Complications avoidance in spine surgery adnan albanna
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spine surgery complication avoidance management adnan albanna عدنان البنا
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Complications avoidance in spine surgery adnan albanna
- 2. Pre-existing conditions associated with increased operative risk or difficulties DeformitiesI. scoliosis,• spondylolysis• spondylisthesis• InfectionsI. Tumors Osteoporosis Pre existing instabilities II. III. IV. V. Previous discectomy laminectomy lumbar fusion • • • • operated spinal deformity Inadequate investigationI. Adult degenerative scoliosisClinical Radiological • • & stenosis – neurologic deficit
- 3. Pre-operative medical conditions and risk factors are reported to be: Diabetes Malignancy Tobacco use Obesity Cardiovascular problems Age ≥ 70 yrs Cont-ed
- 4. Pre-operative medical conditions and risk factors are reported to be: Steroid use Immunosuppression Myelodysplasia Post - radiation Weinstein MA et al J. Spin. Disord. 2000 O.K.U. A.A.O.S. Spine 2 2002
- 5. Pre- and intra-operative risk factors are reported to be: Length of pre-operative hospitalization Revision surgery Duration of surgery Number of fused segments Bone graft or methylmethacrylate Blood loss and transfusion Weinstein MA et al J. Spin. Disord. 2000 O.K.U. A.A.O.S. Spine 2 2002
- 6. Intra-operative causes of complications Hemorrhage Facets’ – pedicles’ destruction Screws misplacement Battered nerve roots Graft’s quality and quantity Inadequate decompression
- 10. Intra-Post-operative risk factors are reported to be: The use of instrumentation The type of implants Steel Titanium Cross links Weinstein MA et al J. Spin. Disord. 2000 O.K.U. A.A.O.S. Spine 2 2002
- 11. Early post-operative causes of complications (0 – 3 wks) Haematoma Infection Implants’ failure
- 13. 1st p. op. 3 yrs p.op
- 15. Late post-operative causes of complications (a. 3wks – 3mts) Implants’ failure Screws loosening Broken Dislodged Rods Broken Destabilization Infection Osteoporosis
- 16. Late Heamatoma
- 17. Late infection
- 18. Late infection
- 20. Late post-operative causes of complications (b. > 3mts) Implants failure Destabilization at at at the the the level(s) of the operation level above level below -//- -//- Pseudarthrosis Recurrence of stenosis Late infection
- 21. Post laminectomy - Facetectomy Instability
- 22. Screw loosening
- 23. Broken rods
- 25. Failure of Adjacent Vertebral Segments Failure of the cranial adjacent segment can occur acutely as a result of vertebral body fracture or as a long term complication caused by degeneration of the adjacent motion segment.
- 26. Tissue reactions to Spinal implants Factors of corrosion 1) Combination of different metallic materials 2) 3) Surfaces’ composition and irregularity Micro-movements between the parts spinal instrumentation of the 4) Ions of Cl- from the plasma and intercellular area pH5) 6) Different concentration of O2 ions in free and covered metallic areas
- 27. Metal corrosion galvanic corrosion different metals fretting corrosionsame metals in micro-movement crevice corrosionmetals in different electrolytic fluids
- 28. Galvanic corrosion different metals Accelerated decay due to neighboring of dissimilar metallic implants in a corrosive electrolitic invironment Electrochemical dissimilarity It is possible to take place even between the same type of materials in different end-plate surfaces It is common in articulated spinal implants
- 29. Fretting corrosion same metals in micro-movement
- 30. Ionic debris is additive to the influences of particulate debris and can have a significant impact on local cytotoxicity.
- 31. In vitro studies have shown that these metal particles can be phagocytized intracellularly leading to release of inflammatory cytokines Betts F. et al, Clin Orth., 1992 Lee JM et al, J.B.J.S. 1992
- 32. This inflammatory cascade may lead in turn to: resoption of bone and cellular death Hallab NJ, Cunnigham B et al, Spine 2003
- 33. The potential for bone resorption is particularly distressing in spinal surgery because much of the operation’s success depends on obtaining a spinal fusion.
- 34. The toxic effects of these metal particles also are of great concern because the neural elements are widely exposed during spinal decompressions.
- 35. Although instrumentation is typically left in place in the early post-operative period, all other foreign bodies such as : Bone wax Absorbable gelatin sponge Must be removed
- 40. American Journal of Neuroradiology 27:1573-1575, August 2006© 2006 American Society of Neuroradiology MR Angiography of the Adamkiewicz Artery and Anterior Radiculomedullary Vein: Postmortem Validation R.J. Nijenhuisa,b, M.J. Jacobsb, J.M.A. van Engelshovena and W.H. Backesa SUMMARY: Spinal cord arteries and veins are difficult to visualize and distinguish by MR angiographic techniques because of their smallsizes, similar spatial course, and close vascular anatomy. Contrast- enhanced MR angiography was demonstrated to dynamic Adamkiewicz artery from the anterior radiculomedullary v thoracolumbar spinal cord. The location of the Adamkiew the anterior radiculomedullary vein could be validated in t specimen of a thoracoabdominal aortic aneurysm patient. resolve the e ry and mortem ally ein i icz a he p n th rte ost
- 44. CSF leakage Air embolism CSF leakage Air embolism CSF leakage
- 45. Duraseal
- 46. Vertebroplasty Aorta Cement leakage Spinal canal Nerve root compression Spinal canal
- 48. Personal communication with the patient and relatives in case of complications
- 50. Treatment of post – operative infection Early and decisive treatment should be initiated on diagnosis As medical management is likely to fail, aggressive surgical intervention typically is suggested for post-operative infections O.K.U. A.A.O.S. Spine 2 2002
- 51. Hardware removal is appropriate: if the instrumentation has failed in refractory infections in cases of late hematogenous infection occurring after a fusion has healed
- 53. Above spondylodesia Extension of instability spondylodesia