TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 111

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 111. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 1104 Section Complications imaging is mandatory in order to determine salvage strategies in advance. Hemostasis may be achieved by compression and packing. If the lesion occurred during drilling a screw in the drill hole is a good option. The screw at the opposite side if not in place should be skipped and a salvage Gallie procedure can be performed instead of using Magerl screws. Pseudoaneurysm and arteriovenous fistulae are rare sequelae 61 . Stenting maybe efficacious. Posterior Approaches to the Thoracic and Lumbar Spine Approach-related intraoperative complications are rare. Excessive bleeding can occur. The risk is reduced by adequate patient positioning and change of platelet inhibitors and anticoagulants to other drugs preoperatively. Very rarely lesions of anterior structures occur due to direct accidental stab trauma. Relatively rare is an accidental lesion of the dural sac or of the spinal cord during preparation of the approach. It is mandatory to use imaging to determine whether the posterior vertebral elements are intact otherwise preparation has to be conducted with more caution. Check preoperative X-rays for bony defects Procedure Related Complications Decompressive Cervical and Lumbar Surgery Decompressive surgery in the cervical and lumbar spine is the most frequently performed intervention but also prompts the need for revisions and surgery of the adjacent segments. In some cases complications can be avoided if the preoperative radiograph is checked for bony defects. In primary cases this precaution helps to avoid unintended dural lacerations . in spina bifida occulta . Wash out Floseal after epidural vein bleeding has stopped Epidural Vein Bleeding The blood loss may be considerable and can substantially reduce visualization compromising surgical success. Epidural bleeding usually stops after wound closure and turning the patient into the supine position. Reports on cauda equina syndrome caused by postoperative continued epidural bleeding are

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