[Perioperative Management of Spine and Spinal Cord Surgery]

Spinal surgery is primarily performed to improve neurological function; compared with intracranial surgery, it is rarely conducted to address life-threatening conditions. As the goal of treatment is functional recovery, postoperative complications must be minimized. Appropriate perioperative management is therefore essential, and includes careful preoperative neurological evaluation; postoperative monitoring of neurological, respiratory, and circulatory status; and early detection and management of complications. Several complications of spinal surgery require attention. Firstly, airway obstruction caused by cervical swelling after anterior cervical surgery, postoperative epidural hematoma leading to neurological deterioration, and cerebrospinal fluid (CSF) leakage are the major complications requiring urgent intervention. Cervical spine surgery has several characteristic complications, depending on the surgical approach; for example, anterior procedures may cause airway compromise, esophageal injury, or recurrent laryngeal nerve palsy, whereas posterior procedures are more commonly associated with C5 palsy and surgical site infection. Thoracic spine surgery requires careful postoperative management as the spinal canal is relatively narrow, while the spinal cord is vulnerable to ischemia. In lumbar spine surgery, symptoms primarily involve the cauda equina, while major complications include epidural hematoma, CSF leakage, and surgical site infection. Appropriate perioperative evaluation and prompt management of complications at the spinal level are essential for achieving favorable surgical outcomes.