Spinal Fusion pp 361-387

Complications of Spinal Fusions

  • Jerome M. Cotler
  • Andrew M. Star


Spinal fusion has associated complications that are similar to those resulting from any other surgical intervention. Thus, whenever a fusion is recommended as part of the care program for a patient these factors must be included in the equation. Are the positive anticipated responses of the procedure sufficient to justify subjecting the patient to the risks? In order to answer this question, the surgeon must be familiar with the complications and have a sense of their prevalence. Much of this data is not really available today, but when possible an attempt for perspective will be offered. A text such as this prepared for orthopaedists, neurosurgeons, fellows and residents will not include complications frequently managed by alternative medical personnel. However, we would expect the reader to be aware of the following complications: hepatitis, renal failure, AIDS, antibiotic toxicity, diffuse intravascular coagulopathy, urinary tract infection, inappropriate antidiuretic hormone release, transfusion reactions, cardiac failure, malignant hyperthermia, drug dependency, atelectasis, pulmonary edema, and pulmonary embolus.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Simchen E, Stein H, Sacks TG, Shapiro M, Michel J. Multivariate analysis of determinants of postoperative wound infection in orthopaedic patients. J Hosp Infect 1984;5:137.PubMedGoogle Scholar
  2. 2.
    Barber FA, Anterior cervical fusion. Rocky Mountain Med J 1978;75:29.PubMedGoogle Scholar
  3. 3.
    Tew JM, Mayfield FH. Complications of surgery of the anterior cervical spine. In: Clinical Neurosurgery. Baltimore: Williams & Willems, 1976:424.Google Scholar
  4. 4.
    Kostuik JP, Hall BB. Spinal fusions to the sacrum in adults and scoliosis. Spine 1983;8:489.PubMedGoogle Scholar
  5. 5.
    Watkins MB. Posterolateral fusion in pseudarthrosis and posterior element defects of the lumbosacral spine. Clin Orthop Rel Res 1964;35:80.Google Scholar
  6. 6.
    Prothero SR, Parkes JC, Stinchfield EE. Complications after low-back fusion in 1000 patients. J Bone Joint Surg 1966;48A:57.Google Scholar
  7. 7.
    Lonstein J, Winter R, Moe J, Gaines D. Wound infection with Harrington instrumentation and spine fusion for scoliosis. Clin Orthop Rel Res 1973;96:222.Google Scholar
  8. 8.
    Altemeier WA, Alexander JW. Retroperitoneal abscesses. Arch Surg 1961;83:512.PubMedGoogle Scholar
  9. 9.
    Meyers MA. Dynamic Radiology of the Abdomen. New York: Springer-Verlag, 1982:110.Google Scholar
  10. 10.
    Simons GW, Sty JR, Starshak RJ. Retroperitoneal and retrofascial abscesses. J Bone Joint Surg 1983;65A:1041.Google Scholar
  11. 11.
    Mayfield FH, Kurokawa K. Watertight closure of spinal dura mater. J Neurosurg 1975;43:639.PubMedGoogle Scholar
  12. 12.
    Urist MR, Dawson E. Intertransverse process fusion with the aid of chemosterilized autolyzed antigen-extracted allogeneic (AAA) bone. Clin Orthop Rel Res 1981;154:97.Google Scholar
  13. 13.
    Burwell RG. Studies in the transplantation of bone. J Bone Joint Surg 1966;48B:532.Google Scholar
  14. 14.
    Burwell RG. Studies in the transplantation of bone. J Bone Joint Surg 1963;45B:386.Google Scholar
  15. 15.
    Goldberg VM, Lance EM. Revascularization and accretion in transplantation. J Bone Joint Surg 1972;54A:807.Google Scholar
  16. 16.
    Goldberg VM, Stevenson S. Natural history of autografts and allografts. Clin Orthop Rel Res 1987;225:7.Google Scholar
  17. 17.
