OKOJ, Volume 8, No. 5

Instrumentation-Related Complications of Spinal Surgery

Complications arising from spinal surgery instrumentation present a host of challenges in diagnosis, treatment, and prevention. The spinal cord, nerve roots, and vascular and visceral structures all are vulnerable to injury caused by improper implant positioning, implant fixation failure, or a combination of these. Adverse events related to instrumentation, ranging from the benign to the catastrophic, may be detected intraoperatively or following surgery. Although a number of innovative new techniques have been developed to treat these complications, currently there exist no Level I or Level II standards by which to evaluate these methods. The absence of such data is perhaps due to a confluence of legal, financial, and social pressures that lead to underreporting. An established registry for documentation of instrumentation-related failures and complications of spinal surgery not only would heighten collective understanding among the orthopaedic community of diagnosis, treatment, and prevention of such complications, but it also would result in improved patient care.

    • Keywords:
    • anterior cervical instrumentation,

    • bicortical fixation,

    • bone-screw interface failure,

    • cortical spine perforation,

    • delayed aortic erosion,

    • esophageal perforation,

    • failure of fixation,

    • hardware prominence,

    • inferior pedicle screw placement,

    • instrumentation failure prevention,

    • instrumentation malpositioning,

    • instrumentation-related complications,

    • intraoperative instrumentation complications,

    • lateral pedicle screw violation,

    • lumbar nonunion,

    • lumbar pedical screw placement,

    • thoracic pedicle screw placement,

    • mechanical failure,

    • medial pedicle screw placement,

    • medial spine perforation,

    • pedicle screw breach,

    • pedicle screw failure,

    • pedicle screw injuries,

    • pedicle screw placement,

    • polymethylmethacrylate,

    • postoperative instrumentation complications,

    • premature failure of fixation,

    • prominence injuries,

    • spinal construct stability,

    • spinal fixation,

    • spinal fusion,

    • spinal rod migration,

    • spinal surgery instrumentation,

    • thoracic plate-screw instrumentation,

    • thoracolumbar screw placement,

    • thoracolumbar vascular injury,

    • ventral migration

    • Subspecialty:
    • Spine,

Meniscal Tears

A meniscal tear is any break in the continuity of the surface of the medial or lateral meniscus. Meniscal tears may occur in isolation or in association with a ligament injury or fracture. The mechanism of injury usually involves a twisting maneuver or a rapid change in direction on a weight-bearing knee. Degenerative tears may occur from activities of daily living. The diagnosis can be made through a careful patient history, physical examination, and plain radiography. If necessary, an MR image can be obtained. Arthroscopy is the accepted standard for diagnosis of meniscal pathology. Management includes nonsurgical and surgical treatment options; these include: observation, trephination, meniscectomy, meniscal repair, meniscal allograft transplantation, or meniscal replacement with collagen scaffold.

    • Keywords:
    • meniscus injuries,

    • meniscus lesions,

    • meniscal injury,

    • meniscectomy,

    • meniscal repair,

    • meniscal allograft transplantation

    • Subspecialty:
    • Sports Medicine,