Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
J Clin Neurosci. 2020 Nov;81:12-17. doi: 10.1016/j.jocn.2020.09.012. Epub 2020 Sep 25.
As the surgical techniques have been significantly developed, thoracic spine surgery is currently increasingly indicated for a variety of pathologies such as degenerative spondylosis, ligament ossification, spinal deformity, infectious diseases, trauma and tumors. Thoracic spine has the distinctive anatomy with the rib attachment and the proximity to great vessels and lungs, and spinal cord has particular vulnerability due to its unique circulation system. Thus, both anterior and posterior approach surgeries have their own risks unique to this spinal segment. To be capable of challenging the spinal disorders in thoracic spine, surgeons must be aware of possible complications and their avoidance methods as well as management strategy. In the present narrative review paper, the complications in thoracic spine surgery are categorized into approach-related complications, neurological complications, wound-related complications, mechanical and instrument-related complications, as well as medical complications along with pre-, intra- and post-operative considerations. Their pathologies, possible sequelae, incidence, risk factors, prevention and management are discussed. As for some of the complications that are also commonly seen in cervical or lumbar spine, focus is placed on their importance in thoracic spine surgery. To prevent these adverse events associated with thoracic spine surgery, surgeons should be familiar with detailed knowledge of thoracic anatomy related to its approach as well as physiological characteristics.
随着外科技术的显著发展，目前胸椎手术越来越多地用于治疗各种疾病，如退行性脊柱疾病、韧带骨化、脊柱畸形、感染性疾病、创伤和肿瘤。胸椎具有独特的解剖结构，与肋骨相连，靠近大血管和肺部，由于其独特的循环系统，脊髓特别脆弱。因此，前路和后路手术都有其在这个脊柱节段特有的风险。为了能够治疗胸椎的脊柱疾病，外科医生必须了解可能的并发症及其预防方法和管理策略。在本叙述性综述中，将胸椎手术的并发症分为与入路相关的并发症、神经并发症、伤口相关的并发症、机械和器械相关的并发症，以及术前、术中和术后的医疗并发症。讨论了它们的病理、可能的后果、发生率、危险因素、预防和处理。对于一些也常见于颈椎或腰椎的并发症，重点放在它们在胸椎手术中的重要性上。为了预防与胸椎手术相关的这些不良事件，外科医生应该熟悉与入路相关的详细的胸椎解剖学知识及其生理特点。
