Vascular complications in anterior thoracolumbar spinal reconstruction

2002 ◽  
Vol 96 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Rod J. Oskouian ◽  
J. Patrick Johnson
Keyword(s):  
Vascular Injury ◽  
Reconstructive Surgery ◽  
Spinal Surgery ◽  
Surgical Techniques ◽  
Vascular Complications ◽  
Reconstructive Procedures ◽  
Content Type ◽  
Spinal Reconstruction ◽  
Lumbar Spinal ◽  
Fine Print

Object. Anterior approaches in thoracic and lumbar spinal surgery have potentially serious vascular injury—related complications. In this study the authors evaluate the incidence of vascular complications in anterior approaches to the thoracic and lumbar spine in cases requiring reconstructive surgery. Methods. The authors retrospectively reviewed the medical records of 207 patients who underwent anterior thoracic and lumbar spinal reconstructive surgery during the period from 1992 through 1999 to determine the incidence, causes, and management of vascular complications. Overall, the incidence of vascular complications following reconstructive spinal surgery was 5.8% (12 patients) and the mortality rate was 1% (two patient deaths). In seven patients (3.4%), direct vascular injuries developed as a result of surgical techniques or error; one patient died as a result. Five patients (2.4%) developed deep venous thromboses, and one patient in this subgroup died of pulmonary embolism. Conclusions. Vascular injury to the great vessels is a known and potentially serious complication associated with anterior spinal reconstructive procedures. The authors found, however, that the incidence is relatively low in cases in which venous injuries occurred acutely and arterial injuries presented in a delayed fashion.

Diagnosis and treatment of Ogilvie's syndrome after lumbar spinal surgery

1992 ◽  
Vol 76 (6) ◽  
pp. 1012-1016 ◽  
Author(s):  
Robert A. Feldman ◽  
Richard C. Karl
Keyword(s):  
Spinal Surgery ◽  
Mechanical Obstruction ◽  
Ogilvie's Syndrome ◽  
Ogilvie’S Syndrome ◽  
Content Type ◽  
Cecal Perforation ◽  
Life Threatening ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal ◽  
Fine Print

✓ Three patients who developed Ogilvie's syndrome following lumbar spinal surgery are described. Ogilvie's syndrome, also known as pseudo-obstruction of the colon, is characterized by massive cecal distention without mechanical obstruction. If this condition is not recognized and not promptly treated, it may be complicated by cecal perforation, a life-threatening hazard. The etiology, diagnosis, management, and potential relationship between lumbar spinal surgery and Ogilvie's syndrome are discussed.

Visceral and vascular complications resulting from anterior lumbar interbody fusion

1999 ◽  
Vol 91 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Viswanathan Rajaraman ◽  
Roy Vingan ◽  
Patrick Roth ◽  
Robert F. Heary ◽  
Lisa Conklin ◽  
...  
Keyword(s):  
General Surgery ◽  
Spinal Surgery ◽  
Interbody Fusion ◽  
Burst Fracture ◽  
Vascular Complications ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Sympathetic Dysfunction ◽  
Fine Print

