Complications of Cervical Spine Surgery

By Dr Arun Pal Singh

Complications of cervical spine surgery are in immediate postoperative period or delayed and some of the complications of cervical spine surgery are restricted to approach only.

Early [Postoperative] Complications

Neurologic Deficit

Neurological deficit is the 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 a 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 may occur as a complication but usually can be identified preoperatively. Whether traumatic or iatrogenic, should be repaired primarily. If the tear is irreparable, a fascial graft should be sewn into place. Avoid a wound drainage system if the patient has a dural tear and antibiotics should be administered.

In case of a 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 the 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

Pseudoarthrosis means false joint and occurs because of failure of the 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 treatment.

Complications Associated with Anterior Approach

These complications of cervical spine surgery are associated with an anterior approach to the cervical spine.

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 a 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% of 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 the upper eyelid, meiosis [constriction of pupil], and anhydrosis[lack of sweating on the affected side of the face].

Symptomatic anterior pseudarthrosis can be treated with repeat anterior surgery, or, preferably, posterior instrumentation and fusion.

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About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

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