Đang chuẩn bị liên kết để tải về tài liệu:
Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 112

Không đóng trình duyệt đến khi xuất hiện nút TẢI XUỐNG Tải xuống

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 112. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 1114 Section Complications weight patients are at higher risk 22 105 . Causal treatment is reduction of the correction. This is usually not required. The symptoms will ameliorate within weeks and with intravenous hyperalimentation. In rare cases duodenojejunostomy will be required. Urogenital Complications Urinary Tract Infection Check for bladder residual urine The most frequent urogenital complication is a simple urinary tract infection UTI which can occur in up to 9 of patients 5 . Ascending infection with pyelonephritis or sepsis is rare. These complications can be minimized when perioperative catheterization is used only when absolutely indicated. On the other hand incomplete bladder emptying also increases the risk of infection. Ultrasonography is very helpful in estimating the residual urine amount which should be less than 100 cc. Postoperative Anuresis Check perianal sensation in postoperative anuresis In the immediate postoperative period patients often have difficulty in urinating. The most frequent cause is the inability to empty the bladder in a lying position. However anal tone and sensation must be controlled to rule out a cauda equina syndrome. Early mobilization solves this problem. If this is not possible catheterization is necessary to avoid bladder overdistension. Urinary Bladder Dysfunction After anterior surgery a bladder dysfunction can result from an injury to the parasympathetic presacral nerves especially at the level of L5 S1. This complication can perhaps be reduced by a retroperitoneal approach where the sympathetic and parasympathetic fibers located close to the peritoneum in the bifurcation of the vessels are left intact 34 . Retrograde Ejaculation Initial reports have perhaps underestimated the problem. A survey of 20 surgeons in 1984 reported 0.42 retrograde ejaculation and 0.44 impotence following anterior lumbar spine fusion 37 . The more thoroughly studies were undertaken the higher 2-4 was the reported incidence 8 11 99 . It .