If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time.

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1 If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time. You may be worried about your future, both in respect of finances and care. You may be grieving for the loss of a loved one. Our medical negligence solicitors understand this and know that you will have a number of questions about what went wrong. We are highly experienced in helping clients pursue claims following errors and complications arising out of spinal surgery. This guide provides an outline of the expertise we have in relation to spinal surgery. If you think you could have a potential claim for negligence arising out of spinal surgery, contact our team today for a free, no obligation assessment of your case. Anatomy of the Spine The spine acts as a support column. The spinal column consists of twenty four bones called vertebrae. They are connected together by small joints (called facet joints) and a spongy intervertebral disc, which together allow a small amount of movement between each vertebra, and a large amount of flexibility over the spine as a whole. There are 7 vertebrae in the cervical spine (neck). The cervical spine connects the skull to the thoracic spine. The cervical spine functions to protect the spinal cord and nerve roots while supporting the skull and allowing flexibility to position the head. The cervical spine is highly mobile and more prone to degenerative change than other levels of the spine. There are 12 vertebrae of the thoracic spine (upper back). The thoracic spine is a more rigid column than the cervical or lumbar spine because of the rib cage. There are 5 vertebrae in the lumbar spine (lower back). The lumbar vertebrae are larger than the cervical or thoracic vertebrae. The sacrum and coccyx are normally fused and attached to the pelvis. Page 1 of 6

2 Spinal Cord The spinal cord is a long nearly cylindrical structure lodged in the vertebral canal extending from the base of the skull to the upper part of the lumbar region. The spinal cord conducts sensory and motor impulses to and from the brain and controls many reflexes. Thirty one pairs of spinal nerves come out of the cord at different levels. Spinal Trauma With a spinal injury, the key questions are:- What is the mechanism of injury? Are there other injuries, including life threatening injuries? Is there actual or impending neurological damage? What is the best treatment method (operative or non-operative) for the particular fracture? The most important decision initially is whether to operate or not. The wrong decision could have serious implications for the patient. Spinal Cord Compression Spinal cord compression is an abnormal and often serious condition resulting from pressure on the spinal cord. The symptoms range from temporary numbness of an extremity to quadriplegia (paralysis of all 4 limbs: the arms, legs, and trunk of the body below the level of the associated injury to the spinal cord), depending on the cause, severity, and location of the pressure. Causes include spinal fracture, vertebral dislocation, tumour, haemorrhage or accumulation of fluid. Page 2 of 6

3 Spinal Tumours Spinal tumours are often benign but their growth can have a serious impact on the spinal cord. The outcome of surgery depends of treatment before there is complete compression of the spinal cord and loss of cord function. Issues arise concerning the delay diagnosing the condition and therefore delay in treatment. Other issues arise concerning the benefits and risks of surgery, which vary according to the type of tumour, and the patient giving informed consent. Level of injury and extent and extent of paralysis The extent of paralysis depends on the level and severity of the injury to the spinal cord. Injury at cervical level 4 can cause tetraplegia resulting in complete paralysis below the neck. Injury at cervical level 6 can cause tetraplegia resulting in partial paralysis of the hands and arms as well as the lower body. Injury at thoracic level 4 can cause paraplegia resulting in paralysis below the chest. Injury at lumbar level 1 can cause paraplegia resulting in paralysis below the waist. Complications of Spinal Surgery Extensive surgery to the spine can cause instability and significant long-term problems. Various fixation devices are used to try and prevent these complications. Complications of surgery on the cervical spine include perforation of the soft tissue structures, the nerves and the arteries in the neck. There can be irreversible damage to the spinal cord leading to paralysis below that level. Page 3 of 6

