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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
- Hemorrhage with cord compression
- 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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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
- Hemorrhage with cord compression
- 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
