Complications from spine surgery are not just devastating because they happen, or because we believe that complications can be avoided, but are magnified because many of the complications occur in elective cases. Catastrophic outcomes in surgeries that are intended to improve lifestyle and comfort do not fit our sensibility. In the first Neurosurgical Focus issue on complications published in October 2024, most of the complications shared involved cranial neurosurgery. Many of these complications occurred in cases in which there was no acceptable option except to operate, such as cases involving extensive arteriovenous malformations, tumors, and aneurysms. In life-threatening diseases, the existence of challenged outcomes is often considered the trade-off. In spine surgery, however, we face risks of worse functional outcomes in patients who often have other options. We roll stochastic dice with each surgery. A 2% risk of a certain complication occurs with random precision and strikes with 100% completeness. This makes complications in spine surgery hard to express to patients in their full reality, hard to process for the surgeon when they do occur, and sometimes hard to bring to light, because the presence of a serious complication in an elective case horrifies. This issue of Neurosurgical Focus, like the laudable issue before, attempts to grapple with these challenges by presenting spinal complications in all of their attendant difficulties. These case illustrations were all written by esteemed and senior neurosurgeons who share hundreds of years of experience among them. The authors have a track record of sound judgment and technical excellence but are laying bare the challenges they have faced, primarily because they recognize the benefits of awareness and of the personal lessons they learned. A layer of anonymity is created by disassociating individual work from the authors. Videos were narrated by an individual who was not involved in video or case preparation.
Mahan et al. (Sun,) studied this question.