Daniel A Capen MD Downey Orthopedic Group COMPLICATIONS IN CERVICAL AND LUMBAR SPINAL SURGERY

Daniel A Capen MD Downey Orthopedic Group COMPLICATIONS IN CERVICAL AND LUMBAR SPINAL SURGERY

Complications in Spinal Surgery Positioning Complications Approach Complications Procedure Complications Post-surgical Complications

Complications in Cervical Spine Surgery Nassr et al Journal of Neurosurgical Spine 2010 Analysis of 25 Studies- 8.9% Overall Rate No Difference if Prospective or Retrospective Rates Increased in >60 Age Increased for Diagnosis of Spondylosis with Myelopathy

Positioning Complications Brachial Plexopathy from Shoulder Taping Ulnar Nerve Injury Occular Compression Blindness in Posterior Surgery Knee and Ankle Compression Malpositioning to Create Kyphosis or Hyperlordosis

Anterior Approach Related Complications Dysphagia Dysphonia Horners Syndrome Injury to Chassaignac s Ganglion Carotid Injury Excessive Lumbar Tissue Trauma All Related to Retraction and Anterior Spine Dissection

Procedure Related Complications Vertebral Artery Injury Nassr- 0.3% Anterior Neurologic Injury 0.3-0.4% Poor Cage or Graft Placement End-Plate Violation Incomplete Decompression Lordosis Loss Insufficient Fixation From Malpositioned Screws or Cages

Post Surgical Complications Dysphagia- Bazaz Spine 2002 >50% of 249 Patients Had Moderate or Severe in the 1 st Month 12.5% at 12 Months Risk Factors Number of Levels, Length of Surgery, Female Patients Indication for Hardware Explantation if Severe

Post Surgical Complications in Lumbar Surgery DVT 5-7% incidence Compression Stockings, Early Ambulation Cage Migration,Screw Cut Out-Immediate repositioning Infection rates 2-13% Low In Alif, Higher in Posterior Approaches Incisional Vancomycin Powder in ALL Posterior Instrumented Fusions Rates Reduced to <1%

Post Surgical Complications Dysphonia Recurrent Laryngeal Nerve Injury Kahraman et al Euro-Spine 2007-235 Cases Incidence 1.27 % 3 males All Surgery at C6/7 Improvement with Time

Post Surgical Complications Retro-Pharyngeal Hematoma Palumbo et al 2012 Open Ortho Journal 0.2 to 1.9% Tachypnea, Desaturation Throat Swelling Life Threatening--- Immediate Evacuation Surgical Drain for All Anterior Cases-24hrs

Posterior Cervical Complications Graham et al Spine 1996 1.8% Radiculopathy with Lateral Mass Fixation <15mm Screws Facet Fracture or Violation 6% Rate Pedicle Penetration 6.8% Overall Neurologic Injury Rate >2%

Post Surgical Infection in Cervical Surgery Rates 0.4 to 4.5% Vacarro et al 2003 Posterior Approach Greater-Muscle Trauma and Blood Loss Staph Strep Klebsiella If Anterior Infection Need to R/O Esophageal Perforation Age, Smoking, Immune Compromise- Increase Infection Risk

Avoidance of Complications SSEP and MEP Monitoring Careful Pre Surgical Positioning Real Time Imaging for Fixation Frequent Relaxation of Retraction Avoid Bi-cortical Screws Anterior or Posterior Hemostasis, Irrigation and Drainage Vancomycin In Lumbar PSF and all MRSA Cases

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Cerebral Aneurysms Incidence Diagnosis Treatment Options Daniel A Capen MD

Cerebral Aneursyms

Cerebral Aneurysms Associated with Hernia, Peripheral Aneurysm 1 in 50 in US Population 1% of population at autopsy At or Near Circle of Willis At Arterial Junctions

Types of Aneurysms Saccular Berry Most Frequent Fusiform Usually do Not Rupture Charco-Bouchard Usually <15mm Hypertension- Usually Slow Bleed Giant Aneurysm > 2.5 cm Always Risk for Sudden Death or Hemorrhagic Stroke

Types of Aneurysms

Aneurysm Risk Factors Marfan Syndrome Polycystic kidney Disease Neurofibromatosis Hereditary Telangectasia Ehlers Danlos Type II and IV

CAUSES of Aneurysm Genetic Tendency Weakness of Connective Tissue High Blood Pressure Mycosis, Infection, Trauma Drug Abuse Cocaine, Amphetamines

SIGNS AND SYMPTOMS Headache Nausea- Vomiting Confusion Visual Disturbance Focal Facial Numbness Meningismus Focal Neural Defecit Sudden Coma

Diagnosis CAT SCAN with Angiography MRI for post- aneurysm Bleed Screen For Any Of Risk Patients

Angiography

Treatment Options Observation if Diagnosed But No Symptoms Endovascular Embolization or Coil Craniotomy For Clipping

Cerebral Aneurysms

Treatment Options

Results With Rupture 40% Mortality Rate 15% Die Before Reaching Hospital Female > Male For Rupture Once Aneurysm Ruptures >60% Have Permanent Neurologic Deficits

Multiple Aneurysms

Cerebral Aneurysms

Diagnosis

Types Of Aneurysms

Multiple Aneurysms