Abdul Gofar Sastrodiningrat

Departemen Ilmu Bedah Saraf

Fakultas Kedokteran Universitas Sumatera Utara

N EU R O LO G IC A L
C O M P LIC ATIO N S IN
LU M B A R S P IN E S U R G ER Y
Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual
Meeting 2009
1
 N EU RO LO G ICAL
CO M PLICATIO N S

Spine surgery is actually very save

As complications can occur in any

invasive procedure spine surgery
is no different

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual
Meeting 2009
2
 Lum bar Spine Anatom y

The disc

The
Vascularisation
Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual
Meeting 2009 3
 N eurologicalInjuries

Direct Injuries Indirect Injuries

Intraoperative Injuries Postoperative Injuries

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual
Meeting 2009
4
 D irect Injuries Intra-operative injury

A piece of equipment touching the wrong spot

Kerrison punch, osteotome, rongeur, high speed drill, bovie electrocautery

LACERATION OF DURA
Most frequent complication ;
microdiscectomy 1.8% ; primary COMPRESSION CONTUSION
lumbar decompression 5% ; Revision
17.4% of the nerve root
weakness paralysis
CSF leak : below the level of surgery
infection
headache
AVULSION
LACERATION OF THE NERVE
ROOT
nerve damage
nerve root pulled away
(very rare most likely to happen if there is
a large amount of scar after multiple
previous spine surgeries)

Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual
Meeting 2009
5
 Indirect Injuries

DISRUPTION OF BLOOD
SUPPLY GRADUAL
COMPRESSION
something could happen
in the spine that blocks
the blood flow to the
spinal cord (pieces of bone developing hematoma
compressed against each other) putting pressure to nerve
roots paralysis and
Ischemia cell death numbness below the waist
Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual Meeting
2009
6
 Another Intra O perative Injury
POSITIONING
Good position stomach area hangs free ; Spine lines up exactly as it should

Ischemic Optic Neck-shoulder girdle

- Brachial plexus
Neuropathies - Suprascapular nerve
Elbow region
1. Anterior Ischemic Optic
- Ulnar nerve and Radial nerve
Neuropathy
Wrist
2. Posterior Ischemic - Median nerve
neuropathy - Ulnar nerve
Lower extremity
- Sciatic nerve and Peroneal nerve
Compression and
Cervical spine
Traction - Tandem stenosis
Neuropathies in the Complication of Spinal or Epidural
Upper and Lower Extremities Anesthesia needle puncture
blood compression
Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS Annual
Meeting 2009 7
Post O perative Com plications
Immediate assessment after surgery to check any injury that might happened
during the surgery

INFECTION
- Discectomy 1%
- Posterior spinal fusion 2
5%
- Instrunentation up to 9%
- Anterior spinal fusion < 1%
- Anterior cervical 0.3 3% Epidural hematoma
PSEUDOARTHROSIS Pseudomeningocele
- increasing back pain
- confirmation by CT
Incontinence
Sexual dysfunction
Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS
Annual Meeting 2009 8
Vaccaro AR, Baron EM : Spine Surgery ; AANS Guidelines of Spine Surgery 2007 ; AAOS
Annual Meeting 2009 9