4 The complications of lumbar disc surgery can be very serious, again leading to paralysis below that level. Other complications of spinal surgery include operating based on a wrong diagnosis, delay in surgery taking place, and operating at the wrong level of the spine. Failure to identify the correct level may mean that the procedure takes longer and is more complicated or that the source of the problem is missed altogether. Cervical Laminectomy There are 7 vertebrae which make up the cervical (neck) part of the spinal column, which is one of the more flexible parts of the spine. Each disc consists of a soft spongy central portion and a tougher fibrous outer coat. At the back the vertebrae are joined together by a thick ligament and a small joint at either side (the facet joints). The spinal cord and the nerves to the arms lie in the spinal canal between the vertebral bodies and discs at the front, and the laminae, ligament and facet joints behind. The structures of the neck gradually wear or degenerate with age and changes occur. The ligament gets much thicker, bony overgrowth occurs around the facet joints and the disc at the front starts to bulge backwards. These changes make the spinal canal (where the spinal cord sits) much narrower (stenosis). If it gets too narrow there is insufficient room for the spinal cord itself, which becomes squashed and compressed. It may cease to function properly and cause symptoms in the arms and legs such as weakness, tingling, sensory loss, bladder and bowel disturbance or even complete paralysis. This is essentially a degenerative condition associated with getting old. These changes in the spine do not improve on their own. If the symptoms are severe, disabling and/or deteriorating then surgery is often the best solution. Anterior Cervical Discectomy and Fusion Directly behind the discs are the spinal cord and the exiting spinal nerves. The discs can dry out with age. They become less spongy and small tears start to occur in the fibrous coat. The fibrous coat is thinnest at the back (by the spinal cord and nerves) Page 4 of 6

5 and this is where problems usually develop. The fibrous coat may become torn to such an extent that the spongy nucleus inside may cause it to bulge out or a piece of the nucleus may squirt out of the disc and press on the spinal cord and/or the exiting nerve root. This is a prolapsed intervertebral disc (slipped disc). It causes severe pain and weakness and/or sensory changes in an area of the arm or hand supplied by the compressed nerve. Weakness and sensory change in the legs, or bladder and bowel dysfunction, can also be caused by the disc compressing the spinal cord itself. If the disc fragment is large, and the symptoms do not resolve or if the symptoms deteriorate then surgical removal of the damaged disc may be required. Lumbar Laminectomy The spinal cord sits in a canal that runs through the middle of the spinal vertebrae. This spinal canal narrows with age, particularly in the lower back (lumbar region). Wear and tear in the facet joints causes bony overgrowth in the canal, some thickening of the surrounding ligaments and some bulging of the disc. All of these can narrow the canal so that there is less room for the nerves. This can cause progressive walking difficulties and leg pain, often with pins and needles or tingling in the legs, which settles with rest in a seated position. The diagnosis can usually be confirmed with MRI (magnetic resonance image) scans which show the narrowing (stenosis) of the spinal canal. The changes come with age and they do not resolve spontaneously. If the symptoms are severe, disabling and/or worsening it is often necessary to consider a surgical operation. Lumbar Disc Surgery Failure to relieve symptoms following operation for a lumbar disc prolapse can be due to failure to operate at the correct level. It may be an indication of careless technique and should not occur. The level to be explored should have been worked out before the operation from clinical and radiological examination. If the space explored is found to be normal, this suggests that the wrong level has been exposed. The surgeon must then explore the space above or below as may be appropriate. If the surgeon is in doubt about the level during the operation, an x-ray check should be obtained. Nerve root damage Page 5 of 6

6 (from cutting or undue retraction) is an indication of careless technique, and the consequences may be disabling. The usual error is late diagnosis and failure to explore the operative level after first performing MRI (magnetic resonance imaging) scans. Do you need advice about a potential claim for medical negligence? This is only a very short summary of what is a complicated medico-legal topic. All claims for medical negligence require a detailed assessment of the factual, medical and legal issues surrounding the circumstances of the treatment. Switalskis can help you find a way through this maze. If you have been affected by these issues or have undergone spinal surgery and believe there may have been a problem, please contact our specialist team who would be very happy to discuss the issues with you. If you would like to talk to a specialist medical negligence solicitor, in confidence, call us now on , us at or visit our website: Page 6 of 6

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