The risks of open lumbar spine surgery (traditional open surgery) Any surgery must be performed under anesthesia. At present, general anesthesia is the main choice for lumbar spine surgery, that is, after tracheal intubation, ventilator to maintain breathing, intravenous administration of anesthetics or intravenous and tracheal inhalation (anesthetics) combined with the safety of these drugs is very good and easy to control, coupled with the current technological advances, real-time monitoring of heart and lung function and bleeding during surgery. However, risks still exist, such as allergic reactions to drugs, cardiac arrhythmias, cardiac arrest, overdose due to individual differences in sensitivity to drugs, etc. These factors are all accidental factors that cannot be prevented. There are also factors that lead to injury during the operation, such as injury to the airway and voice box, reflux of food or digestive juices causing reflux trachea and lung injury, and finally pneumonia. Lumbar spine surgery has the potential to cause paralysis Lumbar spine disease involves the cauda equina or nerve roots. A herniated disc or spinal stenosis involves either the cauda equina or the nerve roots. The central type of herniation compresses mainly the cauda equina, and the nerve roots on one side when it is partial. There are many causes of lumbar spinal stenosis, mainly lumbar disc herniation, ligamentum flavum hypertrophy, nerve root canal stenosis, and osteophytes. The purpose of surgery is to release these compression factors. Then, there is a risk of damaging the nerve roots during the surgery. The nerve root will lose its original normal anatomical structure after a long period of compression, making it difficult to identify during surgery resulting in misinjury, or the nerve root must be distracted from the already compressed nerve root when removing the anterior compressor during surgery due to excessive compression of the nerve root, resulting in temporary or permanent dysfunction (paralysis) of the nerve root due to distraction injury. Injury to a single nerve root is an incomplete palsy, with the end result being numbness and walking claudication. The longer the patient’s disease duration the more difficult surgery becomes and the greater the risk of this nerve root injury. In addition to this, the most common injury is to the dura mater, a dense membrane that surrounds the spinal cord and cauda equina and is protected by the cerebrospinal fluid in which the spinal cord and nerves float. Dural injuries result in cerebrospinal fluid leaks, which are not terrible and can usually be cured with little severity. The most common risk after lumbar spine surgery is infection The risk of infection exists with any surgery. The source of bacteria can invade the body through the flow of air during surgery, or through surgical instruments. Currently, operating rooms in tertiary care hospitals are equipped with laminar flow equipment, allowing for an environment with virtually no bacteria in the air. The equipment and technology for sterilization are so good that the chance of such possibility of infection by air and instruments is very low, and if there is there will be an incident of group infection. Some patients may also have bacteria in their bodies before surgery, only that they do not develop the disease because of the body’s resistance, and after surgery makes the body’s resistance drop and causes the infection to occur. In short, the risk of infection is already very low, and the treatment of infection is not very difficult, and the cure rate is very high. Cardiopulmonary insufficiency is the most risk factor affecting lumbar spine surgery Most patients with lumbar spine disease are elderly patients, and elderly patients are often accompanied by diseases of other organs of the body. The most common ones are coronary heart disease, hypertension, diabetes, pulmonary heart disease, osteoporosis, etc. Among them, cardiopulmonary insufficiency is the most risky factor affecting surgery. The surgery itself can be very traumatic for the patient, simply because the patient is not in pain after anesthesia. This trauma can lead not only to cardiopulmonary dysfunction, but also to imbalance in the coagulation and fibrinolytic systems, as well as to water-electrolyte imbalance, all of which can lead to serious complications and even life-threatening conditions. Happily, due to the advancement of technology and increased awareness, patients with complications of other systemic diseases mostly pass the dangerous period of surgery safely. The establishment of intensive care units (ICU) has made it possible to operate on patients who were not in a position to do so, making the risk of surgery much lower.