Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Complications of Spine Surgery 10 articles


Prolonged Bed Rest as Adjuvant Therapy After Complex Reconstructive Spine Surgery

Rex A. W. Marco MD, Ryan M. Stuckey MD, Stephanie P. Holloway MHA

The benefits of postoperative mobilization include decreased incidence of pulmonary complications, pressure ulcers, and progression of deep vein thrombosis. However, the complexity of certain spinal reconstructions and the patient’s physiologic condition may preclude the possibility of early mobilization. Prolonged bed rest after spine surgery is controversial.

Spinal Cord Injury Resulting From Injury Missed on CT Scan: The Danger of Relying on CT Alone for Collar Removal

Gregory Gebauer MD, MS, Meredith Osterman MD, James Harrop MD, Alexander Vaccaro MD, PhD

Strict criteria have been used before removing cervical collars in patients with injuries who have midline pain or are unable to be reliably examined. This sometimes leads to prolonged immobilization in cervical collars or use of MRI to rule out injury. Several studies suggest a collar may be removed in the absence of fractures, dislocation, or pathologic subluxation on a cervical CT scan. This may avoid the morbidity of prolonged cervical immobilization or cost of advanced imaging study but risks devastating consequences from missing injuries.

Capacitive Coupling Reduces Instrumentation-related Infection in Rabbit Spines: A Pilot Study

Mohit Gilotra MD, Cullen Griffith MD, Jason Schiavone BA, Naren Nimmagadda BS, Jenna Noveau BS, Steven C. Ludwig MD

Postoperative spine infections cause considerable morbidity. Patients are subjected to long-term antibiotic regimens and may require further surgery. Delivery of electric current through instrumentation can detach biofilm, allowing better antibiotic penetration and assisting in eradicating infection.

Combined Anterior-Posterior Surgery is the Most Important Risk Factor for Developing Proximal Junctional Kyphosis in Idiopathic Scoliosis

Han Jo Kim MD, Mitsuru Yagi MD, PhD, Joseph Nyugen MS, Matthew E. Cunningham MD, PhD, Oheneba Boachie-Adjei MD

Several studies have identified risk factors for proximal junctional kyphosis (PJK) after instrumentation for scoliosis, but the relative risks are unclear.

CT and MRI-based Diagnosis of Craniocervical Dislocations: The Role of the Occipitoatlantal Ligament

Kristen Radcliff MD, Christopher Kepler MD, Charles Reitman MD, James Harrop MD, Alexander Vaccaro MD, PhD

Craniocervical dislocations are rare, potentially devastating injuries. A diagnosis of craniocervical dislocations may be delayed as a result of their low incidence and paucity of diagnostic criteria based on CT and MRI. Delay in diagnosis may contribute to neurological injury from secondary displacement resulting from instability. The purpose of this study was to define CT and MRI-based diagnostic criteria for craniocervical dislocations to facilitate early injury recognition and stabilization.

Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

D’Mitri A. Sofianos MD, Michael R. Briseño MD, Joshua Abrams DO, Alpesh A. Patel MD

The lateral transpsoas approach to the lumbar spine was developed to eliminate the need for an anterior-approach surgeon and retraction of the great vessels and has the potential for shorter operative times. However, the reported complications associated with this approach vary.

Cauda Equina Syndrome After a TLIF Resulting From Postoperative Expansion of a Hydrogel Dural Sealant

Brian J. Neuman MD, Kristen Radcliff MD, Jeffery Rihn MD

DuraSeal(Coviden, Waltham, MA, USA), a hydrogel sealant, is primarily used as an adjunct to a dural repair. Its use has also been described to seal off an annulotomy after a transforaminal lumbar interbody fusion when recombinant human bone morphogenetic protein-2 (rhBMP-2) is used. This aids in the reduction of postoperative radiculitis caused by rhBMP-2. However, as a result of its hydrophilic properties, DuraSealhas the potential to swell, which could lead to compression of the thecal sac.

Case Report: Cauda Equina Syndrome Associated With an Interspinous Device

Worawat Limthongkul MD, Wicharn Yingsakmongkol MD

Although postoperative spinal epidural hematoma (SEH) is not uncommon, hematomas that require surgery are rare. Cauda equina syndrome (CES) may be associated with postoperative SEH. In these cases, early recognition and emergency decompression can prevent further damage and better neurologic recovery.

Odontoid Fractures With Neurologic Deficit Have Higher Mortality and Morbidity

Amar Patel BS, Harvey E. Smith MD, Kris Radcliff MD, Navin Yadlapalli BS, Alexander R. Vaccaro MD, PhD

Type II odontoid fractures are reportedly increasing in incidence and occur primarily in the elderly. Neurologic deficits (ND) at presentation add to the morbidity of these fractures; however, reports are limited as a result of small case series. It is unclear what specific complications are associated with ND and whether these result in increased incidence of mortality.