17-06-2025
How Safe Is Spine Surgery? What To Know And What To Ask Your Surgeon
A post-operative x-ray showing a spinal deformity correction for scoliosis. A common surgery for ... More scoliosis is an instrumentation and fusion using rods and screws.
Facing a recommendation for spine surgery can certainly spark anxiety. The prospect of any operation is daunting, yet for many, the promise of relief from pain or disability is tempered by a hope for non-surgical alternatives. Fortunately, surgery is rarely the first option.
But when it's the best—or only—path forward, how safe is it? What steps are surgeons taking to enhance safety? And what questions should patients be asking their surgeon?
Over the past century, spine surgery has evolved dramatically, driven by the relentless innovation of our surgical giants. Conditions once deemed untreatable—complex fractures, spinal tumors, and deformities like scoliosis (sideways curvature), kyphosis (forward curvature), or excessive lordosis (backward curvature)—are now manageable, even life-saving. These advancements stem from breakthroughs in science, technology, and patient safety protocols.
Take scoliosis treatment as an example. In 1946, the Milwaukee Brace, a cumbersome leather-and-metal device extending from chin to torso, was a groundbreaking yet uncomfortable solution for post-polio scoliosis. It bordered on the archaic. Surgery for scoliosis was a last resort, reserved for extreme cases, with outcomes that pale by today's standards as surgeons grappled with understanding the spine's complex three-dimensional nature all while developing the technology necessary to treat it.
By 2025, the landscape is unrecognizable. Advanced imaging creates precise 3D models of a patient's spine, enabling custom rods tailored to individual anatomy. For adolescent idiopathic scoliosis, pediatric patients often leave the hospital just two or three days post-surgery with predictable outcomes—a testament to cutting-edge technology, refined surgical techniques, and integrated hospital systems.
Spine surgery isn't one-size-fits-all. Unlike more standardized procedures like hip replacements, spine surgery spans a spectrum of complexity. Minimally invasive discectomies, which remove small disc fragments that may herniate and push on nerves, should take around 30 minutes and allow same-day discharge. In contrast, severe scoliosis corrections may involve staged surgeries, intensive care, or traction devices like halo clamps, where weights gradually realign the spine over weeks to minimize spinal cord risks.
Risks and recovery vary widely. A discectomy for a herniated disc has low complication rates and predictable results. Adolescent idiopathic scoliosis, common in teenage girls, has well-documented outcomes. However, severe, inflexible deformities that need aggressive bony carpentry to correct the spine's alignment carry complication rates up to 60%, with major deformity surgeries posing a 1% mortality risk within a year.
Social media amplifies patient voices but can accidentally mislead patients by comparing recoveries without context. Outcomes can differ vastly, even for the same diagnosis. Surgeons must clearly communicate these nuances to align expectations.
Surgical consent forms list numerous risks, and experienced surgeons know these are not just theoretical. However, below are the three primary concerns, with questions patients should ask to gain clarity and confidence.
Paralysis is a major fear, but true paralysis is extremely rare. The spinal cord, which carries critical signals, typically ends in the upper lumbar spine, so surgeries below this level involve specific nerves, reducing catastrophic risks. A nerve-specific issue, like foot weakness, is more common. For instance, the Scoli-RISK-1 study found 10% of complex adult scoliosis surgery patients had single-nerve deficits two years post-surgery, yet most were still better off than prior to surgery due to their severe presenting conditions.
It's important to note that complex cases, such as tumors or severe deformities, carry higher risks of paralysis. However, tertiary referral centers and specialized surgeons focus on these cases with ongoing research, including the development of AI-powered risk assessment tools, to help mitigate these risks.
Spine surgery alters spine biomechanics, potentially stressing the levels above and below surgery causing adjacent segment disease, where nearby spinal levels degenerate, necessitating further procedures. Scoliosis curves above and below surgery may progress. Non-healing bone at the surgical site is another risk. Advanced imaging, patient-specific instrumentation, patient selection and preoperative planning reduce these issues.
Even successful surgeries may not eliminate pain, as outcomes prioritize spinal cord protection and quality of life improvements. Postoperative risks can affect major body systems, including the heart, lungs, and kidneys, necessitating robust hospital support.
Surgeons are actively reducing complications in complex cases through innovation and collaboration. Lawrence G. Lenke, MD, Surgeon-in-Chief at Och Spine Hospital and Professor of Orthopedic Surgery at Columbia University, is widely recognized as the world's leading expert on spinal deformity. In discussion for this article, he reflected on over 34 years of treating the most complex spine patients globally. He credits three key developments for safer surgeries in difficult cases:
Organizations like the Scoliosis Research Society (SRS) play a pivotal role in advancing safety initiatives, ensuring consistent, reproducible outcomes in the United States and worldwide. As the premier international society for spinal deformity, the SRS is committed to fostering optimal care for all patients with spinal deformities. Current SRS President, Laurel C. Blakemore, MD, stated, 'The SRS's vision is to enhance the quality of life for all patients with spinal deformities, and improving safety is a critical component of that mission. Since its inception, SRS members have contributed to a complications database. This month, we launched our Outcomes and Benchmarking app, which enables the deidentified collection of data on surgical complications. This tool will allow us to gather real-time data on perioperative complications, deepening our understanding and elevating the quality of care for spinal deformities.'
Patients can take comfort in knowing that the science of spine surgery is advancing rapidly.
The Spine Safety Summit, an annual meeting in New York City, brings together stakeholders in spine surgery—including patients, surgeons, hospitals, insurance companies, and technology developers—to collaborate on reducing harm. Organized under the Project for Safety in Spine Surgery (SP3), the summit fosters open discussions about complications to improve the safety and quality of spine care.
Course Chairman and Director of Pediatric Spine and Scoliosis at Columbia University Medical Center, Michael G. Vitale, MD, MPH, stated, 'The idea started as a course where senior surgeons shared complications from their careers in an open forum to discuss lessons learned. Over the past 10 years, the summit has seen consistent demand from surgeons and others eager to learn how to leverage systems, flatten hierarchies, optimize culture, and confront human fallibility. We have developed nine best practice guidelines and checklists, published two books, and inspired many surgeons to create local programming on safety. This year, we are once again oversold with overflow seating—a testament to the hunger surgeons have to improve outcomes for our patients.'
Spine surgery is safer than ever, but risks persist, and a zero-complication rate is neither achievable nor ideal. Patients must partner with surgeons to understand their procedure's scope and ask pointed questions. With rapid advancements in technology, data-driven safety protocols, and global collaboration, the field is poised to deliver better outcomes daily.
