Summary of Key Points Cerebrospinal fluid (CSF) fistulas and pseudomeningoceles are rare complications of spinal surgery. CSF fistulas usually develop shortly after surgery, resulting in increased postoperative morbidity, duration of hospitalization, and cost of care. Pseudomeningoceles develop more slowly and…
Summary of Key Points Neurological complications associated with spine surgery may result in a need for additional surgery, prolonged length of stay, and need for subsequent care (rehab, therapy, assistive devices). The spinal cord is at risk in any spine…
Summary of Key Points Although most surgeons understand the importance of sterile technique in preventing surgical site infections, other steps can be taken before, during, and after the procedure to reduce the risk. Thorough preoperative evaluation, including nasal Staphylococcus aureus…
Summary of Key Points Medical complications following spine surgery are common. Complications can involve essentially every organ system. Thromboembolic complications such as deep venous thrombosis (DVT) and pulmonary embolism can occur in up to 31% and 13% of spine surgery…
Summary of Key Points Pseudoarthrosis of the spine is defined as a failure of bony union. Symptoms include persistent pain, failure of instrumentation, and instability. Diagnosis of pseudoarthrosis remains a challenge and requires high clinical suspicion, as well as utilization…
Summary of Key Points Osteointegration of a spinal implant implies both a mechanical and a morphological bond at the bone–implant interface. The biological process of osteointegration involves three phases: clot formation and initial mesenchymal cell differentiation, initial bone formation, and…
Summary of Key Points Spinal biologics can alter the existing biological environment to enhance specific cellular/molecular activity to further a clinical goal by facilitating osteoinduction, osteoconduction, and/or osteogenesis. Autograft can be taken from the iliac crest or locally from the…
Summary of Key Points A crisis requires swift and decisive action by the healthcare team. In the unlikely event of cardiac arrest, the patient in the prone position will require closed or reverse cardiopulmonary resuscitation or, rarely, a last-resort open…
Summary of Key Points Blood transfusion is no longer driven by the “10/30 hemoglobin/hematocrit rule,” because as little as one unit of homologous blood transfusion can increase postoperative complications. Therefore, a more restrictive transfusion protocol has become the standard of…
Summary of Key Points Intraoperative neurophysiological monitoring is useful in detecting neurological deficits during major deformity corrective spinal surgeries. Somatosensory-evoked potential monitoring evaluates the functioning of the dorsal aspect of the spinal cord. Transcranial electrical stimulation motor-evoked potentials can monitor…