Object. The literature on abdominal and general surgery—related complications following anterior lumbar interbody fusion (ALIF) is scant. In this retrospective review of 60 patients in whom ALIF was performed at their institutions between 1996 and 1998, the authors detail the associated complications and their correlation with perioperative factors. The causes, strategies for their avoidance, and the clinical course of these complications are also discussed. Methods. The study group was composed of 31 men and 29 women whose mean age was 42 years (range 29–71 years). The preoperative diagnosis was discogenic back pain in 33 patients (55%); failed back syndrome in 11 (18.3%); pseudarthrosis in five (8.3%); postlaminectomy syndrome in four (6.6%); spondylolisthesis in three (5%); burst fracture in two (3.3%); and malignancy in two (3.3%). A retroperitoneal approach to the spine was used in 57 of the 60 patients. One interspace was exposed in 28 patients (46.6%), two in 28 (46.6%), and three in four (6.6%). Discectomy and interbody fusion in which the authors placed titanium cages or bone dowels was performed in 56 patients and corpectomy with instrumentation in four. Seven (11.6%) of 60 patients had undergone previous abdominal surgery and 29 (48.3%) had undergone previous spinal surgery. The follow-up period averaged 12 ± 4 months (mean ± standard deviation). Twenty-four general surgery—related complications occurred in 23 patients (38.3%), including sympathetic dysfunction in six; vascular injury in four; somatic neural injury in three; sexual dysfunction in three; prolonged ileus in three; wound incompetence in two; and deep venous thrombosis, acute pancreatitis, and bowel injury in one patient each. There were no deaths. The incidence of complications was not associated with underlying diagnosis (p > 0.1), age (p > 0.5), previous abdominal or spinal surgery (p > 0.1), or the number of levels exposed (p > 0.1). Conclusions. This report provides a detailed analysis of the general surgery—related complications following ALIF. Although many of these complications have been recognized in the literature, the significance of sympathetic dysfunction appears to have been underestimated. The high incidence of complications in this series likely reflects the strict criteria. Many of these complications were minor and resolved over time without long-term sequelae.

Vascular complications related to lumbar disc surgery

2004 ◽  
Vol 100 (3) ◽  
pp. 249-253 ◽  
Author(s):  
Hakan Bingol ◽  
Faruk Cingoz ◽  
Ahmet Turan Yilmaz ◽  
Mehmet Yasar ◽  
Harun Tatar
Keyword(s):  
Vascular Injury ◽  
Postoperative Period ◽  
Lumbar Disc ◽  
Vascular Complications ◽  
Lumbar Disc Surgery ◽  
Dacron Graft ◽  
Content Type ◽  
Disc Surgery ◽  
Late Postoperative Period ◽  
Fine Print

Object. Vascular complications related to lumbar disc operations are rare but extremely fatal conditions. The authors analyzed data retrospectively obtained in 13 patients with vascular complications that occurred during lumbar disc operations performed between January 1990 and January 2002. Methods. One patient underwent an L5—S1 procedure and the remaining underwent L4–5 surgery. Missed injuries, which were found during the late postoperative period, included pseudoaneurysm in four cases and an arteriovenous fistula in one. In all cases except one in which complication occurred early in the postoperative period, the retroperitoneal area was reached via a transperitoneal approach. In eight patients with complications occurring early in the postoperative period, Dacron graft was placed in four with arterial injuries and saphenous vein graft in one. In three cases of arterial injury and five of venous injury, the lesion was repaired using the primer suture technique. The most commonly affected vessels were left common iliac arteries (76.9%) and left common iliac vein (30.8%). In eight early cases, shock or preshock due to hemorrhage developed during the early phase. During the late postoperative period, graft-related infection occurred in two cases in which Dacron graft was placed, and axillofemoral extraanatomical bypass surgery was later performed. There was no surgery-related death. During a mean follow-up period of 5.6 years, none of the patients suffered any problems related to vascular injury. Conclusions. Despite its low incidence, iatrogenic vascular injury related to lumbar disc surgery is a possible complication. During lumbar disc operations early diagnosis of vascular injuries and urgent transperitoneal surgery can save patients' lives.

The effects of dexamethasone on bone fusion in an experimental model of posterolateral lumbar spinal arthrodesis

2001 ◽  
Vol 94 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Paul D. Sawin ◽  
Curtis A. Dickman ◽  
Neil R. Crawford ◽  
M. Stephen Melton ◽  
William D. Bichard ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Bone Graft ◽  
Spinal Fusion ◽  
Experimental Model ◽  
Content Type ◽  
Bone Fusion ◽  
Group 12 ◽  
Spinal Arthrodesis ◽  
Lumbar Spinal ◽  
Fine Print

