Treatment strategies for the surgical complications of thoracic spinal stenosis: a retrospective analysis of two hundred and eighty three cases

Abstract

Purpose Our aim was to investigate the causes of and treatment strategies for surgical complications of thoracic spinal stenosis. Methods Between May 1990 and May 2010, 283 patients with thoracic spinal stenosis were treated in our department. Three physicians were assigned to patient follow-up. Patient medical records and radiographs were reviewed. Complications were categorised as perioperative, mid-to longterm and donor-site. Results Follow-up was completed for 254 patients; 249 patients survived. Follow-up time ranged from one to 19 years, with a mean of six years and two months. There were 107 cases with complications an incidence rate of 42.1 %. Eleven cases were pulmonary infection, seven transient nerve-root injury, three pulmonary injury and one vertebral canal haematoma, all of which resolved. Thirteen cases of spinal cord injury postoperatively were treated using dehydration and corticosteroid therapy; eight recovered to the preoperation level, and five deteriorated. Eleven cases resulted in dural injury, and four led to cerebrospinal fluid leakage. There were five cases of wound-fat liquefaction and one of wound infection. Seven cases with deep venous thrombosis of the lower limb resolved by elevating the affected limb and administration of low-molecular-weight dextran. Seven cases of delayed wound healing recovered following change of dressings and antibiotic administration. Four cases of delayed bone-graft fusion recovered by extending the external fixation time. One case of bone-graft absorption was treated by iliac bone grafting and bracing. Two cases of internal fixation breakage were treated by removing the internal fixation.Conclusions Thoracic spinal stenosis surgery may result in various complications but has a good prognosis with proper treatment. The key points in reducing complications are the surgeon's familiarity with operative imperatives and the appropriate surgical approach.

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

“…18 These reported cases of early neurological deficit are consistent with known etiologies of acute neurological deterioration following spine surgery—that is, direct intraoperative spinal cord injury and postoperative epidural hematoma. 29–31 …”

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

“…This artery lies on the left side at T7-L4 in about 80% of cases and usually supplies the nutrient arteries to the spinal cord at T9-L1. 15,57,62,67,77 Injury to the Adamkiewicz artery may be disastrous. Intraoperative evoked-potential monitoring can reduce the risk of spinal cord injury.…”

“…73,74 Another serious surgical complication in thoracic OLF surgery is spinal cord injury. 62,75,76 Several procedures were followed with the aim of minimizing the risk of spinal cord injury. To avoid injury to the blood supply to the spinal cord, the microcirculation around the intervertebral foramen should be protected when ligating the vertebral segmental vessels.…”

A systematic review of surgical procedures on thoracic myelopathy

“…Patients with thoracic myelopathy always company with the symptoms of motor and sensory function reduction of lower limbs, and these symptoms often could not be relieved by conservative treatments, so surgical treatment gradually become the standard treatment for patients with thoracic myelopathy. However, the optimal surgical procedure is still controversial [2]. Posterior decompression and circumferential decompression through posterior approach were mostly applied on thoracic spine surgery, because nearby structures, such as aorta and esophagus, may be injured or damaged by anterior approach, and then the fatal complications might be encountered [3].…”