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Postoperative Spinal Complications
Bryson Borg, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Synonyms

          • Iatrogenic complications
        • Definitions

          • Cord abnormality, neurologic deficit or hardware failure, or malposition arising as direct or indirect result of prior surgery (including altered biomechanics)
          • Acute: Multiple diverse etiologies
            • Hemorrhage with cord compression
              • Epidural
              • Subdural (may extend from posterior fossa surgery site)
              • Intramedullary (rarely due to surgery)
              • Hemosiderosis (chronic sequelae)
            • Cord infarction
              • Aortic aneurysms repair with anterior spinal artery occlusion or embolization
              • Spinal vascular malformation repair/embolization
              • Direct operative cord trauma
              • Secondary to compression from hematoma
              • Hypoperfusion/cardiac tamponade
              • Rare: Hyperextension injury to cord from operative malpositioning of neck
            • Graft/hardware malposition
              • Graft extrusion/displacement with cord compression
              • Hardware (pedicle screw) malposition with cord/thecal sac compression
            • Spinal anesthesia related
              • Catheter-induced hematoma
              • Celiac plexus block (chemical toxicity)
              • Epidural catheter malposition with intracord injection of anesthetic
            • Infection
              • Graft collapse with cord compression
              • Cord compression from abscess
              • Rare: Intramedullary abscess
          • Chronic
            • Accelerated disc degeneration (junctional or transitional disease) with herniation/stenosis
            • Pseudomeningocele/CSF leak
            • Arachnoiditis
            • Peridural fibrosis
            • Recurrent herniation
            • Instability
              • Altered biomechanics with accelerated degeneration
          • Remote from surgical site
            • General risks associated with surgery: Risk related to anesthesia, blood loss &/or hypovolemia, myocardial infarction, stroke, pulmonary embolism, deep vein thrombosis, and nosocomial pneumonia
            • Intracranial hemorrhage
              • While rare, when does occur is most commonly involving cerebellar hemispheres
            • Postoperative ischemic optic neuropathy
              • Not an imaging diagnosis

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Nonvascular Interventions

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Willson MC et al: Postoperative spine complications. Neuroimaging Clin N Am. 24(2):305-26, 2014
                                      2. Di Silvestre M et al: Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976). 32(15):1655-61, 2007
                                      3. Deen HG et al: Early complications of posterior rod-screw fixation of the cervical and upper thoracic spine. Neurosurgery. 59(5):1062-7; discussion 1067-8, 2006
                                      4. Okuda S et al: Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine. 4(4):304-9, 2006
                                      5. Fayyazi AH et al: Accuracy of computed tomography in assessing thoracic pedicle screw malposition. J Spinal Disord Tech. 17(5):367-71, 2004
                                      6. Uribe J et al: Delayed postoperative spinal epidural hematomas. Spine J. 3(2):125-9, 2003
                                      7. Kou J et al: Risk factors for spinal epidural hematoma after spinal surgery. Spine. 27(15):1670-3, 2002
                                      8. Lin CC et al: Spinal cord infarction caused by cardiac tamponade. Am J Phys Med Rehabil. 81(1):68-71, 2002
                                      9. Pelletier MP et al: Paraplegia after routine cardiac surgery: a rare complication. J Card Surg. 17(5):410-2, 2002
                                      10. Yonenobu K et al: Neurologic complications of surgery for cervical compression myelopathy. Spine. 16(11):1277-82, 1991
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Synonyms

                                              • Iatrogenic complications
                                            • Definitions

                                              • Cord abnormality, neurologic deficit or hardware failure, or malposition arising as direct or indirect result of prior surgery (including altered biomechanics)
                                              • Acute: Multiple diverse etiologies
                                                • Hemorrhage with cord compression
                                                  • Epidural
                                                  • Subdural (may extend from posterior fossa surgery site)
                                                  • Intramedullary (rarely due to surgery)
                                                  • Hemosiderosis (chronic sequelae)
                                                • Cord infarction
                                                  • Aortic aneurysms repair with anterior spinal artery occlusion or embolization
                                                  • Spinal vascular malformation repair/embolization
                                                  • Direct operative cord trauma
                                                  • Secondary to compression from hematoma
                                                  • Hypoperfusion/cardiac tamponade
                                                  • Rare: Hyperextension injury to cord from operative malpositioning of neck
                                                • Graft/hardware malposition
                                                  • Graft extrusion/displacement with cord compression
                                                  • Hardware (pedicle screw) malposition with cord/thecal sac compression
                                                • Spinal anesthesia related
                                                  • Catheter-induced hematoma
                                                  • Celiac plexus block (chemical toxicity)
                                                  • Epidural catheter malposition with intracord injection of anesthetic
                                                • Infection
                                                  • Graft collapse with cord compression
                                                  • Cord compression from abscess
                                                  • Rare: Intramedullary abscess
                                              • Chronic
                                                • Accelerated disc degeneration (junctional or transitional disease) with herniation/stenosis
                                                • Pseudomeningocele/CSF leak
                                                • Arachnoiditis
                                                • Peridural fibrosis
                                                • Recurrent herniation
                                                • Instability
                                                  • Altered biomechanics with accelerated degeneration
                                              • Remote from surgical site
                                                • General risks associated with surgery: Risk related to anesthesia, blood loss &/or hypovolemia, myocardial infarction, stroke, pulmonary embolism, deep vein thrombosis, and nosocomial pneumonia
                                                • Intracranial hemorrhage
                                                  • While rare, when does occur is most commonly involving cerebellar hemispheres
                                                • Postoperative ischemic optic neuropathy
                                                  • Not an imaging diagnosis

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Nonvascular Interventions

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Willson MC et al: Postoperative spine complications. Neuroimaging Clin N Am. 24(2):305-26, 2014
                                                                          2. Di Silvestre M et al: Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976). 32(15):1655-61, 2007
                                                                          3. Deen HG et al: Early complications of posterior rod-screw fixation of the cervical and upper thoracic spine. Neurosurgery. 59(5):1062-7; discussion 1067-8, 2006
                                                                          4. Okuda S et al: Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine. 4(4):304-9, 2006
                                                                          5. Fayyazi AH et al: Accuracy of computed tomography in assessing thoracic pedicle screw malposition. J Spinal Disord Tech. 17(5):367-71, 2004
                                                                          6. Uribe J et al: Delayed postoperative spinal epidural hematomas. Spine J. 3(2):125-9, 2003
                                                                          7. Kou J et al: Risk factors for spinal epidural hematoma after spinal surgery. Spine. 27(15):1670-3, 2002
                                                                          8. Lin CC et al: Spinal cord infarction caused by cardiac tamponade. Am J Phys Med Rehabil. 81(1):68-71, 2002
                                                                          9. Pelletier MP et al: Paraplegia after routine cardiac surgery: a rare complication. J Card Surg. 17(5):410-2, 2002
                                                                          10. Yonenobu K et al: Neurologic complications of surgery for cervical compression myelopathy. Spine. 16(11):1277-82, 1991