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Complications of Spinal Surgery

Complications of Spinal Surgery. Himanshu Sharma Glasgow. Oops…. ‘ FAILED BACK SYNDROME ’. 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. General

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Complications of Spinal Surgery

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  1. Complications of Spinal Surgery Himanshu Sharma Glasgow

  2. Oops….

  3. ‘FAILED BACK SYNDROME’

  4. 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

  5. General Mortality Anaesthetic DVT/PE Chest/urinary infections Positioning Local Nerve injury Dural tear Bleeding Infection Pseudarthrosis Instrumentation Complications of Spinal Surgery

  6. Wrong Level “3 commonest causes of poor result” • Wrong level • Wrong level • Wrong level [McCullough]

  7. Nerve Root Injury • <1% of procedures • Beware wonky anatomy • Beware previous surgery

  8. 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%

  9. Dural Tear Presentation • Early • Late • Headache, nausea, meningism • Wound leakage

  10. Dural Tears - Management • Recognition and exposure • Repair – Suture, patch, fibrin glue, continuous wound suture • Testing • Post-op bed rest, antibiotics

  11. Cauda equina syndrome • 1:300 • High index of suspicion Revisiting theatre & recovery • Clinical • MRI

  12. BleedingEpidural Bleeding Per-op • Inflammatory mass • Controllable with good vision & bipolar

  13. BleedingMajor Vessel Damage

  14. BleedingEpidural Haematoma • Severe pain • Varying clinical picture • Documented neuro-obs mandatory

  15. Infection

  16. Positional • Meralgia paraesthetica • Compartment syndrome • Blindness

  17. Recurrent disc -Border enhancement -Positive mass effect Epidural scar -Diffuse enhancement -Negative mass effect MRI

  18. Post-discectomy syndrome • Epidural scarring D/D Recurrent disc prolapse

  19. Inadequate Decompression

  20. Fusion • Pseudarthrosis • Implant failure • Junctional degeneration/deformity [Fusion disease]

  21. Back Pain / Instability • Small number of patients have much worse back pain after surgery • Iatrogenic de-stabilisation • Type I • Type II

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

  23. Pedicle Screws

  24. Medial Wall

  25. Causes Malposition Screw too large Tapping Osteoporosis Consequences Reduced hold Dural tear Nerve root injury Pedicle Fracture

  26. Pedicle Screw Breakage • Short screws • Small screws • Short insertion • Long fusions • Anterior column insufficiency

  27. Implant loosening

  28. Simple OperationPotential Problems

  29. VertebroplastyComplications

  30. Complications relatingCervical spine operations

  31. ComplicationsSummary • Avoid Pre-op planning

  32. ComplicationsSummary • Avoid Pre-op planning

  33. ComplicationsSummary • Avoid Pre-op planning Careful surgery

  34. ComplicationsSummary • Avoid Pre-op planning Careful surgery • Anticipate

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

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