Spinal stenosis is described as narrowing of the spine, often causing impingement on the spinal cord, which causes symptoms. These include pain in the anatomical area affected, motor difficulties and sensory abnormalities. It is classified based on anatomical location, such as cervical, thoracic and lumbar segments. Symptoms include pain, altered sensations and motor weakness in the area of distribution.
Infection
Infection is a risk with all surgical procedures. The effects of infection can be especially devastating as pathogens can gain access to the cerebrospinal fluid and epidural space. Minimally invasive surgery using many small incisions to gain access has lower rates of infection than the classic open approach which utilizes one large incision to access the spine.
Spinal Fluid Leak
Cerebrospinal fluid leak is another complication of this procedure that is often easily treatable. Direct suturing of the defect causing the leak is usually difficult in minimally invasive surgery so often muscle, fat, and synthetic sealants such as fibrin glue are used to patch up the defect. Overnight bed rest is usually sufficient to seal it. The open approach it is sutured fairly easily.
Neurologic Complications
Neurologic complications can include damage to the nerves (radiculopathy) from manipulation during surgery to direct spinal cord injury from instrumentation. Due to the location in the spinal cord, sensory and motor abnormalities are usually more prominent in the upper extremities. Full neurologic exam is warranted upon waking from anesthesia and while recovery is ongoing.
Vascular complications
This includes damage to the vertebral vein and/or the vertebral artery, which is a prominent source of blood supply to the spinal cord. Usually hemostatic pressure applied during surgery is enough to control venous bleeding, while arterial bleeding will require direct repair due to the more serious consequences. Full neurologic exams are also warranted to monitor for damage to the spinal cord if vascular complications are suspected
References
- Orthopedic Clinics of North America. "Posterior Minimally Invasive Approaches for the Cervical Spine." Gala V, O'Toole J, Voyadzis J, Fessler R. Volume 38, Issue 3 (July 2007)
- "Campbell's Operative Orthopaedics, 11th Edition;" Canale & Beaty; 2007
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