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Things That Can Go Wrong in Spinal Corrective Surgery
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Posted on: 01/12/2011
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There's more to worry about during spinal deformity surgery than just technical problems on the part of the surgeon. Errors can occur involving equipment, medications, communication, and body parts (i.e., operating on the wrong site).
In this literature review, surgeons from the Albany Medical College in New York collected data on complications during orthopedic surgery involving the spine. They specifically focused on problems that were unrelated to the surgeon's technical skill.
The goal of this study was to improve patient safety by preventing and reducing adverse events (AEs). Adverse events are different from complications. Adverse events refer to any unexpected problems that occur. Complications were defined as adverse events that have a measurable or observable (negative) effect on patient results or outcomes.
Seven key areas were discussed: 1) patient positioning, 2) nutrition, 3) blood loss, 4) other health problems called comorbidities, 5) time in the operating room, 6) pulmonary (lung) problems, and 7) gastrointestinal (GI) problems.
Over time, surgeons have found the ideal position for patients having spinal surgery to correct spine deformities like scoliosis. The patient is placed prone (face down) with the head, neck, and hips supported in a neutral position. The bed is tilted to keep the head elevated slightly above the feet. The arms and legs are supported in a restful position without pressure on the joints.
Using this position has helped improve breathing, reduce pressure on the heart and lungs, lower pressure on the head and face, and decrease blood loss. Even with this good position, new problems such as blindness have cropped up. Pressure on the face and loss of blood supply over a long period of time can lead to this loss of vision.
Blindness is a fairly new complication probably from increased surgical time and more health problems in patients having surgery. The loss of vision can be permanent, so preventing the problem is a high priority. As a result, different head support systems have been developed for use during spinal deformity corrective surgery.
Other problems related to position such as pressure on nerves or kinking of blood vessels can be prevented with closer patient surveillance. This is especially true towards the end of the procedure when the surgeon and anesthesiologist have left the operating room.
Good nutrition before surgery is important to aid the immune system and speed healing. Older and overweight patients must be assessed carefully for possible malnutrition. Serious GI problems from loss of blood supply to the gut can even cause death.
The surgeon has many things to watch for during and after spinal corrective surgery that involves lengthening the spine. Vomiting, dehydration, fluid imbalances, and electrolyte problems are common.
Patients who develop blood clots or air bubbles in the heart or brain after spinal correction surgery have a 50 per cent chance of death. Every effort is made to assess patients for risk factors and to prevent such problems. Patients with heart problems, diabetes, obesity, and those who smoke or abuse alcohol are the most likely to develop complications after any surgery including spinal corrective surgery.
As far as blood loss goes, every effort is made to reduce bleeding during the procedure. The anesthesiologist and surgeon must work together to reduce surgical time. They use every technique possible to prevent blood loss and the need for blood transfusion. Many new methods have been developed to aid in this effort. Specific tools and techniques used are reviewed for surgeons who might be interested in an update in this area.
In summary, the authors of this article identify potential adverse events and complications associated with corrective surgery for spinal deformities. The Academy of Orthopedic Surgeons' Patient Safety Committee can use this information to provide surgeons with a checklist to follow before, during, and after spinal surgery. The intended outcome is to reduce errors unrelated to the surgery itself.
The next step will be to study the effect any measures taken have in reducing these complications. Surgeons and operating room staff can then focus time and energy on the most effective methods for preventing adverse events that are not directly caused by the surgeon.
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References:
Allen Carl, MD, et al. Complications in Spinal Deformity Surgery. In Spine. December 1, 2010. Vol. 35. No. 25. Pp. 2215-2223.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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