Complications in Orthopaedics: Spine Surgery

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Title Page
Complications in Orthopaedics: Spine Surgery
Copyright
Dedication
Contributors
Preface
Contents
1 Introduction
2 Optimization to Avoid Complications
	Introduction
	Preoperative Hemoglobin
	Bone Mineral Density
	Body Mass Index
	Albumin/Prealbumin
	Smoking
	Mental Health Disorders
	Frailty
	Vitamin D Deficiency
	Hemoglobin A1c
	Conclusion
	References
3 Managing Medical Complications
	Cardiovascular Complications
		Myocardial Infarction
		Venous Thromboembolism
		Hypotension
	Infectious Complications
		Postoperative Fever
		UTI and CAUTI
		Pneumonia
		Surgical Site Infection
	GI Complications
		Constipation, Ileus, and Bowel Obstruction
	Pulmonary Complications
		Hypoxia and Respiratory Failure
		Atelectasis
		Pulmonary Embolism
	Neurologic Complications
		Postoperative Pain
		Delirium
	Genitourinary Complications
		Urinary Retention
		Acute Kidney Injury
	Endocrine Complications
		Adrenal Insufficiency
		Hyperglycemia and Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic State
	Hematologic Complications
		Bleeding
		Thrombocytopenia
	References
4 Avoiding Complications in Pain Management Before and After Spine Surgery
	Introduction
	Preoperative
	Multimodal Pain Therapy
		Acetaminophen
		NSAIDs
		Neuropathic agents
	Regional Anesthesia
	Chronic Opioid Use and Weaning
		Methadone
		Suboxone
		Naltrexone
	Psychological Issues
	Postoperative
	Conclusion
	References
5 Avoiding Complications in Outpatient Spine Surgery
	Introduction
	Complication Risk Factors
	Cervical Spine Complications
		Anterior Cervical Approaches
			Airway Complications and Management
			Dysphagia and Recurrent Laryngeal Nerve Palsy
			Postoperative Anterior Cervical Hematoma
	Posterior Cervical Approaches
		Posterior Cervical Epidural Hematoma
	Lumbar Spine Complications
		Anterior Approaches to the Lumbar Spine
			Ileus
			Vascular Injury
			Sympathetic Nerve Injury
	Lateral Approaches to the Lumbar Spine
	Posterior Approaches to the Lumbar Spine
		Postoperative Lumbar Epidural Hematoma
		Cerebrospinal Fluid Leak
	Conclusion
	References
6 Managing Spinal Cord Injuries
	Introduction
	Neuroanatomy Overview
	SCI Overview
	SCI Classification
	Acute and Chronic
	Paraplegia and Tetraplegia
	Complete and Incomplete
	Upper Motor Neuron Signs and Lower Motor Neuron Signs
	Management
		Acute Management
		Neurogenic Bowel
		Neurogenic Bladder
		Skin and Pressure Injury
		Blood Pressure Regulation
		Venous Thromboembolism
		Other Important Chronic Considerations
	Rehabilitation
	Navigating Prognosis, Function, and Uncertainty
	Conclusion
	References
7 Managing Nerve Root Injuries
	Introduction
		Nerve Root Injuries: Clinical Evaluation
		Nerve Root Injuries: Diagnosis
	Nonoperative management
		Physical therapy
		Modalities
		Oral medications
		Intervention with Injections
	Operative Management
		Surgical Intervention
		Tendon transfer for nerve injuries
		Postoperative orthotic management
		Psychological Considerations
	Conclusions
	References
8 Prevention, Diagnosis, and Management of Postoperative Spine Infections
	Introduction
		Preoperative Considerations
			Age
			Body Habitus
			Diabetes Mellitus
			Nicotine
			Nutrition
			Nares MRSA Colonization
			Renal Disease
			Surgical Approach
		Perioperative Management
		Diagnosis and Management of Postoperative Infection
			Work-up
			Surgery
			Antibiotics
			Bacteria
	Conclusions
	References
9 When to Operate on the Cervical Spine?
	Introduction
	Standard Indications
	Controversial Considerations for Operative Intervention
	Traumatic Cervical Spine
		Introduction
		Evaluating the Cervical Trauma Patient
			A. Cervical Spinal Cord Injury
		Timeline of Controversy
		Discussion
		A Summary: Operative Considerations in Acute Spinal Cord Injury SCI
			B. Geriatric Odontoid Fractures
		Classification
		Management Considerations
		A Summary: Operative Considerations for Geriatric Odontoid Fractures
		Cervical Polytrauma—Multiple Cervical Spinal Fractures
		A Summary: Operative Considerations in Combined Cervical Spine Fractures
			A. Degenerative Cervical Stenosis
	Degenerative Cervical Spine
	Classification
