Complications of Spinal Surgery

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Complications of Spinal Surgery

• Himanshu Sharma
• Glasgow

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• Oops.

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FAILED BACK SYNDROME
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• Type I-Improper case selection
• Type II-Incorrect diagnosis
• Type III-Incorrect indication
• Type IV-Incorrect level
• Type V-Incorrect surgery
• Type VI-Iatrogenic
• Type VII-Idiosyncratic

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Complications of Spinal Surgery

• General
• Mortality
• Anaesthetic DVT/PE
• Chest/urinary infections
• Positioning

• Local
• Nerve injury
• Dural tear
• Bleeding
• Infection
• Pseudarthrosis
• Instrumentation

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Wrong Level

• 3 commonest causes of poor result
• Wrong level
• Wrong level
• Wrong level
• McCullough

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Nerve Root Injury

• lt1 of procedures
• Beware wonky anatomy
• Beware previous surgery

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Dural Tears

• Incidence
• Rare in non-decompressive surgery
• More common in decompressive surgery
• Discectomy 1-4
• Decompression for stenosis 5-10
• Revision decompression 11-20

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Dural Tear

• Presentation
• Early
• Late
• Headache, nausea, meningism
• Wound leakage

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Dural Tears - Management

• Recognition and exposure
• Repair Suture, patch, fibrin glue, continuous
  wound suture
• Testing
• Post-op bed rest, antibiotics

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Cauda equina syndrome

• 1300
• High index of suspicion
• Revisiting theatre recovery
• Clinical
• MRI

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BleedingEpidural Bleeding Per-op

• Inflammatory mass
• Controllable with good vision bipolar

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BleedingMajor Vessel Damage
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BleedingEpidural Haematoma

• Severe pain
• Varying clinical picture
• Documented neuro-obs mandatory

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Infection
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Positional

• Meralgia paraesthetica
• Compartment syndrome
• Blindness

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MRI

• Recurrent disc
• -Border enhancement
• -Positive mass effect

• Epidural scar
• -Diffuse enhancement
• -Negative mass effect

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Post-discectomy syndrome

• Epidural scarring
• D/D
• Recurrent disc prolapse

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Inadequate Decompression
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Fusion

• Pseudarthrosis
• Implant failure
• Junctional degeneration/deformity
• Fusion disease

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Back Pain / Instability

• Small number of patients have much worse back
  pain after surgery
• Iatrogenic de-stabilisation
• Type I
• Type II

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Other ProblemsPseudarthrosis

• Pain
• Late implant breakage
• Incidental
• Difficult to diagnose X-ray, tomograms, isotope
  bone scan, CT, MRI
• Treatment revision, re-grafting

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Pedicle Screws
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Medial Wall
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Pedicle Fracture

• Causes
• Malposition
• Screw too large
• Tapping
• Osteoporosis

• Consequences
• Reduced hold
• Dural tear
• Nerve root injury

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Pedicle Screw Breakage

• Short screws
• Small screws
• Short insertion
• Long fusions
• Anterior column insufficiency

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Implant loosening
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Simple OperationPotential Problems
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VertebroplastyComplications
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Complications relatingCervical spine operations
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ComplicationsSummary

• Avoid Pre-op planning

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ComplicationsSummary

• Avoid Pre-op planning

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ComplicationsSummary

• Avoid Pre-op planning
• Careful surgery

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ComplicationsSummary

• Avoid Pre-op planning
• Careful surgery
• Anticipate

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ComplicationsSummary

• Avoid Pre-op planning
• Careful surgery
• Anticipate
• Deal with Appropriate kit

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