Abdul Gofar Sastrodiningrat Departemen Ilmu Bedah Saraf Fakultas Kedokteran Universitas Sumatera Utara

NEUROLOGICAL COMPLICATIONS IN LUMBAR SPINE SURGERY

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009

NEUROLOGICAL COMPLICATIONS

Spine surgery is actually very save

As complications can occur in any invasive procedure spine surgery is no different

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009

Lumbar Spine Anatomy

The disc
The Vascularisation

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009

Neurological Injuries

Direct Injuries

Indirect Injuries

Intraoperative Injuries

Postoperative Injuries

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009

Direct Injuries

Intra-operative injury

A piece of equipment touching the wrong spot

Kerrison punch, osteotome, rongeur, high speed drill, bovie electrocautery

LACERATION OF DURA
Most frequent complication ; microdiscectomy 1.8% ; primary lumbar decompression 5% ; Revision 17.4%

COMPRESSION CONTUSION of

the nerve root

weakness paralysis below the level of surgery

CSF leak :
infection headache

AVULSION

LACERATION OF THE NERVE ROOT nerve damage

nerve root pulled away

(very rare most likely to happen if there is a large amount of scar after multiple previous spine surgeries)

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009

Indirect Injuries
DISRUPTION OF BLOOD

SUPPLY something could happen in the spine that blocks the blood flow to the spinal cord (pieces of bone
compressed against each other)

GRADUAL COMPRESSION

developing hematoma putting pressure to nerve roots paralysis and numbness below the waist

Ischemia cell death

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009

Another

Intra Operative Injury

POSITIONING
Good position stomach area hangs free ; Spine lines up exactly as it should

Ischemic Optic

Neck-shoulder girdle
- Brachial plexus - Suprascapular nerve

Neuropathies
1. Anterior Ischemic Optic Neuropathy 2. Posterior Ischemic neuropathy

Elbow region Wrist

- Ulnar nerve and Radial nerve

- Median nerve - Ulnar nerve

Compression and Traction

Lower extremity

- Sciatic nerve and Peroneal nerve

Neuropathies in the Upper and

Lower Extremities

Cervical spine - Tandem stenosis

Complication of Spinal or Epidural Anesthesia needle puncture blood compression

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009

Post Operative Complications

Immediate assessment after surgery to check any injury that might happened during the surgery

INFECTION
- Discectomy 1% - Posterior spinal fusion 2 5% - Instrunentation up to 9% - Anterior spinal fusion < 1% - Anterior cervical 0.3 3%

Epidural hematoma
Pseudomeningocele Incontinence

Sexual dysfunction

PSEUDOARTHROSIS
- increasing back pain - confirmation by CT

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting 2009