Complications of Spine Surgery: Neurodeficits of the Spinal Cord and Nerve Roots

Abstract

Neurodeficits associated with spinal cord injury may arise intraoperatively or postoperatively. Such neurologic complications are classified by the American Spinal Injury Association (ASIA) based on lesion type and affected motor and/or sensory function. Epidural hematomas are among the most common postsurgical complication; rarer complications include epidural abscesses, pseudomeningoceles, and cauda equina syndrome. Singh addresses spinal cord syndromes, mechanisms of injury, and specific insults to nerve roots that can result from spine surgery, including complications related to instrumentation. In assessing for possible postoperative injury, careful patient evaluation in the post-anesthesia care unit is essential. Although steroid therapy for management of acute spinal cord injuries is recommended according to specified guidelines, the use of corticosteroids (methylprednisolone) nevertheless remains controversial. This article also provides a discussion on the modalities of intraoperative monitoring, including somatosensory-evoked potentials, motor-evoked potentials, and stimulated electromyography, which can aid in the prevention of spinal cord and nerve root injuries.

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