1. Complications of Spinal Surgery
Himanshu Sharma
Glasgow

3. Oops….

4. ‘FAILED BACK SYNDROME’

5. 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

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

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

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

10. Dural Tears Incidence Rare in non-decompressive surgery
More common in decompressive surgery
Discectomy %
Decompression for stenosis 5-10%
Revision decompression %

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

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

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

16. Bleeding Epidural Bleeding Per-op
Inflammatory mass
Controllable with good vision & bipolar

17. Bleeding Major Vessel Damage

18. Bleeding Epidural Haematoma
Severe pain
Varying clinical picture
Documented neuro-obs mandatory

19. Infection

20. Positional
Meralgia paraesthetica
Compartment syndrome
Blindness

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

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

25. Inadequate Decompression

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

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

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

29. Pedicle Screws

32. Medial Wall

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

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

35. Implant loosening

36. Simple Operation Potential Problems

37. Vertebroplasty Complications

39. Complications relating Cervical spine operations

40. Complications Summary
Avoid Pre-op planning

41. Complications Summary
Avoid Pre-op planning

42. Complications Summary
Avoid Pre-op planning
Careful surgery

43. Complications Summary
Avoid Pre-op planning
Careful surgery
Anticipate

44. Complications Summary
Avoid Pre-op planning
Careful surgery
Anticipate
Deal with Appropriate kit