Object. The use of corticosteroid agents during the healing phase after spinal arthrodesis remains controversial. Although anecdotal opinion suggests that corticosteroids may inhibit bone fusion, such an effect has not been substantiated in clinical trials or laboratory investigations. This study was undertaken to delineate the effect of exogenous corticosteroid administration on bone graft incorporation in an experimental model of posterolateral lumbar fusion. Methods. An established, well-validated model of lumbar intertransverse process spinal fusion in the rabbit was used. Twenty-four adult New Zealand white rabbits underwent L5–6 bilateral posterolateral spinal fusion in which autogenous iliac crest bone graft was used. After surgery, the animals were randomized into two treatment groups: a control group (12 rabbits) that received intramuscular injections of normal saline twice daily and a dexamethasone group (12 rabbits) that received intramuscular dexamethasone (0.05 mg/kg) twice daily. After 42 days, the animals were killed and the integrity of the spinal fusions was assessed by radiography, manual palpation, and biomechanical testing. In seven (58%) of the 12 control rabbits, solid posterolateral fusion was achieved. In no dexamethasone-treated rabbits was successful fusion achieved (p = 0.003). Tensile strength and stiffness of excised spinal segments were significantly lower in dexamethasone-treated animals than in control animals (tensile strength 91.4 ± 30.6 N and 145.3 ± 48.2, respectively, p = 0.004; stiffness 31.4 ± 11.6 and 45.0 ± 15.2 N/mm, respectively, p = 0.02). Conclusions. The corticosteroid agent dexamethasone inhibited bone graft incorporation in a rabbit model of single-level posterolateral lumbar spinal fusion, inducing a significantly higher rate of nonunion, compared with that in saline-treated control animals.

Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidance

2002 ◽  
Vol 97 (3) ◽  
pp. 591-597 ◽  
Author(s):  
Emmanuel Cuny ◽  
Dominique Guehl ◽  
Pierre Burbaud ◽  
Christian Gross ◽  
Vincent Dousset ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Functional Response ◽  
Anterior Commissure ◽  
Surgical Techniques ◽  
High Frequency Stimulation ◽  
Mr Images ◽  
Posterior Commissure ◽  
Content Type ◽  
Fine Print

Object. The goal of this study was to determine the most suitable procedure(s) to localize the optimal site for high-frequency stimulation of the subthalamic nucleus (STN) for the treatment of advanced Parkinson disease. Methods. Stereotactic coordinates of the STN were determined in 14 patients by using three different methods: direct identification of the STN on coronal and axial T2-weighted magnetic resonance (MR) images and indirect targeting in which the STN coordinates are referred to the anterior commissure—posterior commissure (AC—PC) line, which, itself, is determined either by using stereotactic ventriculography or reconstruction from three-dimensional (3D) MR images. During the surgical procedure, electrode implantation was guided by single-unit microrecordings on multiple parallel trajectories and by clinical assessment of stimulations. The site where the optimal functional response was obtained was considered to be the best target. Computerized tomography scanning was performed 3 days later and the scans were combined with preoperative 3D MR images to transfer the position of the best target to the same system of stereotactic coordinates. An algorithm was designed to convert individual stereotactic coordinates into an all-purpose PC-referenced system for comparing the respective accuracy of each method of targeting, according to the position of the best target. Conclusions. The target that is directly identified by MR imaging is more remote (mainly in the lateral axis) from the site of the optimal functional response than targets obtained using other procedures, and the variability of this method in the lateral and superoinferior axes is greater. In contrast, the target defined by 3D MR imaging is closest to the target of optimal functional response and the variability of this method is the least great. Thus, 3D reconstruction adjusted to the AC—PC line is the most accurate technique for STN targeting, whereas direct visualization of the STN on MR images is the least effective. Electrophysiological guidance makes it possible to correct the inherent inaccuracy of the imaging and surgical techniques and is not designed to modify the initial targeting.

