Complications of lumbar microdiscectomy include injury to a nerve root, disc infection, recurrent herniation, arachnoid scarring, and laceration of the iliac artery.
Most symptomatic herniated lumbar discs present with radiculopathy (pathology of the nerve root). Pressure on the root from a herniated disc can cause pain referred to its cutaneous and muscle distribution, as well as weakness in the muscles and loss of sensation in the skin it innervates.
Root injury is a not uncommon complication of lumbar microdiscectomy.
Injury to the cauda equina is also possible with traction on the thecal sac.
Immediate post operative:
Injury to the cauda equina may be discovered as early as in the post op Recovery Room.
Cauda equina injury following lumbar microdiscectomy can present with difficulty with control of urination and/or bowel (incontinence), erectile and ejaculatory dysfunction, loss of anal and scrotal sensation as well as numbness and weakness (possibly to the point of paralysis) of the legs.
Irreversible: root injury lumbar microdiscectomy
Intraoperative: root injury lumbar microdiscectomy
Acute post operative: root injury lumbar microdiscectomy
Long term: root injury lumbar microdiscectomy
root injury lumbar microdiscectomy
Monitoring: cauda equina injury lumbar microdiscectomy
Pharmacology cauda equina injury lumbar microdiscectomy
Equipment cauda equina injury lumbar microdiscectomy
Planning cauda equina injury lumbar microdiscectomy
Technique: cauda equina injury lumbar microdiscectomy
The subclavian vessels can be injured during CVP placement.
The disc space following discectomy contains remnants of disc and, for several weeks after surgery, blood and other body fluid that is a perfect growth medium (environment) for bacteria and other microorganisms.
Disc infection is usually recognized only several days or even weeks after a lumbar microdiscectomy/
Three of the more important causes of disc infection following lumbar microdiscectomy are:
1. intraoperative contamination
2. post operative and
3. from the blood
Patient's with disc infections are typically febrile (with fever). Severe infections can be associated with exhaustion and diffuse aching.
Back pain sometimes accompanies a disc infection.
Untreated bacterial infection can lead to continued destruction of the disc space remnants as well as of the bone in the vertebral bodies above and below the disc space. Some infections progress to shock and death.
The patient with a disc space infection will typically need 3 months of intravenous (IV) antibiotics (usually requires a semi-permanent [removed on completion of course of treatment] catheter in a major vein such as the subclavian or cephalic).
The frequency of disc infections is higher when sterile technique is poor (increased likelihood of intraoperative complications), post operative wound hygeine is suboptimal (drains get dirty and are not changed
With sterile technique and perioperative (before, during, and after surgery) antibiotics most patients avoid
Post operative attention to the cleanliness and integrity of wound dressings.
Treatment of common post operative infections (pulmonary, bladder, sinus) prevents these from becoming the origin of blood borne bacterial emboli .
Discectomies are not complete resections of intravertebral disc material. Whatever is grabbed and pulled out easily is removed, more resistant tissue is left behind.
Cervical discs "recur" much less frequently than lumbar discs because a cervical disc removal is total whereas that of a lumbar disc is partial.
Planning: recurrent herniation lumbar microdiscectomy
Technique:
Recurrent herniation lumbar microdiscectomy is frequently the consequence of the standard surgical
The disc material left behind following microdiscectomy is pushed out through a hole in the annulus that may have been present before surgery, but that is definitely present post-operatively following removal of an intervertebral disc.
A recurrent lumbar disc herniation is diagnosed only after onset of a symptom such as pain or neurologic deficit. Small fragments of disc may not push against any nerve in any vulnerable location and therefore may not cause symptoms. On the other hand, even a relatively small fragment, strategically impinging on a root can cause a painful radiculopathy and/or a radicular neurologic deficit.
Intraoperative: recurrent herniation lumbar microdiscectomy
Immediate post operative: recurrent herniation
Delayed post operative: recurrent herniation lumbar microdiscectomy
Delayed: recurrent herniation lumbar microdiscectomy
The frequency of Cervical discs "recur" much less frequently than lumbar discs because a cervical disc removal is total whereas that of a lumbar disc is partial.
Scar formation in the arachnoid space around the nerve root .
Adhesive arachnoiditis can be asymptomatic and detected postoperatively on a lumbosacral MR.
Patients can present as early as a few weeks post operatively with symptoms suggestive of adhesive arachnoiditis.
Scar forms in most spaces within the body that have been violated by surgical instruments.
Adhesive arachnoiditis contributes to the pain of "failed back" syndrome
The management of post-microdiscectomy adhesive arachnoiditis and epidural scarring.
Scar formation in the subarachnoid and epidural space around nearby nerve roots following lumbar microdiscectomy occurs ___
Epidural and arachnoid scar formation is part of the body's normal healing process. Currently there is no reliable technique for prevention of scarring following microdiscectomy.
The iliac arteries lie in front of the vertebral column
The iliac artery and/or vein can be injured from behind by instruments pulling…
Intraoperative:
The typical scenario of injury to the iliac artery/vein during lumbar microdiscectomy is: neurosurgeon grabs deep into the disc space and grabs with the ends of the forceps. Within a few seconds there is bright red blood filling the disc space and then quickly the entire surgical field. Shortly thereafter anesthesia informs that the patient's blood pressure is down and heart rate is up (consistent with early shock).
The neurosurgeon immediately packs the back wound (gauze pads) and turns the patient supine preparing to open the belly him or herself (if the vascular surgeon he/she has called STAT does not appear within a few minutes). If necessary the neurosurgeon is prepared to clamp off the aorta to save the patient from exsanguination and death.
There are 7 cervical, 12 thoracic, and 4 lumbar intervertebral discs.
Intraoperative:
The best time to discover that a disc was removed at the wrong intervertebral level is intraoperatively.