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 it does occur, it most commonly involves cerebellar hemispheres
Postoperative ischemic optic neuropathy
Not 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
Igoumenou VG et al: Complications of spine surgery for metastasis. Eur J Orthop Surg Traumatol. 30(1):37-56, 2020
Willson MC et al: Postoperative spine complications. Neuroimaging Clin N Am. 24(2):305-26, 2014
Di Silvestre M et al: Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976). 32(15):1655-61, 2007
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
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
Fayyazi AH et al: Accuracy of computed tomography in assessing thoracic pedicle screw malposition. J Spinal Disord Tech. 17(5):367-71, 2004
Uribe J et al: Delayed postoperative spinal epidural hematomas. Spine J. 3(2):125-9, 2003
Kou J et al: Risk factors for spinal epidural hematoma after spinal surgery. Spine. 27(15):1670-3, 2002
Lin CC et al: Spinal cord infarction caused by cardiac tamponade. Am J Phys Med Rehabil. 81(1):68-71, 2002
Pelletier MP et al: Paraplegia after routine cardiac surgery: a rare complication. J Card Surg. 17(5):410-2, 2002
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 it does occur, it most commonly involves cerebellar hemispheres
Postoperative ischemic optic neuropathy
Not 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
Igoumenou VG et al: Complications of spine surgery for metastasis. Eur J Orthop Surg Traumatol. 30(1):37-56, 2020
Willson MC et al: Postoperative spine complications. Neuroimaging Clin N Am. 24(2):305-26, 2014
Di Silvestre M et al: Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976). 32(15):1655-61, 2007
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
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
Fayyazi AH et al: Accuracy of computed tomography in assessing thoracic pedicle screw malposition. J Spinal Disord Tech. 17(5):367-71, 2004
Uribe J et al: Delayed postoperative spinal epidural hematomas. Spine J. 3(2):125-9, 2003
Kou J et al: Risk factors for spinal epidural hematoma after spinal surgery. Spine. 27(15):1670-3, 2002
Lin CC et al: Spinal cord infarction caused by cardiac tamponade. Am J Phys Med Rehabil. 81(1):68-71, 2002
Pelletier MP et al: Paraplegia after routine cardiac surgery: a rare complication. J Card Surg. 17(5):410-2, 2002
Yonenobu K et al: Neurologic complications of surgery for cervical compression myelopathy. Spine. 16(11):1277-82, 1991
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