Cervical spine surgery is a major surgical procedure and like every other surgical procedure has potential for complications. Te complications can be related to injury or type of surgery performed.
Neurological deficit is most devastating complication of spine surgery. The cause could be an intraoperative event such as a direct spinal cord injury, posterior strut or graft displacement. Otherwise failure of the construct could be responsible.
A detailed examination is the key to identification of the problem and it should follow with plain radiographs.
A missed lesion could result in worsened deficit and if this occurs, a full series of cervical, thoracic, and lumbar spine films should be obtained immediately.
Whenever needed a postoperative CT or MRI should be done. Because of the need for MRI titanium implant is preferred which is MRI-compatible.
Imaging helps to assess screw, plate, and graft placement and any impingement on the spinal canal, nerve roots, or vertebral arteries.
Hardware that appears to be a likely cause of neural deficit should be removed in the operating as soon as possible.
Dural tears can be identified peroperatively.Whether traumatic or iatrogenic, should be repaired primarily. If the tear is irrepairable, a fascial graft should be sewn into place. Avoid wound drainage system if patient has a dural tear and antibiotics should be administered.
In case of persistent leak a subarachnoid lumbar drain can be placed. If the leak does not stop, the tear should be re-explored and repaired to avoid formation of a spinal-cutaneous fistula.
Posterior surgery appears to have a slightly higher rate of infection than anterior cervical surgery.
Superficial infections usually occur within the first 10 days after surgery and may be adequately treated with oral antibiotics and local wound care. Wounds should be closely monitored, however. If they do not respond then early intraoperative irrigation and debridement should be performed.
Aggressive, early surgical debridement of deep infections can help avoid late-onset osteomyelitis, epidural abscess, meningitis, and catastrophic instrumentation failure.
Pseudorthrosis means false joint and occurs because of failure of graft bone interface to unite. Symptomatic anterior pseudarthrosis can be treated with repeat anterior surgery, or, preferably, posterior instrumentation and fusion.
If the bone does not fuse the implant would fail ultimately. Events like infection may hasten the process.
Early hardware failure can be associated with insufficiently stable constructs. Multilevel (>2) corpectomies stabilized with anterior fixation alone have a high rate of failure and should be routinely aided with posterior instrumentation and fusion.
Anterior graft or plate extrusion can lead to swallowing difficulty or more seriously, airway compromise.
Late hardware failure, such as screw breakage, is often associated with nonunion, which may or may not be symptomatic or require treatement
Complications Related To the Anterior Approach
Dysphagia or difficulty in swallowing is the most common complication and can occur in up to 50% of cases. Most of the time it is transient and gets relieved in few days.
Recurrent Laryngeal Nerve Palsy
This present as which presents with dysphonia or inability to produce sound using vocal organs. This complication occurs in 4% to 5% cases. An exposure below C5 and revision surgery are risk factors.
Horner’s syndrome is not a frequent complication of the anterior cervical approach. Its cause is the damage to the sympathetic plexus that may occur from overzealous retraction of the longus colli [Prevertebral muscles]. It presents with ptosis [drooping of upper eyelid, meiosis [constriction of pupil], and anhydrosis[lack of sweating on the affected side of the face].