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…
Summary of Key Points Preoperative evaluation of the patient scheduled for spine surgery most commonly focuses on functional capacity, neurological assessment, and upper airway examination. In patients with significant spinal cord compression or an unstable cervical spine undergoing cervical spine…
Summary of Key Points Intraoperative imaging is an essential component of effective and safe spinal surgery. Common indications for intraoperative imaging include anatomic localization, placement and evaluation of spinal instrumentation, tumor resection, and assessment of decompression. Plain film radiography and…
Summary of Key Points Surgical positions, incisions, and retractors are reviewed for cervical, thoracic, lumbar, and sacral operations. Technical details of various surgical approaches are outlined. The anatomy of ventral, dorsal, and combined approaches and how to avoid complications are…