Unusual Intraoperative Occurrences
. Perforation of the pharynx, larynx, trachea, or esophagus, recognized immediately or diagnosed after the development of infectious signs (32- 39).
. Acute graft expulsion or retropulsion with esophageal or spinal cord injury.
. Failure to completely remove a sequestered disc fragment with significant continued root or spinal cord compressiOn.
. Exploration of the wrong intervertebral level, which should be preventable by proper preoperative radiographic testing and intraoperative confirmation of radiographic abnormalities.
. Cerebral infarction caused by carotid or vertebral artery embolization or occlusion due to associated but unrecognized atheromatous vessel disease.
. Cerebrospinal fluid (CSF) leak caused by inadvertent or intended dural laceration, unrepaired or inadequately repaired. Before embarking on cervical spine procedures, the microsurgeon should be familiar with the techniques of opening and closing the dural sac and nerve root sheaths. A fibrin adhesive sealant is available for a watertight closure; it contains a freeze-dried concentrate of human clotting factors that are mixed with thrombin and calcium. This fibrin glue should be used instead of cyanoacrylate glue (because of the latter's known neurotoxicity) (see Chapter 25).
. Formation of a postoperative meningocele or pseudomeningocele as a result of inadequate dural repair.
. A significantly worsened radiculopathy caused by a partial root injury during the decompressive procedure.
. Laceration or inadvertent ligation of the thoracic duct.
. Pneumothorax caused by inadvertent perforation of the pleura.
. Formation of postoperative epidural hematoma.
. Development of epidural abscess or meningitis caused by unrecognized or poorly treated superficial or deep wound infection.
. Unilateral blindness produced by pressure of an assistant's hand resting on the globe.
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