay in shock for a number of days. If ignored the abdomen can become swollen because of limited passage of fluids and food. The solution of this problem is resuming drainage by a temporary nasal-gastric tube and nothing to eat. This complication is very rare and always solvable.


Extra loss of blood
The main abdominal vein and artery are carefully held to the side with a retractor. A very small cut can harm them and over distraction can lead to a rupture of vascular side-branches. Such an extra loss of blood stops immediately after suturing the leak. A vascular surgeon is always on standby to deal with the problem, although this complication happens very seldom. Mostly extra loss of blood is due to a normal leakage during preparing the bone or soft tissues. That�s very individual , depending from patient�s physical condition. If necessary a blood transfusion will be given during or after the operation. Sometimes this normal leakage persists for a while after the surgery. Therefore there is a drainage tube out of the deep wound to collect superfluous blood drainage for one day after surgery. Rarely leakage continues and is lowering the blood pressure. If necessary you will be transferred to the intensive care of a neighbouring university hospital to have an optimal monitoring of the extra loss of blood. Such a transfer happens very seldom and will only be performed after consultation of the vascular surgeon. The complication of extra loss of blood is always solvable and we never experienced a permanent damage.

Thrombosis
Thrombosis is caused by abnormal blood clots in the abdominal and leg blood vessels. Before and after the operation anti -thrombotic medications are given. The risk of such a blood clot is low and mostly of genetic origin. If such a clot happens, it can be well handled by blood thinners in the next months.

Damage to the ureters (urine tubes)
Theoretically damage to the ureters is possible, but this complication has not been seen since our experience with anterior spine surgery from 1980 on.

Ejaculation
Only in the L 5/S1 level there is a minor risk of ejaculation failure after anterior spine surgery. Mostly smokers and people with vascular diseases run a risk. In case of a minor blunt injury of the overlying sympathic nerve plexus the internal balance of prostate muscle function can be disturbed. This causes dry retrograde ejaculation: during the sexual climax, the sperm will be ejected into the bladder instead of ejaculated. Erection and climax remain always unimpaired. Depending on the skills of the surgeon and the age of the patient this risk at L 5/S1 is s 0,1- 0,4% . In the more upper levels the risk is neglegeable. If there is a wish for children in the future, deposit a sperm monster in a sperm bank to be deadly sure.
Infection
Results from the past are not a guarantee for the future, but since our start in 1989 we didn�t encounter any infection at all: zero. One can get a deep infection, despite all the antibiotics given, proper sterilization, etc. In case of a deep infection, revision of the surgery will be necessary with cleaning of the deep wound and maybe removal of the prosthesis, replacing it with a bone transplant from the pelvic rim. Up to the present: no infections. For patients with spinal implants, after the spinal surgery, we recommend antibiotic prophylactic treatment for dental work if there is a possibility of soft tissue bleeding.

Rejection of the implant
Rejection of the implant was never encountered since 1984. The endplates of the artificial disk are made of a chrome cobalt alloy and never have given rise to any allergy. The core is made of the same poly-ethilene material as in hip and knee implants. The cages are made of peek-carbon fibre or stainless steel and neither did not cause allergic reactions or rejection.

Wound healing
An incision is made in the lower abdomen horizontal or vertical from about 7-25 cm depending on body shape and level of surgery. Overweight people need longer and bigger incisions. Dissolvable subcutaneous suturing makes removal of stitches unnecessary. Horizontal incisions could give rise to some folding of the abdominal skin, therefore most women with a nice flat belly choose for a longitudinal incision. Disturbances of abdominal wound healing are rare, mostly depending on the condition of your abdominal wall, and always solvable.

Irritation of the nerves
Sometimes there is a temporary numbness of the thigh that will be restored within one year. Some patients feel a more warmed up left leg after surgery. This the so-called sympathectomy-effect because of temporary disturbance of the sympatric nerve chain on the left side from the repaired spine-segment. It is not unpleasant and most women quite like this effect, but it will not last longer than nine to 12 months.

Displacement, dislocation of the implant: migration to anterior or posterior
Although we encountered some anterior (forward, ventral) sliding of the artificial disk in the past, with the new rough surface of the endplates and better implantation technique there hasn�t been a displacement anymore. A dorsal (backwards, posterior) migration has never been encountered, so there is no danger for the spinal canal. To keep the risk as low as possible we advise to keep rather calm in the first six weeks after surgery, but walking, climbing stairs, driving etc are allowed. If the roentgen films are all right at six weeks postoperative, there are no restrictions anymore, because afterwards there has never been any slippage of the implant. The artificial disk is anchored by its teeth and the enormous inter-segmental pressure of the spine. The implant is a three part implant, but we never encountered coming the endplates and core apart. I n L 5/S1 special angled implants are used to keep on track with the normal alignment of the lower lumbar spine. The prosthesis normally will stay in place for ever, even in a case of for example a traffic accident. There is absolutely no need for extra fixation, cement, screw or glue. We never experienced shifting of a cage implant.

Subsidence of the implant: some migration into the vertebral body
A poor or moderate bone quality of the vertebral bodies could lead to some subsidence into the endplates of the spinal segment. Therefore the biggest possible size of it will be chosen for implantation. A bigger size can lean better on the all around bony rim to prevent subsidence. It is not always possible to implant the most suitable size because of difficulties in the bypassing the soft tissues and vessels. Then we have to make a compromise. A moderate subsidence doesn�t give extra complaints. If so, it can solved by re-implantation or dorsal pedicle screw fusion of that lumbar segment. Primary subsidence is rare nowadays. Some secondary subsidence over a year�s time will always take place, but generally doesn�t cause any complaints or complications.
__________________
ADR Munich 26th July 2002 L5/S1. Aged 82 now
Your best asset is your health
My story is here
http://www.adrsupport.org/alastair.html
Thank goodness for Dr Zeegers I am painfree
I am here to help,I live in the UK


I now run the UK spine site and can be contacted at

www.adrsupportuk.com/
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