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.
Postoperative Complications
Neurologic Deficit
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
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.
Wound infection
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.
Late Complications
Pseudarthrosis
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.
Hardware Failure
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
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
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].
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I am currently 24 days post op anterior cervical discectomy c5-6, c6-7 with plate and screws. a donor bone was used for the graph. 5 days post op i presented to the surgeon for follow experiencing stabbing pain in the base of my neck radiating through my left scapula to my left bicep, and tricep to my forearm. The nurse and APN at the office told me it was muscle spasms that were normal and they would resolve. The physician was also notified. as of today i am still experiencing the same stabbing pain with radiation, calls to the physician have been difficult as i did not recieve a return call until lat night. I was sent for xrays. which, would probably not show and nerve involvement or compression. my question is the possibility of a brachial plexis injury or involvement a possibility and what wopuld be the treatment for this. please advise. I am considering another physician at this time. thank you, stephen
Dr Arun Pal Singh Reply:
November 11th, 2010 at 12:52 pm
@stephen r. francz,
You need to talk to your physician. Or talk to someone else for second opinion.
It is unlikely a brachial plexus involvement but if the symptoms persist, nerve root compression needs to be ruled out.
dear sir
my father age 70 having problem with c4-c6 any complecation in the time of surgery and in recavery time
please give your view to me
thanks
karthick
Dr Arun Pal Singh Reply:
November 27th, 2010 at 12:54 pm
@KARTHIKEYAN.S,
You need to provide me with enough information so that I can answer your questions better.
I had c4-c5 fusion in 2005 and had no problems pos surgery until I fell in 2007 injuring my head,bilateral arms, neck, lower back and legs. My question is I have had problems with my neck and headaches since the fall and now my left arm is going numb with radiating pain. The MRI is showing disc bulging and spondylosis at c6-c7. My question is…Could this have been caused by the fall since I had no problems for 2 years and it started after the fall or is this normal degeneration?
Dr Arun Pal Singh Reply:
September 8th, 2011 at 7:12 am
@KAthleen C,
It could be either.
Can you elaborate on your answer? I am curious as to your answer because since I had no problems before the fall, it seems the fall would have caused or aggravated the present symptoms.And if it is the case that this is normal degeneration after a fusion, then the benefits of a fusion could only last 2 years?
Dr Arun Pal Singh Reply:
September 14th, 2011 at 12:26 pm
@KAthleen C,
Fall could have aggravated the symptoms but it would be hard to prove that since fall occurred long time back.
There could have been natural degeneration and that not necessarily due to fusion per se.
Pointing at the cause would not be possible in my view and you should concentrate more on treatment aspect.
i had a c5-c6 neck fusion in 1992, using bone from my own hip. In 1998 i started having mild headaches. as time went on the headaches got worst. MRI showed some spacing and a bone spur at the point of surgery. My question is ..What may be causing the severe headaches and is the bone spur a problem???
Dr Arun Pal Singh Reply:
November 19th, 2011 at 12:21 pm
@greg,
Cannot say much with the available info. Did you ask your doctor?
I did ask several doctors but due to the fact it was a job related injury and the fect that the company has most of the doctors on payroll in town none of them will touch the case. They willhow ever go so far as to say there is a problem but not be specific or offer to give any advice other than live with what i have. and i’m sorry but i do need to be able to live life as pain free as possible in order to function on a daily basis
Dr Arun Pal Singh Reply:
December 17th, 2011 at 6:59 am
@greg,
At the most I can give you a general advise on your condition. You need to see a doctor for the treatement.