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COMPLICATIONS IN CERVICAL AND LUMBAR SPINAL SURGERY Daniel A Capen MD Downey Orthopedic Group
COMPLICATIONS IN CERVICAL AND LUMBAR SPINAL SURGERY
Daniel A Capen MD Downey Orthopedic Group
Complications in Spinal Surgery
Positioning Complications
Approach Complications
Procedure Complications
Post-surgical Complications
Complications in Cervical Spine Surgery
Nassr et al Journal of Neurosurgical Spine 2010
Analysis of 25 Studies- 8.9% Overall Rate
No Difference if Prospective or Retrospective
Rates Increased in >60 Age
Increased for Diagnosis of Spondylosis with Myelopathy
Positioning Complications
Brachial Plexopathy from Shoulder Taping
Ulnar Nerve Injury
Occular Compression Blindness in Posterior Surgery
Knee and Ankle Compression
Malpositioning to Create Kyphosis or Hyperlordosis
Anterior Approach Related Complications
Dysphagia
Dysphonia
Horners Syndrome Injury to Chassaignac’s Ganglion
Carotid Injury
Excessive Lumbar Tissue Trauma
All Related to Retraction and Anterior Spine Dissection
Procedure Related Complications
Vertebral Artery Injury Nassr- 0.3% Anterior
Neurologic Injury 0.3-0.4%
Poor Cage or Graft Placement
End-Plate Violation
Incomplete Decompression
Lordosis Loss
Insufficient Fixation From Malpositioned Screws or Cages
Post Surgical Complications
Dysphagia- Bazaz Spine 2002
>50% of 249 Patients Had Moderate or Severe in the 1st Month
12.5% at 12 Months
Risk Factors Number of Levels, Length of Surgery, Female Patients
Indication for Hardware Explantation if Severe
Post Surgical Complications in Lumbar Surgery DVT—5-7% incidence Compression
Stockings, Early Ambulation
Cage Migration ,Screw Cut Out-Immediate repositioning
Infection rates 2-13% Low In Alif, Higher in Posterior Approaches
Incisional Vancomycin Powder in ALL Posterior Instrumented Fusions
Rates Reduced to <1%
Post Surgical Complications
Dysphonia
Recurrent Laryngeal Nerve Injury
Kahraman et al Euro-Spine 2007- 235 Cases
Incidence 1.27 % 3 males
All Surgery at C6/7
Improvement with Time
Post Surgical Complications
Retro-Pharyngeal Hematoma
Palumbo et al 2012 Open Ortho Journal
0.2 to 1.9%
Tachypnea, Desaturation Throat Swelling
Life Threatening--- Immediate Evacuation
Surgical Drain for All Anterior Cases-24hrs
Posterior Cervical Complications
Graham et al Spine 1996 1.8% Radiculopathy with Lateral Mass Fixation <15mm Screws
Facet Fracture or Violation 6% Rate
Pedicle Penetration 6.8%
Overall Neurologic Injury Rate >2%
Post Surgical Infection in Cervical Surgery
Rates 0.4 to 4.5% Vacarro et al 2003
Posterior Approach Greater-Muscle Trauma and Blood Loss
Staph Strep Klebsiella
If Anterior Infection Need to R/O Esophageal Perforation
Age, Smoking, Immune Compromise-Increase Infection Risk
Avoidance of Complications
SSEP and MEP Monitoring
Careful Pre Surgical Positioning
Real Time Imaging for Fixation
Frequent Relaxation of Retraction
Avoid Bi-cortical Screws Anterior or Posterior
Hemostasis, Irrigation and Drainage
Vancomycin In Lumbar PSF and all MRSA Cases
THANK YOU
Cerebral Aneurysms
Incidence
Diagnosis
Treatment Options
Daniel A Capen MD
Cerebral Aneursyms
Cerebral Aneurysms
Associated with Hernia, Peripheral Aneurysm
1 in 50 in US Population
1% of population at autopsy
At or Near Circle of Willis
At Arterial Junctions
Types of Aneurysms
Saccular—”Berry” Most Frequent
Fusiform –Usually do Not Rupture
Charco-Bouchard –Usually <15mm –Hypertension- Usually Slow Bleed
Giant Aneurysm > 2.5 cm Always Risk for Sudden Death or Hemorrhagic Stroke
Types of Aneurysms
Aneurysm Risk Factors
Marfan Syndrome
Polycystic kidney Disease
Neurofibromatosis
Hereditary Telangectasia
Ehlers – Danlos Type II and IV
CAUSES of Aneurysm
Genetic Tendency
Weakness of Connective Tissue
High Blood Pressure
Mycosis, Infection, Trauma
Drug Abuse—Cocaine, Amphetamines
SIGNS AND SYMPTOMS
Headache
Nausea- Vomiting
Confusion
Visual Disturbance
Focal Facial Numbness
Meningismus
Focal Neural Defecit
Sudden Coma
Diagnosis
CAT SCAN with Angiography
MRI for post- aneurysm Bleed
Screen For Any Of Risk Patients
Angiography
Treatment Options
Observation if Diagnosed But No Symptoms
Endovascular Embolization or Coil
Craniotomy For Clipping
Cerebral Aneurysms
Treatment Options
Results With Rupture
40% Mortality Rate
15% Die Before Reaching Hospital
Female > Male For Rupture
Once Aneurysm Ruptures >60% Have Permanent Neurologic Deficits
Multiple Aneurysms
Cerebral Aneurysms
Diagnosis
Types Of Aneurysms
Multiple Aneurysms