	Historical Indications
	Controversy
	Summary
	Oncology
	Classification
	Controversy—Evolution of the Timing of Surgical Intervention
	Controversy—Radiation and Surgery in the Cervical Spine
	Conclusion
	References
10 General Complications of Cervical Spine Surgery
	Preoperative considerations
	Intraoperative complications
	Postoperative Complications
		Neurologic Complications
			Spinal Cord Injury
			Recurrent Laryngeal Nerve Palsy
			C5 Palsy
			Horner syndrome
		Gastrointestinal Complications
		Hematoma and Infection
		Mechanical Complications
	Conclusion
	References
11 Anterior Approach Related Complications
	Introduction
	Postoperative Dysphagia
	Esophageal Injury
	Recurrent Laryngeal Nerve Injury/Vocal Cord Injury
	Thoracic Duct Injury
	Horner Syndrome
	Hypoglossal Injury
	Hematomas/Airway Compromise
	Instrumentation Related Complications
	Conclusion
	References
12 Posterior Approach Related Complications
	Introduction
	Positioning Complications
	Intraoperative Complications
		Occipito-cervical Junction
		Subaxial Cervical Spine
		Cervicothoracic Junction
	Intraoperative Dural Injury and Cerebral Spinal Fluid Leakage
	Postoperative Wound Complications
	Postoperative C5 Palsy
	Conclusion
	References
13 Long-Term Complications following Cervical Spine Surgery
	Introduction
	Adjacent Segment Degeneration/Disease
	Adjacent Level Ossification Development
	Heterotopic Ossification after Cervical Disc Replacement
	Distal Junctional Kyphosis
	Pseudoarthrosis
	Postdecompression Kyphosis after Posterior Cervical Decompression
	Conclusions
	References
14 Complications of Posterior Minimally Invasive Surgery of the Cervical Spine
	Introduction
	MIS Posterior Cervical Procedures
		Posterior Cervical Foraminotomy
		Cervical Laminectomy
		Percutaneous Pedicle Screw Stabilization
		Percutaneous Cervical Intrafacet Stabilization
	Conclusion
	References
15 When to Operate on the Thoracic Spine
	Metastatic Spine Tumors
		Neurologic Indications
		Oncologic Indications
		Mechanical Indications
		Systemic Indications
		Diagnostic Indications
		Conclusion
	Trauma
		Instability
		Thoracolumbar Injury Classification and Severity Score
		Neurological Deficit
		Traumatic Deformity
		Timing of Surgery
		Conclusion
	Thoracic Stenosis
		Thoracic Disc Herniations
		Ossified Ligamentum Flavum
		Ossification of the Posterior Longitudinal Ligament
	Spinal Deformity
	Infection
		Intraspinal Infections
		Spondylodiscitis
		Paraspinal Abscesses
	Conclusion
	References
16 Minimally Invasive Lateral Approach Related Complications
	Introduction
	Brief Considerations
	Complications Overview
		Intercostal Neuralgia
		Pulmonary
		Durotomy
		Diaphragm Injury
	Future Directions
	Conclusions
	References
17 Complications of the Posterior Approach in Thoracic Spine Surgery
	Introduction
		Costotransversectomy Approach
		Transpedicular Approach
		Posterior Approach for Thoracic Corpectomy
	Pathology-Specific Complications from Posterior Approaches
		Thoracic Disc Herniations
		Metastatic Tumors
		Spinal Infections
		Pott’s Disease
		Vertebral Osteomyelitis
		Epidural Abscess
	Conclusion
	References
18 Long-term Complications of Thoracic Spine Surgery
	Overview
	Post-laminectomy Thoracic Kyphosis
	Thoracic Pseudoarthrosis
	Adjacent Segment Pathology
		Proximal Segment Pathology
		Distal Segment Pathology
	Chronic Sequalae of Acute Complications
		Hemothorax and Pneumothorax
		Chylothorax
		Chronic Spinal Cord Injury and Neurological Deficits
	Global Mitigation of Long-Term Thoracic Complications
		Smoking Cessation
		Bone Mineral Density
		Weight Loss
	Conclusion
	References
19 When to Operate on the Lumbar Spine
	Low Back Pain and Lumbar Surgery Indications
		Degenerative Disc Disease
		Herniated Nucleus Pulposus
		Spinal Stenosis
		Spondylolisthesis
	Deformity
	Conclusions
	References
20 General Complication in Lumbar Spine Surgery
	Introduction
	Neurovascular Injuries
		Neurologic Injury
		Vascular Injury
	Infection
	Spinal Fluid Leaks
	Pseudarthrosis
	Medical Complications
	Conclusion
	References
21 Avoiding Complications Associated With Anterior Lumbar Surgery
	Introduction
	Preoperative Factors
	Previous Surgery
	Vessel Anatomy
	Intraoperative Complications
	Postoperative Complications
