Abdominal complications following posterior spinal fusion in patients with previous abdominal surgeries

Abstract

<jats:p>Perioperative abdominal complications associated with spine surgery are rare. Although most known abdominal complications occur in conjunction with anterior spinal fusions, there is a paucity of reports reviewing abdominal complications occurring with posterior spinal fusions. The authors review 4 patients who experienced a perioperative abdominal complication following a posterior spinal fusion. In each of these patients, a history of abdominal surgery is present. Given the physiological changes that occur with surgery in the prone position, patients with previous abdominal surgeries are at risk for developing abdominal complications in the perioperative period.</jats:p>

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

“…5 Patients with previous abdominal surgeries are at particularly high risk as tight abdominal closures can reduce abdominal compliance, increasing abdominal pressure. In addition, patients with previous abdominal surgeries are at risk for incisional hernia, particularly if the patient is also obese.…”

“…In addition, patients with previous abdominal surgeries are at risk for incisional hernia, particularly if the patient is also obese. 5 Bleeding from vertebral veins during spinal surgery is increased in the prone position and can obscure the surgical field and prolong surgical time. 17 Multiple thin-walled, low-pressure venous plexuses closely related to the vertebrae are connected to chest and abdominal venous supplies.…”

“…Similarly, the Jackson table also achieves a freely hanging abdomen, which decreases visceral congestion and pressure on the cardiac and respiratory systems. 1,5,7 A study by Akinci et al, showed a decrease in intra-abdominal pressure and bleeding when spinal surgery patients were placed in a jackknife position rather than the prone position, as it uses hip flexion to relax and decrease intra-abdominal pressure while supporting the chest. 19 Monitoring intra-abdominal pressure by intravesicular transducer should be considered for highrisk patients or high risk procedures.…”

“…If abdominal compartment syndrome is suspected, delay for emergency abdominal decompression should be avoided. 5 Nerve palsies and neuropraxia Surgery in prone position has increased risk of injury of cervical spine and brachial plexus due to focal pressure points or strain in flexion or extension, leading to increased intraneural venous pressure, local edema, and impaired axoplasmic transmission. 1,7 Risk factors include hypotension, diabetes, hypothermia, anatomic variations, and malnutrition.…”

“…4 Inappropriate pressure on vital structures of the abdomen can cause ischemia and organ failure, resulting in prolonged hospitalization, permanent disability, or death. 5 Cardiovascular changes associated with prone surgery increase risk of intraoperative cardiac arrest. At the same time, prone surgery is also associated with airway management and CPR issues as access to anterior structures is limited.…”