Pedicle Subtraction Osteotomy (PSO) is a major surgical procedure performed to correct severe spinal deformities, particularly those involving sagittal imbalance. While effective in restoring spinal alignment and improving patient posture and function, it is associated with a range of potential perioperative complications due to its complexity and invasiveness.
Understanding PSO Complications
The complications associated with PSO can vary in severity and may affect different bodily systems, including neurological, infectious, and cardiopulmonary systems. These risks highlight the importance of careful patient selection, meticulous surgical technique, and comprehensive perioperative management to mitigate adverse outcomes.
Based on available data, the following complications have been observed in patients undergoing Pedicle Subtraction Osteotomy:
| Complication | Incidence (%) |
|---|---|
| Neurologic deficit | 6.2 |
| Deep wound infection | 4.6 |
| Myocardial infarction | 1.5 |
| Pneumonia | 3.0 |
Detailed Overview of Complications
Let's look into some of these potential issues in more detail:
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Neurologic Deficit: This is one of the most concerning complications, involving damage to nerves or the spinal cord. It can manifest as new or worsened weakness, numbness, or even paralysis in parts of the body, often requiring immediate intervention and potentially long-term rehabilitation. The intricate nature of spinal surgery, particularly osteotomies that involve bone removal near the spinal cord, contributes to this risk.
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Deep Wound Infection: As with any major surgery, there is a risk of infection at the surgical site. A deep wound infection affects tissues beneath the skin and can be severe, often necessitating additional surgical procedures, prolonged antibiotic treatment, and extended hospital stays. Proper sterile techniques and prophylactic antibiotics are crucial to reduce this risk.
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Pneumonia: This respiratory complication involves inflammation of the lung tissue, typically caused by bacteria or viruses. Patients undergoing extensive spinal surgery are at increased risk due to prolonged bed rest, reduced lung expansion, and potential aspiration. Postoperative respiratory care, including deep breathing exercises and early mobilization, is vital in prevention.
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Myocardial Infarction (Heart Attack): A serious cardiovascular event, a heart attack can occur when blood flow to a part of the heart is blocked. This complication is particularly concerning in patients with pre-existing cardiac conditions or those experiencing significant physiological stress during or after surgery. Comprehensive preoperative cardiac evaluation is essential to identify and manage at-risk individuals.
These complications underscore the need for a thorough risk-benefit assessment before undergoing PSO and highlight the critical role of an experienced multidisciplinary surgical team in managing such complex cases.
