Complications
Deep infection encompasses osteomyelitis or paravertebral tissue inflammation mass. It occurs in 10% of trauma patients.[175] Superficial infection may respond to antibiotics, whereas deep infection requires irrigation and debridement.[75] As minimally invasive techniques are becoming the gold standard, the incidence of infections will probably decrease.[10]
This is a rare problem that occurs with prolonged use of a backboard (>6 hours). To help avoid this, the posterior trunk should be inspected and the backboard removed as soon as possible.[177]
Related to conservative treatment. Evidence suggests non-operative treatment is associated with a significant progression of deformity at 8-year follow-up: compression (50%), gibbus (hump or swelling) (23%), disk collapse (23%), scoliosis (23%), and spondylosis (46%).[174]
Patients should be assessed for instability, deformity, nonunion, malunion, and persistent neural compression. If none of the above is found, intensive physical therapy should be considered. If even physical therapy fails, then consider referring the patient for further assessment by the multidisciplinary pain management team.
Thromboembolism is reported at 18% to 100%, depending on the diagnostic technique used, time after injury, and concurrent risk factors.[72] If no prophylaxis is used, the incidence is estimated to be 40% in patients with acute spinal cord injury. Two major factors contributing to the thrombosis include hypercoagulability and stasis due to muscle paralysis.
The mainstays of treatment and prevention are compression stockings, intermittent pressure devices, and anticoagulation.[10][11][172][173]
Thromboembolism is reported at 18% to 100%, depending on the diagnostic technique used, time after injury, and concurrent risk factors.[72] If no prophylaxis is used, the incidence is estimated to be 40% in patients with acute spinal cord injury. Two major factors contributing to thrombosis include hypercoagulability and stasis due to muscle paralysis. Pulmonary embolism occurs in about 5% of trauma patients with acute spinal cord injury.
The mainstays of treatment and prevention are compression stockings, intermittent pressure devices, and anticoagulation.[11][172][173]
Respiratory problems may occur with prolonged bed rest. This complication can be prevented with early rehabilitation and physical therapy.
Retrograde influx of organisms and infection is common in patients with poor bladder emptying.[176]
Evidence suggests pedicle cortical perforation occurs in 21% of patients with pedicle screw fixation, independent of surgical experience, screw size, and spinal level. Evidence from the Scoliosis Research Society Morbidity and Mortality Committee in 1987 suggests that neurologic injury occurs in 3.2% of patients; fracture of the pedicle screw in 4.2%; cerebrospinal fluid (CSF) leak in 4.2%; deep postoperative infection in 4%; transient neurapraxia in 2.4%; and permanent nerve root injury in 2.3%.[72]
Can occur secondary to denervation or devascularization. Transmuscular approaches in anterior surgery may lead to hernias.
The incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones.[178][179] Suture repair and endovascular techniques are useful in the management of these severe complications.[178]
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