	Conclusion
	References
22 Lateral Approach Related Complications
	Background
	General Complications
	Lateral transpsoas complications
	Lateral antepsoas complications
	Major complications
	Conclusions
	References
23 Posterior Approach Related Complications
	Introduction
	Surgical site infections
		Classification
		Risk Factors
		Posterior approach
		Diagnosis
		Treatment
	Wound dehiscence
		Treatment
	Symptomatic postoperative epidural hematoma
	Muscle flap reconstruction in complex spine surgery
	Prevention
	Conclusion
	References
24 Long-Term Complications of Lumbar Spine Surgery
	Introduction
	Pseudarthrosis
		Risk Factors
	Diagnosis of Pseudarthrosis
	Complication Avoidance
	Management
	Adjacent Segment Disease
		Natural History, Risk Factors, and Diagnosis
		Avoidance and Management of ASD
	Failed Back Surgery Syndrome
		Risk Factors, Etiology, and Diagnosis
		Management
	References
25 Complications of Minimally Invasive Surgery of the Lumbar Spine
	Introduction
	MISS Decompression and Discectomy
	Lateral Interbody Fusion
	Oblique Lumbar Interbody Fusion
	Minimally Invasive Transforaminal Lumbar Interbody Fusion
	Spinal Endoscopy
	Minimally Invasive Deformity Correction
	Conclusion
	References
26 When to Operate on Pediatric Spine Deformity
	When to Operate on Early Onset Scoliosis
		Natural History
		Indications for Surgery
	When to Operate on Congenital Scoliosis
		Natural History
		Indications for Surgery
			Correction Techniques
	When to Operate on Adolescent Idiopathic Scoliosis
		Natural History
		Indications for Surgery
			Correction Techniques
	When to Operate on Neuromuscular Scoliosis
		Natural History
		Indications for Surgery
			Correction Techniques
	When to Operate on Scheuermann’s Kyphosis
		Natural History
		Indications for surgery
	Conclusion
	References
27 General Complications in Pediatric Spinal Deformity
	Introduction
		Neurologic Injury in Posterior Spinal Fusion
		Spinal Cord Injury in Posterior Spinal Fusion
		General Nonneurologic Postoperative Complications
	References
28 Complications Associated with Congenital and Neuromuscular Scoliosis
	Congenital Scoliosis
	Neuromuscular Scoliosis
	Complications in the Treatment of Congenital and Neuromuscular Scoliosis
		Systemic Complications
			Positioning Complications
			Intraoperative Blood Loss and Need for Transfusion
			Pulmonary Complications
			Gastrointestinal Complications
			Genitourinary Complications
		Surgical Complications
			Surgical Site Infections
			Neurologic Injury
			Implant Malposition
			Implant-related Complications
			Proximal Junctional Kyphosis
			Complications specific to growing-rod constructs
			Complications of Hemivertebra Excision
	Conclusion
	References
29 Long-Term Complications in Pediatric Spine Surgery
	Delayed Postoperative Neurologic Deficit
	Delayed Infections
	Adding on Phenomena
	Sagittal Malalignment and Junctional Problems
	Rod Fractures and Pseudoarthrosis
	Conclusion
	References
30 When to Operate on Adult Spine Deformity
	Introduction
	Treatment of Adult Spinal Deformity: Nonoperative Management
	Treatment of Adult Spinal Deformity: Operative Management
		Preoperative Evaluation & Patient Selection
	Intraoperative Considerations
	Operative Technique
	Vascular Complications
	Proximal Junctional Kyphosis
	Pseudarthrosis
	Mortality
	Case 1
	Conclusion
	References
31 Complications of Adult Deformity Surgery
	Introduction
	Challenges in Classifying Complications and Current Classification Systems
	Medical Complications
		Cardiopulmonary Complications
		Gastrointestinal Complications
		Postoperative Delirium
	Surgical Complications
		Surgical Site Infection
		Implant Failure
		Junctional Kyphosis and Failure
	Neural Complications
	Case Example
	Conclusion
	References
32 Osteotomy and Surgical Correction Related Complications
	Introduction
	Neurologic Deficit
	Dural Tear
	Intraoperative Bleeding
	Medical Complications
	Pearls and Pitfalls
	Conclusion
	Disclosures
	References
33 Long-Term Complications
	Introduction
	Biological Failure
	Instrumentation Failure
	Adjacent Segment Disease, Proximal and Distal Junctional Failure
	Poor Patient-Reported Outcomes
	Conclusions
	References
Confidence is ClinicalKey