Complications and Management  

Infected AIS or Deformity 

• Management 
  • Preop Imaging 
    • Screw Halo (loosoe) 
    • Broken Hardwar 
    • Graft subsidence 
    • Soft Tissue Collectiono 
  • BW 
  • Operative 
    • 5 cultures including soft tissue 
    • 9L NS low flow 
    • Remove loose HW 
      • replace if any instability (ie: osteotomy) 
      • Alternative fixation methods (ie: hooks, wires) 
    • Remove graft, replace with osteocet with Abx 
    • Vancomycin powder 
    • Drain 
    • Primary closure or Plastics 
    • IV Abx x 6 weels 

Dural Tear Intraop 

• Incidence 1-17% 
• RF 
  • Revision 
  • Decompression for stenosis 
  • Age 
  • Ossified LF 
  • High BMI 
• Challenging tear 
  • Nerve root 
  • Anterior spine (from posterior approach) 
• Management 
  • Expose tear 
    • Proximal and distal extension oof decompression 
  • Closure 
    • Primary 
      • Watertight closure with 5-0 prolene 
      • Fibrin augment 
    • Alternative 
      • Dural patch 
      • Fat patch 
      • Fascia path 
    • Check – Valsalva (40mmHg x 20s) 
  • Alternative 
    • Dural drain 
    • Post op bed rest (24-48h) (no evidence) 

Dural Tear Post Op (Pseudomeningocele) 

• Causes 
  • Missed dural tear 
  • Failed repair 
  • Spontaneous late tear 
• Symptoms and Signs 
  • Post op postural headache 
  • N/V 
  • Back pain and fullness 
  • Abducens nerve palsy (traction) 
  • Fistula 
  • SSI 
• Asymptomatic 
  • Monitor; anticipate scarring and resolution 1 year 
• Symptomatic early 
  • MRI 
  • r/o infection 
  • Monitor 
• Symptomatic persistent 
  • Primary repair (as aforementioned) 
  • Dural patch 
  • Fibrin augment