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].
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.
Hello, I had anterior discectomy and fusion of C5-C6 and C6-C7 because of herniation and myelopathy the 17th of November 2011. 2 peek cages were inserted and the fusion was attained with 5 screws and a titanium plate. Previous to the surgery I had no significant symptoms, but the neurosurgeon said that the compression was severe.
After the surgery I developed shoulder and neck pain, my physicians says it is because of muscular spasms and recommended heat pillow and physiotherapy. One week ago I had an X ray where it shows that the plate is in good position at C5, but at C6 the plate stars separating slightly and at C7 it progresses to a maximum separation of 9 mm. My physician was not alarmed at this finding said there was no problem since the cages are in place and that I just should not do “violent” movements. I have not significant dysphagia, but I feel as I had a lump in the throat.
What is your opinion, do I need to wear again a collar, should I get surgery again to get a posterior fixation??
Thank you for your opinion.
Dr Arun Pal Singh Reply:
March 10th, 2012 at 2:18 pm
@Anette,
If plate is separating and you have symptoms [lump in throat], one needs to have a careful follow up. If pate continues to move further and symptoms worsen and fusion has taken place, palte removal may be required
I am a 53 y/o WF 6ft/220#, diagnosed with herniated C 5-6 & C 6-7 in the 90′s ,experienced severe stabbing pain in neck under R shoulder blade down lateral upper arm into elbow over top of forearm into hand esp 1st & 2nd finger, treated conservatively with NSAIDS & analgesics, improved over several months with mod residual numbness in 1st 2 fingers. In 2009 diagnosed with ruptured L 5 had discectomy, repeat LARGE hernitation with portion of the capsule included, 5 wk post-op to 1st surf. Emerg surg done. Have partial paresthesia in L calf & foot 2+ yr post-op. Fell 3 weeks ago on concrete. Landed on R shoulder, strongly jarring neck, ect. Experienced progressive pain. I related this to the fall & expected it to improve, but it did not. Pain became unbearable. Had MRI 2 wk post fall shows mod herniation C5-6 more extensive C6-7 with displacement of cord to posterior with mild pressure against, mod stenosis noted & some occlusion of nerve path. Had epidural injection with moderate relief of pain for first week, but numbness has worsened including Thumb & 1st 2 fingers to the point of difficulty doing fine motor skills, such as typing turning pages act. Pain has been grad resuming over past few days starting with neck, then under shoulder blade, down lateral upper arm, with stabbing pains occasionally all the way thru affected fingers. Percocet 10 does little for this stabbing pain but does give mod relief from other. Saw surgeon yesterday, he recommends decompressing C 5-7 & a titanium plate. But points out numbness might not be reversible. I have all faith in my surgeon, but I forgot to ask a few questions, and I will pose these to him upon my next conversation with him also. I was rather shell shocked when he said surgery even though I do not know why as this has been an on going prob for years. So for my questions: Is a type of bone or filler always used with the plate? What about a C collar after surg? To be worn how long? In general how long are you restricted & what type of restrictions? And any other info you might provide is appreciated! I realize all situations vary depending on preferences & pt history, I would just like some ideas so I can plan ahead. Of note I am a well controlled type 2 Diabetic, smoked 1- 1 1/2 pk a day for years but am trying to at least decrease for now, I know the negative effects. I have hypertension, hyperlipedimia, gout,( also well controlled with meds) & have been on Vit D & coral Ca since a TAH years ago. Thanks again for your time & thoughts.
Bonnie P
Dr Arun Pal Singh Reply:
March 29th, 2012 at 12:44 am
@Bonnie P,
I am sorry for the delay in reply.
Decompression is required in compressions not relieved by non operative means. It involves the disc removal and fixation and grafting.
Post operative neck immobilization is generally required for 6-8 weeks but mainly depends on strength of fixation.
One is able to carry out non strenuous daily routines within 2-3 weeks,
What is the latest at your end? Have you undergone surgery or still pending?
ACD at C5/6, post-op 4 weeks. Full remission of arm and shoulder pain, tingling and numbness in my hand immediately post-op. Neck getting better with each passing week. Swallowing fine unless my head is tilted down. 3 days ago, awoke to a full return of symptoms in my right arm. Have yet to call the doc. Hoping the symptoms are temporary, but not abating after 3 days.
Dr Arun Pal Singh Reply:
April 18th, 2012 at 11:43 pm
@stephen,
How is the situation now?