    Heiple KG, Chase SW, Herndon CH. A comparative study of the healing process following different types of bone transplantation. J Bone Joint Surg 1963;45A:1593.Google Scholar
  18. 18.
    May VR, Mauck WR. Exploration of the spine for pseudarthrosis following spinal fusion in the treatment of scoliosis. Clin Orthop Rel Res 1967;53:115.Google Scholar
  19. 19.
    Stabler CL, Eismont FJ, Brown MD, Green BA, Malinin TI. Failure of posterior cervical fusions using cadaveric bone graft in children. J Bone Joint Surg 1985;67A:370.Google Scholar
  20. 20.
    Brown MD, Malinin TI, David PB. A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop Rel Res 1976;119:231.Google Scholar
  21. 21a.
    Nasca RJ, Whelchel JD. Use of cryopreserved bone in spinal surgery. Spine 1987; 12:222.PubMedGoogle Scholar
  22. 21b.
    Ray RD, Holloway JA. Vascularization of bone grafts and implants. Clin Orthop 1957;87:43.Google Scholar
  23. 22.
    Albrektsson T. The healing of autologous bone grafts after varying degrees of surgical trauma. J Bone Joint Surg 1980;62B:403.Google Scholar
  24. 23.
    Watson-Jones R. Transplantation of bone. In: Fracture and Joint Injuries. Ed. 4. Baltimore: Williams & Wilkins, 1955.Google Scholar
  25. 24.
    Heppenstall RB. Bone grafting. In: Fracture Treatment and Healing. Philadelphia: Saunders, 1980:97–112.Google Scholar
  26. 25.
    Cockin J. Autologous bone grafting—complications at the donor site. Abstract. J Bone Joint Surg 1971;53B:153.Google Scholar
  27. 26.
    Frymoyer JW, Howe J, Kuhlmann D. The long-term effects of spinal fusion on the sacroiliac joints and ilium. Clin Orthop Rel Res 1978;134:196.Google Scholar
  28. 27.
    Coventry MB, Tapper EM. Pelvic instability. J Bone Joint Surg 1972;54A:83.Google Scholar
  29. 28.
    Lichtblau S. Dislocation of the sacro-iliac joint. J Bone Joint Surg 1962;44A:193.Google Scholar
  30. 29.
    Escalas F, DeWald RL. Combined traumatic arteriovenous fistula and ureteral injury: a complication of iliac bone-grafting. J Bone Joint Surg 1977;59A:270.Google Scholar
  31. 30.
    Kahn B. Superior gluteal artery laceration, a complication of iliac bone graft surgery. Clin Orthop Rel Res 1979;140:204.Google Scholar
  32. 31.
    Cotler HB. Personal communication.Google Scholar
  33. 32.
    Cowley SP, Anderson LD. Brief note: hernias through donor sites for iliac-bone grafts. J Bone Joint Surg 1983;65A:1023.Google Scholar
  34. 33.
    Froimson AI, Cummings AG. Iliac hernia following hip arthrodesis. Clin Orthop Rel Res 1971;80:89.Google Scholar
  35. 34.
    Lotem M, Maor P, Haimoff H, Woloch Y. Lumbar hernia at an iliac bone graft donor site. Clin Orthop Rel Res 1971;80:130.Google Scholar
  36. 35.
    Oldfield MC. Iliac hernia after bone-grafting. Lancet 1:810.Google Scholar
  37. 36.
    Prytek LJ, Kelly CC. Management of herniation through large iliac bone defects. Clin Orthop Rel Res 1960;152:998.Google Scholar
  38. 37.
    Quinnell RC, Stockdale HR. Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Spine 1981;6:263.PubMedGoogle Scholar
  39. 38.
    Bosworth DM. Repair of herniae through iliac-crest defects. J Bone Joint Surg 1955;37A:1069.Google Scholar
  40. 39.
    Hsu K, Zucherman JF, White AH. Bone grafts and implants in spine surgery. In: White AH, Rothman RH, Ray CD, eds. Lumbar Spine Surgery. St. Louis: Mosby, 1987:434–458.Google Scholar
  41. 40.
    Hollingshead WH. Anatomy for Surgeons. Volume 3, The back and limbs. Philadelphia: Harper and Row, 1982.Google Scholar
  42. 41.
    Chow SP, Leong JCY, Srmlt AM, Yau ACMC. Anterior spinal fusion for deranged lumbar intervertebral disc. Spine 1980;5:452.PubMedGoogle Scholar
  43. 42.
    Weikel AM, Habal MB. Meralgia paresthetica: a complication of iliac bone procurement. Plast Reconstr Surg 1977; 60:572.PubMedGoogle Scholar
  44. 43.
    Bernardt M. Ueber isolirt im geriete des n. cutaneus femoris externis Norkommends parasthesiea. Neurol Zentralbl 1895;12:242.Google Scholar
  45. 44.
    Hollingshead WH. Textbook of Anatomy. Philadelphia: Harper and Row, 1974.Google Scholar
  46. 45.
    Smith SE, DeLee JC, Ramamurthy S. Ilioguinal neuralgia following iliac bone-grafting. J Bone Joint Surg 1984; 66A:1306.Google Scholar
  47. 46.
    Drury BJ. Clinical evaluation of back and leg pain due to irritation of the superior cluneal nerve. Abst. J Bone Joint Surg 1967;49A:199.Google Scholar
  48. 47.
    Frymoyer JW, Hanley E, Howe J, Kuhlmann D, Matteri R. Disc excision and spine fusion in the management of lumbar disc disease. Spine 1978;3:1.PubMedGoogle Scholar
  49. 48.
    Ginsburg HH, Goldstein LA, Robinson SC, Haake PW, Devanny JR, Chan DPK, Suk SI. Back pain in postoperative idiopathic scoliosis. Abstract Spine 1979;4:518.Google Scholar
  50. 49.
    MacEwen GD. Personal communication.Google Scholar
  51. 50.
    Enneking, WF. Personal communication.Google Scholar
  52. 51.
    Friedlaender GE. Current concepts review: bone grafts. J Bone Joint Surg 1987;69A:786.Google Scholar
  53. 52.
    Friedlaender GE, Tross RB, Doganis AC, Kirkwood JM, Baron R. Effects of chemotherapeutic agents on bone. J Bone Joint Surg 1984;66A:602.Google Scholar
  54. 53.
    Bulger RF, Rejowski JE, Beatty RA. Vocal cord paralysis associated with anterior cervical fusion: considerations for prevention and treatment. J Neurosurg 1985;62:657.PubMedGoogle Scholar
  55. 54a.
    Sanders G, Uyeda RY, Karlan MS. Nonrecurrent inferior laryngeal nerves and their association with a recurrent branch. Am J Surg 1983;146:501.PubMedGoogle Scholar
  56. 54b.
    Heeneman H. Vocal cord paralysis following approaches to the anterior cervical spine. Laryngoscope 1973;83:17.PubMedGoogle Scholar
  57. 55.
    Meurman Y. Operative mediofixation of the vocal cord in complete unilateral paralysis. AM A Arch Otolaryngol 1952;55:544.Google Scholar
  58. 56.
    Jacobson L. Bilateral vocal cord paralysis. Anesthesia 1979;34:1020.Google Scholar
  59. 57.
    Johnson RM, Southwick WO. Function and surgical anatomy of the neck. In: Rothman RH, Simeone FA, eds. The Spine. Philadelphia: Saunders, 1982:67–187.Google Scholar
  60. 58.
    Lindskog GE, Liebow AA, Glenn WWL. Thoracic and Cardiovascular Surgery with Related Pathology. New York: Appleton Century Crofts, 1962:439–440.Google Scholar
  61. 59.
    Flynn TB. Neurologic complications of anterior cervical interbody fusion. Spine 1982;7:536.PubMedGoogle Scholar
  62. 60.
    Balmaseda MT, Pellioni DJ. Esophagocutaneous fistula in spinal cord injury: a complication of anterior cervical fusion. Arch Phys Med Rehabil 1985;66:783.PubMedGoogle Scholar
  63. 61.
    Hilgenberg AD, Grillo HC. Acquired nonmalignant tracheoesophageal fistula. J Thorac Cardiovasc Surg 1983;85:492.PubMedGoogle Scholar
  64. 62.
    Freebody D, Bendall R, Taylor RD. Anterior transperitoneal lumbar fusion. J Bone Joint Surg 1971;53B:617.Google Scholar
  65. 63.
    Yonenobu K, Okada K, Fuji T, Fujiwara K, Yamashita K, Ono K. Causes of neurologic deterioration following surgical treatment of cervical myelopathy. Spine 1986;11:818.PubMedGoogle Scholar
  66. 64.
    Kraus DR, Stauffer ES. Spinal cord injury as a complication of elective anterior cervical fusion. Clin Orthop Rel Res 1975;112:130.Google Scholar
  67. 65.
    Braunstein EM, Hunter LY, Bailey RW. Long-term radiographic changes following anterior cervical fusion. Clin Radiol 1980;31:201.PubMedGoogle Scholar
  68. 66.
    Capen DA, Garland DE, Waters RL. Surgical stabilization of the cervical spine: a comparative analysis of anterior and posterior spine fusions. Clin Orth Rel Res 1985;196:229.Google Scholar
  69. 67.
    Hunter LY, Braunstein EM, Bailey RW. Radiographic changes following anterior cervical fusion. Spine 1980;5:399.PubMedGoogle Scholar
  70. 68.
    Welsh LW, Welsh JJ, Chinnici JC. Dysphagia due to cervical spine surgery. Ann Otol Rhinol Laryngol 1987;96:112.PubMedGoogle Scholar
  71. 69.
    Brodsky AE. Cervical angina. Spine 1985;10:699.PubMedGoogle Scholar
  72. 70.
    Thompson RA, Meyer TJ. Posterior surgical stabilization for atlantoaxial subluxation in rheumatoid arthritis. Spine 1985;10:597.PubMedGoogle Scholar
  73. 71.
    Colletta AJ, Mayer PJ. Chylothorax: an unusual complication of anterior thoracic interbody spinal fusion. Spine 1982;7:46.PubMedGoogle Scholar
  74. 72.
    Hodge WA, De Wald RL. Splenic injury complicating the anterior thoracoabdominal surgical approach for scoliosis. J Bone Joint Surg 1983;65A:396.Google Scholar
  75. 73.
    Propst-Proctor SL, Rinsky LA, Bleck EE. The cisterna chyli in orthopaedic surgery. Spine 1983;8:787.PubMedGoogle Scholar
  76. 74.
    Chan FL, Chow SP. Retroperitoneal fibrosis after anterior spinal fusion. Clin Radiol 1983;34:331.PubMedGoogle Scholar
  77. 75.
    Cleveland RH, Gilsanz V, Lebowitz RL, Wilkinson RH. Hydronephrosis from retroperitoneal fibrosis after anterior spine fusion. J Bone Joint Surg 1978;60A:996.Google Scholar
  78. 76.
    Flynn JC, Price CT. Sexual complications of anterior fusion of the lumbar spine. Spine 1984;9:489.PubMedGoogle Scholar
  79. 77.
    van Rens JG, van Horn JR. Long-term results in lumbosacral interbody fusion for spondylolisthesis. Acta Orthop Scand 1982;53:383.PubMedGoogle Scholar
  80. 78.
    Ditunno JF. Personal communication.Google Scholar
  81. 79.
    Goldner JL, McCollum DE, Urbaniak JR. Anterior disc excision and interbody spine fusion for chronic low back pain. In: American Academy of Orthopaedic Surgeons, Symposium on the Spine. St. Louis: Mosby, 1969:111.Google Scholar
  82. 80.
    Sacks S. Anterior interbody fusion of the lumbar spine. J Bone Joint Surg 1965;47B:211.Google Scholar
  83. 81.
    Flynn JC, Hoque MA. Anterior fusion of the lumbar spine. J Bone Joint Surg 1979;61A:1143.Google Scholar
  84. 82.
    Stauffer RN, Coventry MB. Anterior interbody lumbar spine fusion. Analysis of Mayo Clinic series. J Bone Joint Surg 1972;54A:756.Google Scholar
  85. 83.
    Bunnell WP, MacEwen GD, Riser W. Anterior spinal fusion—experimental evaluation of technique. Orthop Trans 1977;1:129.Google Scholar
  86. 84.
    Beetham R. Anterior spinal surgery in Ballarat. In: Proceedings of the Australian Orthopaedic Association. J Bone Joint Surg 1978;52B:392.Google Scholar
  87. 85.
    Dwyer AF. Experience of anterior correction of scoliosis. Clin Orthop Rel Res 1973;93:191.Google Scholar
  88. 86.
    Woolsey RM. Aortic laceration after anterior spinal fusion. Surg Neurol 1986;25:267.PubMedGoogle Scholar
  89. 87.
    Bradford DS, Lonstein JE, Moe JH, Ogilvie JW, Winter RB. Moe’s Textbook of Scoliosis and Other Spinal Deformities. Philadelphia: Saunders, 1987.Google Scholar
  90. 88.
    Grobler LJ, Winter RB, Lonstein JE, Moe JH, Bradford DS. Loss of lumbar lordosis following surgical correction of thoracolumbar deformities: its recognition, treatment and prevention. J Bone Joint Surg 1980;62B:277.Google Scholar
  91. 89.
    Moe JH, Denis F. The iatrogenic loss of lumbar lordosis. Abstract Orthop Trans 1977;1:131.Google Scholar
  92. 90.
    Hasday CA, Passoff TL, Perry J. Gait abnormalities arising from iatrogenic loss of lumbar lordosis secondary to Harrington instrumentation in lumbar fractures. Spine 1983;8:501.PubMedGoogle Scholar
  93. 91.
    Kahanovitz N, Arnoczky SP, Levine DB, Otis JP. The effects of internal fixation of the articular cartilage of unfused canine facet joint cartilage. Spine 1984;9:268.PubMedGoogle Scholar
  94. 92.
    Barrack RL, Whitecloud TS, Skinner HB. Spondylolysis after spinal instrumentation in osteogenesis imperfecta. South Med J 1984;77:1453.PubMedGoogle Scholar
  95. 93.
    Drennan JC, King EW. Cervical dislocation following fusion of the upper thoracic spine for scoliosis. J Bone Joint Surg 1978;60A:1003.Google Scholar
  96. 94.
    Friedman RJ, Micheli LJ. Acquired spondylolisthesis following scoliosis surgery. Clin Orthop Rel Res 1984;190:132.Google Scholar
  97. 95.
    Eismont FJ, Simeone FA. Bone overgrowth (hypertrophy) as a cause of late paraparesis after scoliosis fusion. J Bone Joint Surg 1981;63A:1016.Google Scholar
  98. 96.
    Aurori BF, Weierman RJ, Lowell HA, Nadel CI, Parsons JR. Pseudarthrosis after spinal fusion for scoliosis. Clin Orthop Rel Res 1985;199:153.Google Scholar
  99. 97.
    Goldstein LA. Treatment of idiopathic scoliosis by Harrington instrumentation and spinal fusion. J Bone Joint Surg 1969;51A:209.Google Scholar
  100. 98.
    Hall JE, Gillespie R. Idiopathic scoliosis treated by Harrington instrumentation and spinal fusion. J Bone Joint Surg 1971;53A:198.Google Scholar
  101. 99.
    McMaster MJ, James JIP. Pseudarthrosis after spinal fusion for scoliosis. J Bone Joint Surg 1976;58B:305.Google Scholar
  102. 100.
    Moe JH, Valuska JW. Evaluation of treatment of scoliosis by Harrington instrumentation. J Bone Joint Surg 50A:848.Google Scholar
  103. 101.
    Bowen JR, Ferrer J. Spinal stenosis caused by a Harrington hook in neuromuscular disease. Clin Orthop Rel Res 1983;180:179.Google Scholar
  104. 102.
    Court-Brown CM, McMaster MJ. Pseudarthrosis: a late cause of paraparesis after scoliosis surgery. J Bone Joint Surg 1982;64B:1246.Google Scholar
  105. 103.
    Cleveland M, Bosworth DM, Thompson FR. Pseudarthrosis in the lumbosacral spine. J Bone Joint Surg 1948;30A:302.PubMedGoogle Scholar
  106. 104.
    Dawson EG, Lotysch M, Urist MR. Intertransverse process lumbar arthrodesis with autogenous bone graft. Clin Orthop Rel Res 1981;154:90.Google Scholar
  107. 105.
    DePalma AF, Rothman RH. The nature of pseudarthrosis. Clin Orthop Rel Res 1968;59:113.Google Scholar
  108. 106.
    Thompson WA, Ralston EL. Pseudarthrosis following spine fusion. J Bone Joint Surg 1949;31A:400.PubMedGoogle Scholar
  109. 107.
    Lin PM. Posterior lumbar interbody fusion technique: Complications and pitfalls. Clin Orth Rel Res 1985;193:90.Google Scholar
  110. 108.
    Lehmann TR, Spratt KF, Tozzi JE, Weinstein JN, Reinarz SJ, El-Khoury GY, Colby H. Long term follow-up of lower lumbar fusion patients. Spine 1987;12:97.PubMedGoogle Scholar
  111. 109.
    Birkeland IW, Taylor TKF. Major vascular injuries in lumbar disc surgery. J Bone Joint Surg 1969;51B:4.Google Scholar
  112. 110.
    Borski AA, Smith RA. Ureteral injury in lumbar-disc operation. J Neurosurg 1960;17:925.Google Scholar
  113. 111.
    DeSaussure RL. Vascular injury coincident to disc surgery. J Neurosurg 1959;16:222.PubMedGoogle Scholar
  114. 112.
    Sandoz I, Hodges CV. Ureteral injury incident to lumbar disk operation. J Urol 1965;93:687.PubMedGoogle Scholar
  115. 113.
    Spittell JA, Palumbo PJ, Love JG, Ellis FH. Arteriovenous fistula complicating lumbar-disk surgery. N Engl J Med 1963;268:1162.PubMedGoogle Scholar
  116. 114.
    Brun et JA, Willey JJ. Acquired spondylolysis after spinal fusion. J Bone Joint Surg 1984;66B:720.Google Scholar
  117. 115.
    Wiltse LL, Newman PH, Macnab I. Classification of spondylolysis and spondylolisthesis. Clin Orthop Rel Res 1976;117:23.Google Scholar
  118. 116.
    Macnab I, Dali D. The blood supply of the lumbar spine and its application to the technique of intertransverse lumbar fusion. J Bone Joint Surg 1971;53B:628.Google Scholar
  119. 117.
    Lee CK, Langrana NA. Lumbosacral spinal fusion. Spine 1984;9:574.PubMedGoogle Scholar
  120. 118.
    Brodsky AE. Post-laminectomy and post-fusion stenosis of the lumbar spine. Clin Orthop Rel Res 1976;115:130.Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1990

Authors and Affiliations

  • Jerome M. Cotler
  • Andrew M. Star

There are no affiliations available

Personalised recommendations