Preservation of olfaction in anterior craniofacial approaches

1993 ◽  
Vol 79 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Robert F. Spetzler ◽  
James M. Herman ◽  
Stephen Beals ◽  
Edward Joganic ◽  
John Milligan
Keyword(s):  
Cribriform Plate ◽  
Csf Leak ◽  
En Bloc ◽  
Reconstructive Procedures ◽  
Content Type ◽  
The Mean ◽  
Ethmoid Sinuses ◽  
Fine Print ◽  
Csf Leaks

✓ Through the combined efforts of neurosurgeons, head and neck surgeons, and craniofacial surgeons, the standard transbasal approach to the frontal fossa has been modified to include removal of the orbital roofs, nasion, and ethmoid sinuses. This approach has been combined further with facial disassembly procedures to provide extensive midline exposure to the midface and clival region. Extended frontal approaches, however, necessitate removal of the crista galli and sectioning of the olfactory rootlets with the associated risk of anosmia, cerebrospinal fluid (CSF) leak, and the need for complex reconstruction of the frontal floor. To avoid these problems, the authors have modified the technique of handling the cribriform plate to preserve the olfactory unit. Circumferential osteotomy cuts are made around the cribriform plate to allow an en bloc removal with its attachment to both the dura and underlying mucosa. Opening of the dura is avoided and the cribriform bone is used to reconstruct the floor. Four patients underwent this approach, for treatment of an angiofibroma in three and a fibrosarcoma in one. The mean follow-up period was 7 months. No patients developed a CSF leak, and within 8 weeks olfaction had returned in all patients. There was no other associated morbidity. These data suggest that this modification of the transbasilar approach can alleviate extensive reconstructive procedures and CSF leaks while preserving olfaction.

The crucial decade: modern neurosurgery's definitive development in Harvey Cushing's early research and practice, 1900 to 1910

1997 ◽  
Vol 87 (6) ◽  
pp. 964-971 ◽  
Author(s):  
Samuel H. Greenblatt
Keyword(s):  
Clinical Success ◽  
Surgical Techniques ◽  
Scientific Work ◽  
The United States ◽  
Full Time ◽  
Content Type ◽  
Social Ability ◽  
Harvey Cushing ◽  
Neurological Surgery ◽  
Fine Print

✓ When Harvey Cushing announced his full-time commitment to neurological surgery in 1904, it was a discouraging and discouraged enterprise. Other surgeons' mortality rates for patients with brain tumors were 30 to 50%. By 1910 Cushing had operated on 180 tumors; he had a thriving practice, with a patient mortality rate of less than 13%. The three essential ingredients of his success were: 1) a new surgical conceptualization of intracranial pressure (ICP); 2) technical innovations for controlling ICP; and 3) establishment of a large referral base. In the years 1901 through 1905, the implications of his research on the “Cushing reflex” were quickly translated into surgical techniques for controlling ICP. In the period between 1906 and 1910, Cushing built up his referral practice by publishing widely, and especially by lecturing to medical audiences throughout the United States and Canada. His scientific work on ICP was essential to his clinical success, but without his professional and social ability to build a thriving practice, there would have been insufficient material for him to use to improve his approaches.

Outcome after laminectomy for lumbar spinal stenosis

1994 ◽  
Vol 81 (5) ◽  
pp. 699-706 ◽  
Author(s):  
Gerald F. Tuite ◽  
Joseph D. Stern ◽  
Stephen E. Doran ◽  
Stephen M. Papadopoulos ◽  
John E. McGillicuddy ◽  
...  
Keyword(s):  
Lumbar Fusion ◽  
Patient Questionnaire ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Additional Surgery ◽  
Study Interval ◽  
Washtenaw County ◽  
Lumbar Spinal ◽  
Fine Print

