Disclosures Complications in Cervical Deformity Surgery Stryker - - PDF document

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Complications in Cervical Deformity Surgery

Bobby K-B Tay, MD Clinical Professor Department of Orthopaedic Surgery Director of Spine Fellowship University of California at San Francisco

Disclosures

Stryker Spine: royalties Fellowship support: AOSpine, Globus, Nuvasive .

Types of Complications

4Approach specific

– Anterior – Posterior

4Technique specific

– Osteotomy type: neurologic – Preop planning

Approach Specific Complications

4Anterior Approach

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Incidence of Dysphagia After Anterior Cervical Spine Surgery Bazaz, Lee, Yoo. Spine 2002

4249 consecutive patients

Dysphagia

4Mechanism

– Deinnervation of the pharyngeal or esophageal muscles – Direct muscle trauma – Pharyngeal fibrosis – Edema/hematoma – Prominent hardware/bone graft

4Symptoms/Studies/Treatment

– Trouble eating, heartburn, coughing/choking, regurgitation – Clinical swallow assessment – Videofluoroscopic swallow study

Recurrent laryngeal injury (1.1%)

4Presentation:

– Hoarseness "Breathy voice” – vocal fatigue – Aspiration – Sensation of lump in throat – Singers (consideration)

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4Management:

– Many recover from stretch injury over 6 month period

4Temporary

– Vocal cord injections/medialization various materials – Voice therapy

4Permanent

– Thyroplasty – Arytenoid adduction – Reinnervation surgery – Teflon injection

Infection (1%-2%)

Pharyngeal Perforation

Rare but well recognized complication 40-3.4% in large series 4At C5 - 6 esophagus lies directly on cervical vertebrae and

• nly covered by fascia dorsally

Symptoms

4Neck and pharyngeal pain 4Dysphagia 4Odynophagia 4Aspiration 4Choking 4Fever 4Local tenderness 4Subcutaneous emphysema

Pharyngeal Perforation

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Pharyngeal perforation

4May be difficult to diagnose

– Xray: – CT – Hypaque swallow – Esophagoscopy

Vascular Complications Vertebral artery (0.5%-4.1%)

Anterior 4 Smith et al: 10 VA injury (Incidence: 0.5%) 300-4500cc Corpectomy/hemicorpectomy 6/10 neurologic sequelae 4 Daentzer et al. review of literature 0.05-0.95% 8/29 permanent nerologic comp 4/29 mortality Posterior 4 C1-C2 Lateral exposure >1.5cm Transarticular screw (4.1%) 4 Posterior Subaxial Procedure Lateral mass fixation Pedicle screw placement 3.5-5.4% enter at the C7 foramen enters the foramen at C6 (87-89%)

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Epidural hematoma (0.9%) Dural perforation (0.2%) Complication specific to technique

4SPO/Ponte

4Posterior/Anterior/Posterior or Anterior/Posterior/Anterior (“540”) 43 column osteotomy 4Preop planning

J Neurosurg Spine 19:141–159, 2013

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J Neurosurg Spine 19:141–159, 2013 1.5 cm J Neurosurg Spine 19:141–159, 2013 J Neurosurg Spine 19:141–159, 2013 Chin-Brow Vertical Angle

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JSD Tech 25: 2012 J Neurosurg Spine 19:141–159, 2013

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Loss of correction over time

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High T1 slope

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Abumi, Spine 1999 OShaughnessy Spine 2008 N Study Technique Correction Complications 13 pts 16 pts A-P pedicle screws 7 A-P 3 P-A 1 A-P-A 5 P-A-P 30.8 deg 0.5 deg 38 deg

• 10 deg

screw 2 (15%) CSF 1 (8%) Infx 1 (8%) CSF 13% C5 palsy 19% QUAD 6% Prog 6% trach 19% gastros 25%

Results

Complications 540 fusion in 7/14 pts Osteotomies were performed at 3.9 (3-6) levels anteriorly and 6.6 (3-18) levels posteriorly

4 Durotomy: 2 patients 4 Tracheostomy: 1 pt 4 Subdural hematoma: 1 patient 4 Iliac crest infection: 1 patient 4 Left pneumothorax: 1 patient 4 Transient right C5 palsy: 1 patient 4 Prolonged feeding tube: 2 pts 4 Superficial wound infection: 1 patient 4 Transient recurrent laryngeal nerve palsy: 1 pt 4 Unstable angina: 1 pt 4 average stay in the hospital was 19 days (range 3-55 days) and ICU stay was 6.5 days (range 0-15 days). 4 Days intubated averaged 3.8 days (range 0-15).

Cervical Three Column Osteotomies

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Thank you!