Usefulness of Intraoperative Computed Tomography in Complication Management after Spine Surgery

Abstract

Intraoperative computed tomographic (CT) scanners are used frequently in spine surgery for exact pedicle screw placement. In complication management, imaging is mainly used outside the operation theater. A 69-year-old female patient with progressive cervical radiculopathy and myelopathy due to spinal stenosis at C4/5 and C5/6 underwent two-level anterior decompression and fusion uneventfully. Shortly after surgery the patient developed a rapid loss of motor function in the upper and lower limbs, followed by a rising sensory deficit. A cage dislocation or an epidural hematoma was suspected and immediate surgical decompression was warranted. A CT scan was performed using an intraoperative CT right after reintubation. It showed an extensive epidural hematoma ranging from C2 to C4. A reoperation and removal of the hematoma was performed via a C5 corpectomy, extended to a C4–C5 corpectomy due to persistent compression demonstrated on a second intraoperative CT. After the revision operation the patient presented with only a minimal paraparesis of the lower limbs, declining over the next 2 weeks. A magnetic resonance imaging scan is usually requested in case of a new neurological deficit after cervical spine surgery to detect an epidural hematoma or edema of the spinal cord. Normal neurological examination after extubation followed by rapid progressive deterioration is most likely suspicious to be caused by a hematoma compressing the spinal cord. In the presented case, a CT scan in the operation theater provides adequate imaging information at short hand, aiding the surgeon to perform an emergency revision operation.