✓ All patients who underwent decompressive lumbar laminectomy in the Washtenaw County, Michigan metropolitan area during a 7-year period were studied for the purpose of defining long-term outcome, clinical correlations, and the need for subsequent fusion. Outcome was determined by questionnaire and physical examination from a cohort of 119 patients with an average follow-up evaluation interval of 4.6 years. Patients graded their outcome as much improved (37%), somewhat improved (29%), unchanged (17%), somewhat worse (5%), and much worse (12%) compared to their condition before surgery. Poor outcome correlated with the need for additional surgery, but there were few additional significant correlations. No patient had a lumbar fusion during the study interval. The outcome after laminectomy was found to be less favorable than previously reported, based on a patient questionnaire administered to an unbiased patient population. Further randomized, controlled trials are therefore necessary to determine the efficacy of lumbar fusion as an adjunct to decompressive lumbar laminectomy.

Anatomical suitability of C1–2 transarticular screw placement in pediatric patients

2000 ◽  
Vol 92 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Douglas L. Brockmeyer ◽  
Julie E. York ◽  
Ronald I. Apfelbaum
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Vascular Complications ◽  
Screw Placement ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Transarticular Screw ◽  
Content Type ◽  
Transarticular Screw Fixation ◽  
Fine Print

Object. Craniovertebral instability is a challenging problem in pediatric spinal surgery. Recently, C1–2 transarticular screw fixation has been used to assist in craniovertebral joint stabilization in pediatric patients. Currently there are no available data that define the anatomical suitability of this technique in the pediatric population. The authors report their experience in treating 31 pediatric patients with craniovertebral instability by using C1–2 transarticular screws. Methods. From March 1992 to October 1998, 31 patients who were 16 years of age or younger with atlantooccipital or atlantoaxial instability, or both, were evaluated at our institution. There were 21 boys and 10 girls. Their ages ranged from 4 to 16 years (mean age 10.2 years). The most common causes of instability were os odontoideum (12 patients) and ligamentous laxity (eight patients). Six patients had undergone a total of nine previous attempts at posterior fusion while at outside institutions. All patients underwent extensive preoperative radiological evaluation including fine-slice (1-mm) computerized tomography scanning with multiplanar reconstruction to evaluate the anatomy of the C1–2 joint space. Preoperatively, of the 62 possible C1–2 joint spaces in 31 patients, 55 sides (89%) were considered suitable for transarticular screw placement. In three patients the anatomy was considered unsuitable for bilateral screw placement. In three patients the anatomy was considered inadequate on one side. Fifty-five C1–2 transarticular screws were subsequently placed, and there were no neurological or vascular complications. Conclusions. The authors conclude that C1–2 transarticular screw fixation is technically possible in a large proportion of pediatric patients with craniovertebral instability.

Resorbable posterolateral graft containment in a rabbit spinal fusion model

2002 ◽  
Vol 97 (4) ◽  
pp. 460-463 ◽  
Author(s):  
Ashley R. Poynton ◽  
Fengyu Zheng ◽  
Emre Tomin ◽  
Joseph M. Lane ◽  
G. Bryan Cornwall
Keyword(s):  
Spinal Fusion ◽  
Demineralized Bone Matrix ◽  
Bone Matrix ◽  
Autologous Bone Graft ◽  
Fusion Model ◽  
Content Type ◽  
Lumbar Spinal ◽  
Posterolateral Spinal Fusion ◽  
Mass Volume ◽  
Fine Print

Object. The authors studied the effect of a resorbable graft containment device in a rabbit posterolateral lumbar spinal fusion model. Methods. Twenty rabbits were divided into four groups: autologous bone graft (ABG), ABG with the MacroPore containment device (ABG + MP), demineralized bone matrix (DBM), and DBM with the containment device (DBM + MP). Fusion mass was assessed at 6 weeks with high-resolution radiography and volumetric computerized tomography. The graft containment device was associated with alteration of the fusion mass structure and significant enhancement of fusion mass volume (ABG versus ABG + MP, p = 0.027; DBM versus DBM + MP, p = 0.043). Conclusions. A bioabsorbable protective graft containment device successfully enhanced posterolateral spinal fusion mass volume.

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