Chief, Neuro Spine Surgery & Additional Director, Neurosurgery, Artemis Hospitals, Gurgaon, India
Part 12 of 13 in Making Spine Surgery 100% Safe
What Causes Spine Surgery Complications, and How They're Prevented
August 6, 2026
Spine surgery complications, including infection, nerve injury, bleeding, dural tear, and screw or cement malposition, are largely preventable through accurate diagnosis, the right choice of surgeon, and careful surgical technique. Dr. S. K. Rajan, Chief and Unit Head, Orthopaedics and Spine Neurosurgery at Artemis Hospitals, Gurgaon, breaks down where complications actually originate.
Where Complications Really Come From
Dr. S. K. Rajan explains that complications in spine surgery arise from errors at three possible levels: the diagnosis level, the doctor-selection level, or the surgery level itself. He stresses that many patients travel for spine surgery in India without a clear surgical indication, and that if a cause for pain or weakness cannot be identified, the case is likely not a surgical one at all.
Illustrative Examples of What Can Go Wrong
As cautionary examples, Dr. S. K. Rajan describes cases of wrongly performed surgery where a screw or cement migrated into the spinal canal, causing cord compression. These are presented as illustrations of surgical-level errors to avoid, not outcomes from his own practice, underlining why careful technique and image guidance matter throughout spine surgery.
How Technology Reduces These Risks
Dr. S. K. Rajan's circle of safety, combining the O-arm, spine navigation, intraoperative neuromonitoring, the latest microscope, keyhole instrumentation and a special positioning frame, is specifically designed to reduce the risk of complications such as screw or cement malposition and nerve injury. This combination of technologies, rarely available together under one roof in India, is central to why his spine surgery outcomes are described as more than 99% safe.
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This article is based on a Jivo Masterclass session conducted by Dr. S. K. Rajan, Chief and Unit Head, Orthopaedics and Spine Neurosurgery, Artemis Hospitals, Gurgaon, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. S. K. Rajan taught doctors across Africa on September 15, 2024.
FROM THE LIVE Q&A
Dr. Abraa
Do you use intraoperative neuromonitoring?
Dr. S. K. Rajan
Yes, we do use intraoperative neuromonitoring — we are one of the very few centres in the country who have been using this quite regularly. We were focusing on minimally invasive spine surgery and spine navigation in this talk because of limited time, but yes, we do have neuromonitoring available to us as well.
Frequently Asked Questions
Do you have provisions for doing spine surgeries for children with neural tube defects?▼
Yes, we have specialist spine surgeons and pediatric surgeons also, and I myself do a lot of spine surgery in children — whether they have neural tube defects such as meningocele, Chiari malformation, or tethering of the spinal cord which can cause weakness of the legs. In all those patients we do spine surgeries, also in children who've got scoliosis or hemivertebra deformities, or tumours of the spine. All those patients we have been tackling from the age of 6 months to 18 years of age.
What about the cost of treatment, and the duration of treatment, for a spine problem?▼
The cost of surgery in our hospital for spinal problems can range anything from $3,500 for a discectomy and decompression to $5,500 or $6,000 for fixation of the spine at one level, and even up to $10,000 for more complicated cases — that's usually the range of costs patients most commonly have to bear. Most of these patients, who come walking because of pain in the neck, arm, or lower back going into the legs, usually stay in the hospital for about three to four days, and in the country for about two weeks.
Do you use intraoperative neuromonitoring?▼
Yes, we do use intraoperative neuromonitoring — we are one of the very few centres in the country who have been using this quite regularly. We were focusing on minimally invasive spine surgery and spine navigation in this talk because of limited time, but yes, we do have neuromonitoring available to us as well.
What are the most common complications associated with spine surgery?▼
Dr. Rajan lists infection, nerve injury, bleeding, dural tear, and screw or cement malposition as the main complications.
At what stages can errors leading to spine surgery complications occur?▼
He identifies three possible levels: the diagnosis level, the doctor-selection level, or the surgery level itself.
What happens when a screw or cement is wrongly placed during spine surgery?▼
It can migrate into the spinal canal and cause cord compression, an example Dr. Rajan presents as an illustration of a surgical-level error rather than an outcome from his own practice.
How does technology reduce the risk of spine surgery complications?▼
Dr. Rajan's circle of safety, combining the O-arm, spine navigation, intraoperative neuromonitoring, the latest microscope, keyhole instrumentation and a special positioning frame, is specifically designed to reduce risks such as screw or cement malposition and nerve injury.
In This Series: Making Spine Surgery 100% Safe
- 1.Making Spine Surgery 100% Safe
- 2.Cement Augmentation for Osteoporotic Spinal Fractures
- 3.Cost of Spine Surgery in India
- 4.Why an Integrated Spine Clinic Matters: Team-Based Spine Care
- 5.Intraoperative Neuromonitoring in Spine Surgery
- 6.Keyhole (Minimally Invasive) Spine Surgery Explained
- 7.Lumbar Canal Stenosis: Keyhole Surgery and Recovery
- 8.What Is the O-Arm and How Does It Make Spine Surgery Safer?
- 9.Pediatric Spine Surgery in India: Conditions Treated
- 10.Scoliosis Correction Surgery in India
- 11.Treating Spinal Tuberculosis in India
- 12.What Causes Spine Surgery Complications, and How They're Prevented
- 13.When Is Spine Surgery Actually Needed? Signs You Shouldn't Ignore