Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 110. 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. | 1094 Section Complications Single stage surgery is generally advantageous but in elderly patients caution is warranted Be prepared for typical pitfalls Consider preoperative embolization for highly vascularized tumors Prone position with a free abdomen reduces blood loss Check the headrest to avoid pressure on the eyes reported to be superior to a staged procedure. In a staged operation the main decision must be made whether the condition of the patient will allow the operation to be continued the next day. This offers the advantage that the monitoring devices like pulmonary artery or peripheral artery catheters can be left in place. The main problems are coagulation disorders requiring a longer period of time between the two interventions. Complication rates costs hospital stay and patients preference are in favor of single day interventions when compared to staged procedures. Pitfalls and Salvage Strategies A knowledge of the typical pitfalls of an operation and of strategies to cope with them is necessary before starting. Pitfalls are either approach related or instrumentation related. Instrumentation-related pitfalls often require special instruments or implants. For example unexpected pull-out of screws or hooks may require special implants which should be available . thicker screw bigger hook or bone cement augmentation . Embolization Bleeding from a metastasis in the case of intralesional resection maybe devastating. Preoperative angiographic embolization should be considered especially in renal carcinoma and thyroid cancer. Profound Knowledge of Anatomy This is as simple as it is obvious. Nevertheless it should be stressed that a thorough knowledge of the anatomy and a clear vizualization of the surrounding structures are crucial if complications are to be avoided. Patient Positioning Blood Loss Excessive diffuse blood loss can be prevented in posterior procedures by adequate positioning see Chapter 13 of the patient prone on a Relton Hall frame or other
