Every spine surgery carries real risks: infection, bleeding, nerve injury, anesthesia-related complications, dural tears, and procedure-specific risks that depend on what is being done. As a fellowship-trained spine surgeon in the Las Vegas Valley, I walk every patient through these risks specifically and honestly before they consent to surgery, because the right surgical decision can only be made by a patient who understands both sides of the trade.
The general risks that apply to most spine surgeries
These are the risks present, at varying rates, for most spine procedures.
Infection
Surgical site infections occur in a small percentage of spine procedures. Rates are generally lower with minimally invasive techniques than with open surgery, because smaller incisions and less tissue dissection reduce contamination opportunity. Most infections are superficial and treated with antibiotics. Deep infections involving instrumentation are uncommon but more serious and may require additional surgery.
Bleeding
Blood loss during minimally invasive procedures is typically modest. Most MIS decompressions involve less than 100 mL of blood loss. Larger fusions can lose more, and a transfusion is occasionally needed. Patients on blood thinners require a coordinated plan with their cardiologist before surgery.
Nerve injury
Spine surgery is performed near nerves, so nerve injury is a real risk even in the best hands. Most nerve injuries are temporary irritations that resolve over weeks to months. Permanent nerve injury (new significant weakness or numbness that does not recover) is uncommon but possible. Robotic guidance and intraoperative neuromonitoring (which I use in most cases) reduce this risk by giving real-time feedback during the procedure.
Dural tear
The dura is the membrane around the spinal cord and nerve roots. A small tear in this membrane during surgery is a recognized complication and is more common with revision surgery or severely degenerated anatomy. Most are recognized and repaired during the procedure with no long-term consequence. Occasionally a tear can lead to a CSF leak that requires additional treatment.
Anesthesia risk
General anesthesia carries a small risk of medication reaction, airway issues, heart or lung complications, and rare severe events. The risk is higher in patients with significant heart disease, lung disease, sleep apnea, or obesity. For appropriate endoscopic procedures, I sometimes use local anesthesia with sedation, which avoids many of these risks.
Blood clots
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are risks of any surgery, particularly when patients are off their feet during recovery. Early mobilization (walking the same day for most MIS procedures) significantly reduces this risk. We use mechanical compression devices and, for higher-risk patients, blood thinners to reduce the risk further.
Persistent or recurrent pain
Even a technically perfect surgery does not always resolve all pain. For lumbar decompression, the published "failed back surgery syndrome" rate (persistent or new pain after surgery) varies in the literature but is consistently in the single-digit to low double-digit percent range depending on definition and procedure. Realistic expectations and careful patient selection are the best protection against this.
Procedure-specific risks
Different procedures carry different risk profiles.
Lumbar discectomy / microdiscectomy
- Reherniation: about 5 to 10 percent over the years following surgery, with some studies showing higher rates depending on disc anatomy.
- Increased risk of dural tear in revision cases.
Cervical surgery (ACDF, disc replacement, posterior decompression)
- Hoarseness or swallowing difficulty: more common immediately after surgery and usually resolves over weeks. Persistent hoarseness is uncommon.
- Adjacent segment disease after fusion. Disc replacement preserves motion and has shown lower rates of adjacent segment disease in long-term studies.
Spinal fusion
- Nonunion (fusion does not solidify): higher in smokers, in patients with poor bone quality, and over multiple levels.
- Hardware failure: screws or rods can loosen or break, sometimes requiring revision.
- Adjacent segment disease: the levels above and below a fusion bear more stress and can degenerate faster.
Endoscopic spine surgery
The procedure profile is favorable. Risk of major nerve injury is low because the procedure is performed under direct visualization through the endoscope. Risk of incomplete decompression is the main procedure-specific consideration, and patient selection matters.
Disc replacement
- Implant subsidence or migration: uncommon with current generation devices.
- Heterotopic ossification (bone forming around the implant): can occur and may reduce the motion preservation benefit over time.
- Wear and long-term durability: the latest 10-year FDA Investigational Device Exemption data on cervical disc replacement is encouraging. Long-term 15 to 20 year data is still being gathered.
How minimally invasive techniques affect risk
In general, MIS techniques carry equivalent or lower risk than open techniques for many of these complications, especially for blood loss, infection, and post-operative pain. The American Academy of Orthopaedic Surgeons reports that minimally invasive procedures involve smaller incisions, less muscle damage, and shorter hospital stays, all of which reduce specific complication categories.
This does not mean MIS is "risk-free." Every surgical procedure carries real risk. What MIS does is shift the risk profile favorably for the right candidates.
How to think about risk vs benefit
The right question is not "is this surgery risky" because the answer is always yes. The right question is "does the expected benefit outweigh the risks in my specific case."
For a patient with severe leg pain and weakness from a clear lumbar disc herniation who has failed 8 weeks of conservative care, the risk of a microdiscectomy is small and the expected benefit is large.
For a patient with mild, intermittent back pain and unimpressive imaging who has not tried physical therapy, the same risk profile is much harder to justify, because the expected benefit is smaller and conservative care is much more likely to succeed.
How we reduce risk in our practice
Several specific things matter:
- Patient selection. The wrong procedure on the right anatomy still produces a bad outcome.
- Pre-op optimization. Smoking cessation, diabetes control, weight management, and nutrition all affect complication rates.
- Intraoperative neuromonitoring for most cases that involve nerve roots or the spinal cord.
- Robotic guidance for screw placement in fusion cases.
- Minimally invasive approach where appropriate.
- Standardized infection prophylaxis protocols.
- Early mobilization.
- Honest informed consent. A patient who has been told the truth before surgery handles unexpected complications more constructively if they happen.
What if something goes wrong
A small percentage of patients have complications. When they do, we manage them aggressively and transparently. You see me for follow-up, not a partner or a different physician. We do not disappear from a complication.
For patients with persistent pain after a previously successful surgery (sometimes years later), there is a separate post on what happens if spine surgery doesn't work and what your options are.
The financial side of complications
A reasonable concern is what happens financially if a complication requires additional care. Many of our patients have out-of-network PPO insurance. We work with you to navigate insurance, including the federal IDR arbitration process under the No Surprises Act, so unexpected complications do not become unexpected bills.
For the full cost breakdown, see how much spine surgery costs and what insurance covers.
Ready for a frank conversation about your specific risks?
If you are considering spine surgery and want a clear, honest accounting of the specific risks for your case (not a generic boilerplate), schedule a consultation at sharifspine.com. We will go through the risks, the benefits, and what they mean for your decision.
About the Author
Kevin R. Sharif, MD is an Adult & Pediatric Spine Surgeon practicing in the Las Vegas Valley. Dr. Sharif completed the Norton Leatherman Spine Fellowship with training in both neurosurgical and orthopedic spine surgery, a dual-discipline fellowship profile that is unusual in the field. He is the only spine surgeon in the Las Vegas Valley with both neurosurgical and orthopedic spine fellowship credentials, the most experienced minimally invasive spine surgeon in the region, and the only surgeon in the valley performing endoscopic spine surgery. He has performed more cervical and lumbar disc replacement procedures (motion-preservation alternatives to fusion) than any other surgeon in the valley.
Learn more at sharifspine.com.