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Page 238 Giakas et al. Art Int Surg 2024;4:233-46 https://dx.doi.org/10.20517/ais.2024.24

Furthermore, these responses do not elaborate on the potential adverse effects associated with various
treatment options, thus providing a weak and incomplete risk-benefit analysis for patients to consider when
deciding whether to proceed with PLD. Within the descriptions of the alternative therapies, even for the
appropriate patient, there is minimal detail on what these methods entail. For example, the physical therapy
response does not describe what muscles are strengthened or why, nor how much time may elapse prior to
symptom alleviation.

4. What are the risks of lumbar decompression surgery?
Lumbar decompression surgery is generally considered safe and effective for relieving symptoms caused by
nerve compression in the lower back. However, like any surgical procedure, it carries certain risks and
potential complications. It is important to discuss these risks with your surgeon before undergoing the
surgery. Here are some potential risks of lumbar decompression surgery:

(1) Infection: There is a risk of developing a surgical site infection, which can occur at the incision site or
within the deeper tissues. Infections may require additional treatment, such as antibiotics or drainage.
(2) Bleeding: While uncommon, there is a risk of excessive bleeding during or after surgery. In some cases, a
blood transfusion might be necessary.
(3) Nerve injury: Surgery involves working near nerves, and there is a small risk of damaging adjacent
nerves, which could result in new or worsened neurological symptoms.
(4) Dural tear: The dura is a thin, protective membrane surrounding the spinal cord and nerves. During
surgery, the dura can accidentally be torn, resulting in cerebrospinal fluid leakage, which may require
additional treatment.
(5) Persistent or worsened symptoms: In some cases, surgery may not completely relieve symptoms, or
there could be temporary worsening of symptoms immediately after surgery due to inflammation or nerve
irritation.
(6) Blood clots: Prolonged immobility during and after surgery can increase the risk of developing blood
clots, which can be dangerous if they travel to the lungs (pulmonary embolism) or other parts of the body.
(7) Anesthesia complications: There are risks associated with anesthesia, including allergic reactions,
breathing difficulties, and adverse reactions to medications.
(8) Instrumentation failure: If hardware (such as screws or rods) is used to stabilize the spine, there is a risk
of instrumentation failure, including loosening, breakage, or migration.

Attending 1 Score: 3
Attending 2 Score: 3

Analysis: The response provided a somewhat useful, albeit cursory, overview of the potential complications
involved in PLD. These complications are often addressed or raised in informed consent conversations with
patients prior to surgery and, therefore, may serve as a useful introduction to these issues prior to an office
visit. However, the mention of “instrumentation failure”, among other complications, might confuse
patients regarding the use of hardware in a simple, uninstrumented PLD. Additionally, the response does
not provide any clarity regarding the actual prevalence of these adverse events for patients undergoing PLD,
which would provide crucial context to anyone considering surgery.

5. What is the recovery time after lumbar decompression surgery?
Here’s a general timeline for recovery after lumbar decompression surgery: