Complications in Treatment of Spinal Cord Tumors and Prevention Surgical Strategies

Abstract

Postoperative course after intramedullary or extramedullary intradural spinal cord tumor surgery may be characterized by significant morbidity. Postoperative functional outcome mainly depends on tumor histology, molecular biology, genetic basis, tumor size, location, preoperative neurological status, utilized surgical technique, and postoperative care. Patients with severe preoperative disability may not recover completely and may even deteriorate as a result of surgery. Due to specific anatomical and surgical considerations, many perioperative and postoperative complications can threaten surgical outcome and patient recovery, particularly in high risk patients and even elderly patients. These complications can be persistent and hard to treat, extending the length of hospital stay and significantly raising health care costs. One substantial concern and specific surgical complication is a cerebrospinal fluid leak with concomitant pseudomeningocele formation and meningitis that may occur despite meticulous microsurgical technique. The development or progression of spinal deformity and instability can occur postoperatively, especially in younger patients utilizing multiple level laminectomies, and may necessitate further surgical treatment including spinal fusion and instrumentation. Early postoperative mobilization is essential to prevent the development of pneumonia and deep venous thrombosis with subsequent pulmonary embolization. Therefore, preventive measures and careful surgical practice are necessary to avoid complications in treatment of spinal cord tumors.